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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.
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
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

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
slide14

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%
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

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

slide29
Positive overall attitude to organ donation and procedure among ICU doctors(Avsec, Logar-Zakrajšek, 2009)
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.
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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