How local transplant coordinators might increase the number of potential donors: our experience in lower silesia

Abstract

RENAL transplantation is the treatment of choice for end-stage diseases of the kidney, but it is limited by a shortage of organ donors. In the early 1990s, organ donations were in a state of crisis, and not only in Poland. National organ-sharing organizations and health services try to resolve this problem in various ways. Fortunately, some organizations, such as the Spanish one, have found a proper solution by developing a system of local transplant coordinators. Now we can speak of the “Spanish model” as one that is worth imitating. The first cadaveric renal transplantation in Poland occurred in 1965 in Wroclaw, the capital of Lower Silesia, and a regular kidney transplant program was begun in Wroclaw in 1983. It was limited by a small number of potential organ donors (PODs) reported to our Transplant Center (TC). Therefore, from 1983 to 1992 only 197 potential organ donors (mean 19.7/year) were reported to our TC from the Lower Silesia region, and only 87 harvesting procedures (mean 8.7/year) were performed during that time. A dramatic decrease in organ retrievals occurred between 1993 and 1996 (in 1993, 31 PODs were reported and 11 were harvested; in 1994, 24 PODs were reported and 5 were harvested; in 1995, 22 PODs were reported and 10 were retrieved; and in 1996, 23 were reported and 6 were retrieved), resulting in a small number of transplanted kidneys and therefore in a growing waiting list. Thus, in such situations we have tried to apply a modified “Spanish model” of organ donation in our region. Since the end of 1996, transplant coordinators have been situated in 31 local hospitals. Twice a year they have a special training session with psychologists in management of donors’ families. This has resulted in an increase of reported PODs in 1997 and 1998. In 1997, 40 PODs were reported to our TC from Lower Silesia and 28 organ retrievals were done. By the end of 1998, 43 PODs were reported to our TC and 28 harvesting procedures were performed (Fig 1). The multiorgan harvesting rate was 67.8% in 1997 and 57.1% in 1998. During that period we sent six livers to Germany and two livers to Austria. To increase the number of detected PODs, we developed a Donor Action program in two local hospitals in 1999.