Regionalization of donor organ procurement: first experiences in southern Bavaria and results of a regional donor hospital survey.

Abstract

In order to improve organizational, qualitative, and economic aspects of organ procurement, a model of regionalization was established in the local area of southern Bavaria, as from September 1993, with the following characteristics. A collaborative 24 h-duty schedule with surgeons from all active regional transplant programs. Surgeons are grouped according to their operative qualification level: (1) Group I, capable of retrieving all abdominal organs (liver, pancreas, kidney), (2) Group II, capable of removing kidneys, and (3) Group III, surgical assistance in procurement procedures. All donor organs in the local region are explanted by the local team and foreign recipient centers are supplied with the organs removed by a standardized technique. Only three times during the first, and not once during the second year, did a foreign team insist on traveling to our region to perform a liver retrieval. A survey clearly documented univocal acceptance of this model by donor hospital executives. Simplified organization and less disturbance in operating theaters were among the most frequent arguments in favor, and the familiarity of explant teams in donor hospitals was considered advantageous. Most donor hospitals do not expect to profit in terms of financial savings. When asked for further possible measures to improve organ donation, a clearer legal situation, but also the need for more information and education programs, including better media representation of transplant issues, were cited most frequently. An improvement in financial reimbursements for the donor hospitals as an instrument to enhance willingness for organ donation was not considered essential. In conclusion, our model of regionalization of organ procurement proved to be effective in achieving a high quality of organ retrieval and a reduction in personnel requirements for the transplant centers. In addition, the response from donor hospitals was unequivocally positive and may, thus, positively influence donor activity. Relevant financial savings can result from reduced on-call duties and minimized traveling costs. Further attempts to rationalize organ procurement could possibly include heart(-/lung)surgeons in the regionalized teams.