Kako poboljšati stopu darivanja...2014 and 2015 World Health Assembly: ... The Spanish model also...
Transcript of Kako poboljšati stopu darivanja...2014 and 2015 World Health Assembly: ... The Spanish model also...
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Kako poboljšati stopu darivanja
organa?
Prof dr. sc. Željko Župan, dr. med.
NEFROLOGIJA 2018
Tešanj,18. 10. 2018.
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Padova April 2008 3.
Each day, 18 European (BiH.....?) citizens die whilst
waiting for a suitable organ transplant, that’s almost
6,800 people on a yearly basis*
* 6702 deaths on the waiting list in 2015, Council of Europe data 2017
"Bring back hope to the patients on the waiting list"
Council of Europe 2017
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2014 and 2015
World Health Assembly:
... with spetial attention to maximizing donation from deceased donors; 75 country have DDPsThe Madrid Resolution - Third WHO Global Consultation on Organ Donation
and Transplantation (2010):
...to achive self-sufficiency in organ donation and transplantation (>20 donora pmp)
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40,2
40,2
31,8
31,6
25,7
25,5
23,8
16,8
15,5
14,9
10,9
10,9
STOPA AKTUALNIH UMRLIH
DARIVATELJA ORGANA U SVIJETU 2015.
BROJ REALIZIRANIH DONORA/1 MILION STANOVNIKA/pmp
NEWSLETTER TRANSPLANT 2016
International figures on donation and transplantation 2016
EDQM 2016 vol. 21
BiH 1-2
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Podatci Ministarstva zdravlja RH, siječanj 2017. godine
Eurotransplant Annual Report, January, 2017
STOPA DARIVANJA
na 1 mil. stanovnika/pmp
0
5
10
15
20
25
30
35
40
45
0
20
40
60
80
100
120
140
160
180
2001. 2002. 2003. 2004. 2005. 2006. 2007. 2008. 2009. 2010. 2011. 2012. 2013. 2014. 2015. 2016.
13,013,7
7,2
REALIZIRANI
DONORI
33,5
34,5
28,7
17,1
34,034,3
193% ili 2,9 x
2006. – 2016.
17,7
40,2
STOPA DARIVANJA ORGANA
U RH
9,010,2
13,39,2
36,2
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HRVATSKA - broj transplantacija na 1 mil.stan./god. bubrezi: 53.7 p.m.p jetra: 29.7 p.m.p srce: 10.2 p.m.p gušterača: 1.9 p.m.p
transplantacijska stopa: 93.2 p.m.p
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Opt-out policies on their own are unlikely to sufficiently boost organ donation rates.
The Lancet Gastroenterology & Hepatology
Vol 2 April 2017
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• Na temelju članka 88. Ustava Republike Hrvatske, donosim
ODLUKU O PROGLAŠENJU ZAKONA O UZIMANJU I PRESAĐIVANJU DIJELOVA
LJUDSKOG TIJELA U SVRHU LIJEČENJA
Proglašavam Zakon o uzimanju i presađivanju dijelova ljudskog tijela u svrhu liječenja,
koji je donio Hrvatski sabor na sjednici 3. prosinca 2004. godine.
Broj: 01-081-04-3747/2
Zagreb, 10. prosinca 2004.
Predsjednik
Republike Hrvatske
Stjepan Mesić, v. r.
• Promjene legislative
• Promocijske kampanje
• Registri donora
• Vozačka dozvola&donacija
• Ostali načini promocijen
„KLASIČNE MJERE" ZA POBOLJŠANJE
DONIRANJA
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to American Journal of transplantation, 2017
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Rafael Matesanz, Beatriz Domínguez-Gil, Elisabeth Coll and all. How Spain reached 40
deceased organ donors per million population.
American Journal of Transplantation; Published Online: January 9, 2017 (DOI: 10.1111/ajt.14104).
Lead author Rafael Matesanz, MD, PhD, who is the director of ONT, highlighted that
“good organization in the process of deceased donation and continuous adaptations of
the system to changes are always the basis of successful results in organ donation”.
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The so-called Spanish model relies on the designation of appropriate
professionals (mostly intensive care doctors) to make donation
happen when a patient dies in conditions that allow organ
donation. These professionals are supported in their work by ONT and
regional coordination offices.
The Spanish model also makes it a priority to identify donation
opportunities not only in intensive care units, but also in emergency
departments and hospital wards.
“The most important success is that the system has made organ
donation be routinely considered when a patient dies, regardless of
the circumstances of death,” said ONT’s Beatriz Domínguez-Gil, MD,
PhD, co-author of the article highlighting the Spanish Model’s impact.
“Professionals attending to these patients in our country consider that, in
caring for patients at the end of their lives, it is their duty to
systematically explore their wishes with regards to donating
organs upon their death.”
Furthermore, the model has considered donation after circulatory death.
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Hrvatski model
ZAVOD ZA
TRANSPLANTACIJU I
MEDICINU PRI MZ
• Adekvatna legalna, zdravstvena i
tehnička podloga
---------------------------------------
• Mreža donorskih koordinatora
• Specifičan stručni profil
koordinatora (uglavnom intenzivisti
> 90%), rade u bolnicama
• Adekvatan klinički pristup i
optimalna skrb bolesnika te
potencijalnih i aktualnih donora
• Centralni ured – potporna Agencija
• Kontinuirana revizija potencijalnih
donora
• Velik napor u adekvatnoj edukaciji
• Puno pažnje prema javnim medijima
• Bolnička financijska nadoknada
„TEMELJNI PRINCIPI” HRVATSKOG MODELA
DARIVANJA ORGANA & TRANSPLANTACIJE
SVE TOČKE ZAJEDNO !!!
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USMJERENI, KONCENTRIRANI I ORGANIZIRANI NAPORI
U SVAKODNEVNOJ KLINIČKOJ PRAKSI NEOPHODNI SU DA BI SE UČINILE
ZNAČAJNE PROMJENE!!!
KLJUČNI NEZAKONSKI, NEFINANCIJSKI ....
FAKTORI?
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Bušić M. Organ donation and transplantation - “Croatian model”. Medix 2011;144-49.
Župan Ž. The proposed 2011-2016 national strategy for timely and optimal management of organ
and tissue donors. Medix 2011;149-55.
Action plan for improvement of the organ donation in Croatia from 2011 to 2016.
PROMJENE KLINIČKE PRAKSE?
Rano prepoznavanje, dojava te praćenje
(jednostavan “klinički alat” za prepoznavanje):
- bolesnika visokog rizika za razvoj smrti mozga
- potencijalnih donora
Prihvaćanje i implementacija standardiziranog,
optimalnog zbrinjavanja bolesnika te potencijalnih i
aktualnih donora, „goal-directed” optimizacija donora
Pravovremeno utvrđivanje smrti mozga sukladno
mediko-legalnim standardima
Planiran pristup obitelji
Darivanje organa iz proširenih kriterija
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PUT K DONACIJI ORGANA!
TEŠKO OŠTEĆENJEMOZGA
NEPOVRATANGUBITAK
AKTIVNOSTI MOZGA
OSJETLJIVO RAZDOBLJE
Satima ili danima u trajanju
Patofiziološke promjene povezane s oštećenjem ili
ozljedom mozga
Ekscesivna antiedematozna terapija, SIRS, Sepsa
Cirkulacijski arest i cirkulacijska smrt
Organska disfunkcija – višeorgansko zatajivanje
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Fiziološke promjene udružene s razvojem smrti mozga
„Gol-directed” ili „Aggressive Donor Management”
TEŠKO OŠTEĆENJEMOZGA
NEPOVRATANGUBITAK
FUNKCIJA MOZGA
OSJETLJIVO RAZDOBLJE
USTEZANJESKRBI-WLST
SMRT NEUROLOŠKIM KRITERIJIMA
OSJETLJIVO RAZDOBLJE
TOPLA ISHEMIJA
PUT K DONACIJI ORGANA!
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Beatriz Domingez-Gill, Paul Murphy, Francesco Procaccio
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Motiviran, posvećen, velik radni kapacitet
Dobar odgovor na pritisak i stres
Kapacitet za brz odgovor na
probleme (problem-solving capacity)
Znanje, kompetetnost, klinički autoritet
Prilagodljivost, kreativnost, kapacitet za
improvizaciju
Leadership sposobnosti
Komunikacijske vještine, dobar kapacitet
za odnose i empatiju
VJEŠTINE TRANSPLANTACIJSKOG
(DONORSKOG) KOORDINATORA
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• Površina: 3588 km2 / 6,3% površine RH (56542 km2)
• Broj stanovnika: 291 694 / 6,5% stanovnika, RH (4171000)
• Naseljenost: 82,5/km2 stanovnika / u RH 75,8/km2
• Rijeka: 121 190 (2015.) stanovnika
PRIMORSKO GORANSKA ŽUPANIJA
I KBC RIJEKA
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0
5
10
15
20
25
30
35
40
2010. 2011. 2012. 2013. 2014. 2015. 2016.
KBC RIJEKA
KBC ZAGREB
KBC SPLIT
KBC SESTREMILOSRDNICE
KBC OSIJEK
OB VARAŽDIN
KB DUBRAVA
REALIZIRANI DARIVATELJI ORGANA
U HRVATSKOJ od 2010. do 2016.BROJ REALIZIRANIH
DONORA ORGANA
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KBC RIJEKA
DONIRANJE ORGANA OD UMRLIH OSOBA
2011.2010.2009.2008.2007. 2012.
25
21
1916
13
8
33
2013. 2014.
33
31
2015.
donor conversion rate: ~ 50% ~ 80% >90%
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34,5 33,6 34,3
87
110 110
3,6 X 3,6 X
2,5 X
3428,7
6470
1,9 X 2,4 X 103
2,6 X
pmp
16,5% 13% 18% 24% 23% 18,5%
udio (%) donora iz KBC Rijeka u ukupnom broju donora u RH
REGIONALNA (KBC RIJEKA) vs. REPUBLIČKA
STOPA DONORA od 2010. do 2015.
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BROJ TRANSPLANTIRANIH ORGANA
PO DONORU U KBC RIJEKA vs. RH u 2015.
Podatci Ministarstva zdravlja Republike Hrvatske i KBC Rijeka, siječanj 2016.
169 donora, sr. dob 57 god.
2,87 ± 3,2 organa transplantirano
po donoru
31 donor, sr. dob 56,3 god.
3,48 ± 2,6 organa transplantirano
po donoru
✓
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0
4
8
12
16
20
24
28
32
0-10
10-2
0
20-3
0
30-4
0
40-5
0
50-6
0
60-7
0
70-8
0
80-9
0
RASPODJELA DONORA PO
DOBI/raspon godina
DOB DONORA U KBC RIJEKA
od 2011. do 2015. B
RO
J D
ON
OR
A
DOB DONORA, ukupno 141 donor - srednje dobi = 55,3 vs. 56,8 godina u RH
- najmlađi darivatelj = 17 dana beba
- najstariji darivatelj = 86 godina
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STOPA PROTIVLJENJA OBITELJI
NEPRISTANAK OBITELJI
UKUPAN BROJ DONORA
Podaci Ministarstva Zdravstva RH i KBC Rijeka, siječanj 2018.
HRVATSKA: 2011.- 2017.
KBC RIJEKA: 2011. - 2017.
195 potencijalni donor
97,2% neodbijanje
6 odbijanja obitelji 3,1%
1105 potencijalni donori
79% neodbijanje
253 donora
21% protivljenje
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ORGANI/
TKIVA2011. 2012. 2013. 2014. 2015. UKUPNO
JETRA 18 25 31 30 30 134
BUBREZI 37 48 56 56 60 257
PLUĆA 3 6 10 10 11 40
SRCE 3 9 10 9 7 38
GUŠTERAČA 1 3 5 1 1 11
UKUPNO 62 91 112 106 109 480
BROJ TRANSPLANTIRANIH SOLIDNIH ORGANA
DONIRAN U KBC RIJEKA OD 2011. - 2015.
Podaci Ministarstva zdravlja Republike Hrvatske i KBC Rijeka, siječanj 2016.
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ZAKLJUČCI
Nedostatak organa za transplantacijsko liječenje predstavlja
vrlo bitan javno-društveni problem u nizu zemalja svijeta te
daleko nadmašuje okvire zdravstvenog sustava.
Visoko motivirani transplantacijski koordinatori i angažirani intenzivisti
ključan su faktor uspješnog bolničkog modela darivanja organa
od umrlih osoba.
Organizacijski model, legislativa te svijest javnosti neophodan su
okvir, ali sveobuhvatan proaktivan pristup darivanju organa unutar
bolnica presudan je za osiguranje adekvatnog broja
organa za transplantaciju.
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DONIRANJE ORGANAŽIVOT NA DAR