Organ Donation - Management from Donor Identification to Organ Procurement

Abstract

According to the Transplantation Act (TPG), clinics and transplant commissaries (TxB) are obliged to ensure quality in donor evaluation. They are supervised. TxBs exist in every hospital that carries out organ harvesting and are always available. They are responsible for the conception of the organ donation process and should manage each individual case from the evaluation to the implementation of the patient's wishes.The evaluation for potential organ donors should be routine and supported by IT technology. The intensive care team must inform the TxB about living patients who "come into consideration" as organ donors. Reasons for exclusion can be known rejection, absolute medical contraindications and loss of function of all transplant organs. ICBF (irreversible cessation of brain function) deceased without reasons for exclusion must be reported to the DSO immediately. Talks with relatives about the neurological outcome, the ICBF diagnostics and organ donation are of fundamental importance for the implementation of the (presumed) wish of the potential organ donor and the relatives. The aim of the talks should be a sound decision with which the relatives can conclude. The TxBs support the ICU team to achieve this.Organ donation should be handled like an emergency. Typical bottlenecks are the instrument-based examinations and the availability of the operating room. The TxBs should draw up a schedule, communicate this to the interfaces and be available at all times during the entire organ donation process. Documentation of all details is important, as the TxBs must prepare detailed individual case analyses for quality assurance purposes and forward them to the clinic management and the DSO. Quality circles and especially peer review procedures are used and recommended as further QM tools.