A new insight to the reasons for low deceased donor organs recovery in Poland

1. A new insight to the reasons for low deceased donor organs recovery in Poland Rowiński W., Kobryń A., Danielewicz R., Czerwiński J., Kosieradzki M., Jakubowska-Winecka A., Glyda M., Ostrowski M., Wejda B., Osińska P., Snarska J .University of Warmia &Mazury, Olsztyn, Medical University of Warsaw, Child Health Center, Medical University Poznan, Medical University Szczecin, Poltransplant, Poland

2. Deceased donors (DD) organ recovery rate in our country has never been satisfactory, but over the years kidney transplantation from deceased donors has reached the level of 26 kidneys/ pmp . Due to a number of reasons in 2007, a dramatic fall of organs recovery from deceased donors (DD) occurred Since that time the number of kidney transplantations has never come back to its level in 2006

3. Organ Donors in Poland 2004 - 2011 (Up to 30.10.2011) ---- real donors Poltransplant

4. Deseased donors organs recovery/pmp Transpl.Newsletter 2011

5. Kidney transplantations/pmp Transpl.Newsletter 2011

6. Kindey transplants/ pmp in the countries, of the same or lower recovery rate from dd. Transpl.Newsletter 2011

7. Organ recovery in various districts of Poland greatly vary from 3.3/ pmp (southern eastern part to 34,5/pmp (northern western part Recently carried survey of the attitude and knowledge toward organ donation and transplantation showed positive societal perception (95% of acceptance). Nevertheless the survey among physicians, nurses and roman catholic persist and nuns has shown some lack of knowledge related to legal regulations and recognition of death (oral presentation)

8. DeceasedDonors in Poland (2010)Organsrecovered from 509 deceaseddonors(13,3/pmp)i 70 żywych (nerki i fragment wątroby) 34 15.5 15.7 27.6 14.8 17.5 9.4 20 26.2 19.2 12.8 4.5 13 7.7 12.6 3.3 3.9

9. Do you accept deceased donors organ recovery for transplantation The Society is supporting CBOS, July 2011

10. Aim To assess the reasons for the low deceased donor organs recovery

11. Three attitude and knowledge surveys were recently carried out among: • Physicians (100) and nurses (100) employed in one large district hospital. • Anesthesiologists and neurosurgeons (250) from 20 country hospitals • Catholic priests (100), nuns (100) and Alumni of the Theological schools (100)

12. Survey among nuns (100), priests (100 ) and students (98 students) of the Theological School showed that the virtual acceptance of the use of deceased donors organs for transplantation recovery was quite high (>60%). However one third of questioned population showed the lack of knowledge not only of existing legal regulations, but also of the important documents issued by the Catholic Church. Most of the respondents were of the belief that the family has the right to make the decision regarding organs recovery.

13. The results of the attitude of the small country hospitals nurses toward transplantation showed that the level of knowledge among nurses is not very good. However it corresponded to their age and the time since graduation. Younger nurses showed much more knowledge regarding legal regulations and appreciation and toward recovery of organs from the deceased donors. Survey among physicians showed similar results. 25% of physicians did not know what are the legal regulations,and were not sure when ( and how) to diagnose the brain death

14. The most important finding In the non selected population of anesthesiologists and neurosurgeons was that despite understanding the brain death concept and legal regulation this diagnosis is made mainly for organ recovery reason. Nearly half of the respondents do not diagnose the brain death and await the cardiac arrest in ICU patients

15. Refusal by the family for organ recovery was thought due to: • the lack of confidence to the physicians (50% of respondents), • religious beliefs (40%), • emotional reaction to the loss of the relative (60% of respondents) • the lack of understanding of the brain death concept (35-40% of respondents) • and the fear that the organs would be misused by physicians

16. The new initiative “Regional Partnership for Transplantation” was initiated two years ago by the Polish Union of Transplantation Medicine and Poltransplant in 12 Districts of Poland . The letter of intention was signed by the local government officials, the President of the local Medical University, President of the physicians Chamber, Hospital Managers and the local transplant centers

18. Malopolska District Podkarpacie District Population 3.3 mln Population 2.2 mln 2009 2010 2011 Pot. Donors 2 6.9 7.9 Real donors 1.5 5.5 6.5 2009 2010 2011 Pot. Donors 3.3 5,2 Real donors 3.3 2.4 4.8

19. Donation potential in Poland In 2010 40 000 patients were treated in ICU-s 16285 Pts died Brain deathdiagnosed in 520 deceased ORGANS RECOVERED FROM 450 DONORS In 15 % of deceased pts (2442) the brain death could have been diagnosed So we could have had (1025 Potential donors) * Mortality in neurological & neurosurgical units not taken into consideration

20. Conclusions • Improvement of transplantation program in Poland require extensive educational program among various parts of the society, but most importantly among the physicians, nurses and priests. • The program Partnership for Transplantation has been directed to achieve such means. • The survey of knowledgeregarding the braindeathrecognition and additionally toward the attitudetowarddonation in different part of the country isunderway

21. Anyone who would like to join us in that survey Is most wellcome