S lovenian transplant medicine
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S lovenian transplant medicine . Danica Avsec Ljubljana 2011. History of Slovenia. In the  Early Bronze Age , Proto- Illyrian  tribes settled an area stretching from present-day Albania  to the city of  Trieste . The Holy Roman Empire  controlled the land for nearly 1,000 years. 

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S lovenian transplant medicine

Slovenian transplant medicine

Danica Avsec

Ljubljana 2011


History of slovenia

History of Slovenia

  • In the Early Bronze Age, Proto-Illyrian tribes settled an area stretching from present-dayAlbania to the city of Trieste.

  • TheHoly Roman Empire controlled the land for nearly 1,000 years. 

  • Austro-Hungarian Monarchy

  • Modern-day Slovenia gained its independence from Yugoslavia in 1991, and is today a modern state and a member of the European Union.


Southeastern europe in the 8th centur y

Southeastern Europe in the 8th century


Map of slovenia with roman provinces and cities

Map of Slovenia with Roman provinces and cities


4 geographic regions in slo

4-geographic regions in Slo


Modern slovenia

Modern Slovenia


Transplant activities

Transplant activities

Donor program

Recipient program

TX

Donor centers

SLOTP

Organs

Tissues

National waiting lists

Clinical transplant coordinators

  • preparing the recipients

  • recipient follow-up


History

History


Where we are

Where we are

  • We are performing txs:

    • Kidneys, livers, hearts

    • Pancreas- kidney

    • Heamatopoetic cells

    • Corneas, skin, bones

    • Knie cartilage, tendoms and others

  • Results are very comparable with other international centres

  • The procurement of organs and tissues from the deceased is increasing


  • Transplantation activity numbers performed 2010

    Transplantation activity numbers performed 2010

    Kidney DD: 30,5 pmp

    Kidney LD:0

    Liver LD:0

    Liver DD:13 pmp (A+C)

    Heart:9,5 pmp

    Heart-Lung:0

    Lung:1,5 (W)

    Pancreas:0,5 pmp

    Small bowel 0

    Total number of DD 41

    DBD:41

    DCD: x

    DD:20,5 PMP

    DBD:0 PMP

    DD = Deceased Donor, LD = Living Donor, PMP = per million population

    DBD = Donation after Brain Death, DCD = Donation after Circulatory Death

    11


    Legislative basis

    LeGISLATIVE BASIS


    Legislation basis for organ and tissue transplantation in slovenia

    Legislation basis for organ and tissue transplantation in Slovenia

    • 2000 Legislation on organ and tissue harvesting

    • 2000 Legislation for reproductive medicine

    • 2007 Legislation on quality and safety for cell and tissue transplantation

    • National regulations

    • EU directives, 2010, 2004, 2006

    • New draft - implementation of the directive 2010


    S lovenian transplant medicine

    • Directive 2010/45/EC on Quality and Safety

    • Scope, objectives and definitions

    • Quality and safety of organs

      • National Quality Programmes

      • Organ procurement, procurement organisations, transplantation centres

      • Transport of organs

      • Organ and donor characterisation

      • Traceability

      • Reporting of serious adverse events and reactions

    • Donor and recipient protection and donor selection and evaluation

      • Unpaid and Voluntary Donation

      • Quality and safety aspects of living donation

      • Data protection

    • National oversight authority or authorities

    • Organ Exchange with third countries

    • General provisions


    Consent for donation

    Presumed

    OPT OUT register-new suggestion

    Information given to family

    99%

    Consent for donation

    • Informed - explicit

    • OPT IN register

    • Donor card

    • Less than 1%


    Organizational sheme

    ORGANIZational sheme


    Icu department

    ICU DEPARTMENT

    • BRAIN DEATH Diagnostics

    • DETECTION OF THE DONOR


    Slotp organization and national network

    SLOTP organization and national network

    Donor centers

    Tissue typing

    TXcenters


    International cooperation 1

    International cooperation 1

    Eutransplant ( HU, hypersensitive patients, optimal matching, evaluation, optimal usage of organs )

    Vienna – twinning programme for lung tx

    Bergamo, Graz for children programmes, liver, kidney

    Due to limited facilities at health care, number of cases, number of experts Slovenia is not able to cover all needs and develop all programmes by itself:

    20


    International cooperation 2

    International cooperation 2

    with ONT, CNT and many important experts in the field of donation, transplantation

    On many EC projects, for EDD Guidelines is leading partner

    We are able to notice and analyze some aspects better that bigger countries nd therefore we could share such experience with other countries

    21


    The purposes of national transplant network

    The purposes of national transplant network

    • Increase the availability of organs for transplantation

    • Fully exploit the potential of donation from deceased donors

    • Include all programs for the acquisition of organs(donation system from living donors, as a complementary program)

    • Equal opportunity for treatment with transplantation for all patients

    • Integration with clinicians


    The tasks at the level of government the tasks at the level of government

    The tasks at the level of governmentThe tasks at the level of government

    • Legislative documents

    • Organizational sheme,competent instition

      • Safety and quality as prevention of misuse, abuse

      • Traceability, transparency

      • Efficiency

  • Finances


  • The tools for quality and safety in the field of donation

    The tools for quality and safety in the field of donation

    Coordinators

    Protocols, guidelines

    Education od health care proffesionals and ICU

    doctors

    Motivation of ICU doctors

    Promotion of donation

    International cooperation

    Informatics program

    Controlling and monitoring the efficiency, QAPs

    24


    Technical basis for donor programme

    TECHNICAL BASIS FOR DONOR PROGRAMME


    Icu intensive care doctor s

    ICU - Intensive care doctors

    Knowledge, awareness, motivation

    • to treat the patient optimally

    • to communicate with relatives before death

    • to recognise a non responsive apnoeic coma

    • to make a decision to start BD diagnostics

    • to maintain the donor


    Determination of death detection of the donor

    Determination of death ,detection of the donor

    Treatment

    Maintenance

    Removal,Tx

    Patient

    Donor

    consent


    Motivation in the icu

    Motivation in the ICU

    To know the purpose of the procedures and the results very well

    To release psychological burden

    To trust into the procedures

    To find the help and the support


    S lovenian transplant medicine

    Positive overall attitude to organ donation and procedure among ICU doctors(Avsec, Logar-Zakrajšek, 2009)


    Deceased donors pmp refusal rate

    DECEASED DONORS pmp, refusal rate

    23

    15.9


    Education of all target groups

    Education of all target groups


    Priorities for the near future

    Priorities for the near future

    1. Education, auditing and motivating ICU for increasing donor rate

    2. Improve WL for KTx (now 3,5 %)

    3. EU directives on organ donation

    4. Collaboration

    • We offer educational modules on brain death diagnosticsand research on public awareness

    • Coopeartion with SEEHN countries as benchmarking.

    • Related to ICU role in the donor progamme we offer the cooperation in joint actions on motivation and improving organizational, technical and ethical aspects on the basis of our own twenty-year-experience and current european knowledge reached as partners in different projects.


    Www europeandonationday org

    www.europeandonationday.org


    Diagnostics of brain death workshop

    Diagnostics of brain death, workshop

    • In February 2012, Ljubljana

    • Three parts:

      • Theoretical overview with round table discussions

      • Practical part of clinical tests in the ICU

      • Practical part in the simulation center on the basis of PACT porgramme

  • Cooperation between Slovenija transplant, UMC Ljubljana and regional office for SEEHN countries


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