1,720,971 research outputs found
The epidemiology of brain death in Tuscany: is there need for novel indicators?
No full textQuality monitoring of the donation process requires appropriate indicators. We
performed a retrospective review of all patients with encephalic lesions (ELs)
reported to the Tuscany Quality Program of Donation during 2003 to 2007, seeking
to assess whether there were differences in the
brain-death-to-patients-with-encephalic-lesions (BD/EL) ratio, which is a current
indicator of the efficiency of the donation process. The theoretical framework
was that the type of disease may influence the probability of BD, and the
subsequent donation process. During the study period 2555 patients were reported
to display ELs. The overall BD/EL ratio was 48.1%, that is, 1229 patients were
reported to be BD donors to the regional coordinating center at a later time
point during patient hospitalization. With regard to the etiology, 1374 (53.8%)
patients suffered cerebrovascular (CV disease); 514 (20.1%) traumatic (T); 397
(15.5%) postanoxic (PA); 55 (2.1%) neurological neoplasms (NN); and 215 (8.4%)
other diseases (O). The BD/EL ratio by disease type was 57.2% for CV (786/1374);
58% for T (298/514); 19.4% for PA (77/397); 36.4% for NN (20/55); and 22.3% for O
subjects (48/215). Despite its limitations, the current analysis advocates
stratification of deceased donors by type of disease to allow better
understanding and monitoring of the donation process
The quality assurance program of organ donation in Tuscany
No full textConstant monitoring is paramount in order to detect the criticalities and improve
the results of the deceased donation process. Concomitant with the institution of
a regional transplantation service authority--Organizzazione Toscana
Trapianti--in 2003, Tuscany adopted a program of quality assurance of the
deceased donation process by compulsory reporting of all encephalic deaths from
local intensive care units to the regional transplant office in Florence. The
indicators we adopted were the efficiency of deceased donor (DD) identification,
expressed as the ratio of encephalic deaths (ED) to total deaths with encephalic
lesions (EL) (ie, ED/EL); the efficiency of DD reporting, expressed as the ratio
of reported potential DD (RPDD) to total ED (ie, RPDD/ED); the efficacy of the DD
process, as the ratio between actual DD (ADD) to total ED (ie, ADD/ED); the
conversion rate; the percent of opposition to donation; and the incidence of DD
maintenance failures. Data were collected prospectively, stratified by regional
hospital consortia (Aziende Sanitarie Locali) and compared with international
benchmarks. In the period 2003-2006 the mean efficiency of DD identification was
48.3%+/-4.4% (range 42.6%-53.2%); the mean efficiency of DD reporting was
95.2%+/-2.5% (range 92.5%-98.5%); the mean efficacy of the deceased donation
process was 51.8%+/-2.4% (range 48.6%-54.4%); the mean conversion rate was
59.6%+/-2.2% (range 57.6%-62.7%); the mean opposition rate was 31.9%+/-1.1%
(range 30.6%-33.2%); and the incidence of DD maintenance failure was 5%+/-2.9%
(range 2.2%-8.7%). The breakdown analysis revealed wide interhospital variability
in terms of efficiency of DD identification (from a low of 25% to a high of 80%);
efficacy of the donation process (from a low of 22% to a high of 79%); and
conversion rate (from a low of 29% to a high of 79%). Our results highlight that
the donation process gets started in about 50% of eligible cases. Further
strategies are favored to address this critical area
Tissue procurement and transplantation: a Tuscany perspective
No full textTissue procurement and transplantation are rarely taken into account as
indicators of the efficiency of a regional donor procurement network. We present
herein a retrospective review on Tuscany tissue procurement activities from 2004
until 2006. In 2003 the Tuscan Regional Government appointed a transplantation
service authority to reorganize all regional donation and transplantation
activities: the Organizzazione Toscana Trapianti (OTT). The regional tissue
procurement network was based on either brain death (BD) and cardiac death (CD)
donors under the responsibility of in-hospital transplantation coordinators
(IHTCs). From 2004 to 2006, a total of 397 tissue donors were procured in
Tuscany, and 4151 tissue transplantations were performed: 2909 skin grafts, 1209
bone grafts, and 33 heart valves. Over the same period, a total of 2116 cornea
donors were procured; 4117 corneas were retrieved; 1779 were fit for
transplantation, and 1418 were transplanted. Based on our experience,
implementation of tissue procurement requires use of BD donors and paramount
organizational efforts from IHTCs
Use of resources in corneal tissue procurement: Effects of donor characteristics and clinical practice
No full textEpidemiologia della morte encefalica in Regione Toscana: è necessario introdurre nuovi indicatori?
No full text
Corneal explantation activity in 2002: An analysis of the modified operational schedule
No full textAfter data have been gathered about corneal explants performed within the AOP health-care web throughout 2001, the resulting findings were used to update the selection system for donation fitness and operational procedures. The rejection of anti-HBc-positive grafts and tissues coming from subjects more than 79 years old resulted in decreased donations (256 donations, that is 492 corneal explants in 2001 vs 140, that is 273 in 2002), although the number of deaths was unchanged (1298 in 2001 vs 1294 in 2002). Corneas fit for transplantation did not change in number-126 (25.6% of the total available) in 2001 and 113 (41.4%) in 2002-while the instances of rejected corneas occurred 56.3% less frequently, allowing a savings of great deal of human and money resources. After activity schedules were modified, the results analysis confirmed the expected improvement in 2001
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