Project of Cornea Donation in Rio de Janeiro: Analysis of the Implementation of an Organization Innovation Practice

Abstract

BackgroundFor many cornea disorders, transplantation can be the treatment of first choice. In Brazil, there is a disparity in the number of transplants between regions due to the lack of an oriented system for cornea procurement.The aim of this study was to analyze the implementation of a system exclusively oriented toward the improvement of cornea recovery in the Rio de Janeiro State Organ Procurement Organization (OPO) area. With this system, all cornea donation activities were coordinated by the OPO after telephone referrals following asystolic death. From the perspective of health care innovation, we will discuss the role of the main participants and their interactions following the implementation phase. MethodsOne hospital was chosen to host the project following the first 2 years of the implementation of the State Cornea Donation System. We retrospectively analyzed all deaths between January 1 and December 31, 2016, using the hospital death records and the OPO referrals record. The strategic plan, documents, and interviews were carried out for the analysis of the implementation of this innovation in our region. ResultsOf 1720 deaths in 2016, 1093 (63.5%) were referred to the OPO following asystolic death for assessment and screening, but 819 of these potential tissue donors (PTDs) were not eligible for donation due to medical contraindications. The remaining 274 (25.1%) fulfilled the PTD criteria. Less than half of the families (n = 128) of these PTDs could be contacted requesting donation, but 50% consented. Finally, corneas were procured from 58 patients. The interactions between in-house coordinators and top managers were mandatory for the success of program implementation. ConclusionFor the first time in our country, cornea recovery took place following asystolic death with OPO coordination at a central level. The PTD rate could be estimated, and an analysis of the role of stakeholders could be made for the implementation phase of this innovation in our system.