Optimización del proceso de donación de tejidos en un hospital universitario: 10 años de experiencia / Optimising tissue donation process in a universiy hospital: 10 years of experience

Fundamento y objetivo: La necesidad de tejido para trasplante requiere un esfuerzo continuo en la detección y evaluación de las causas de fallecimiento de los sujetos potencialmente donantes de tejidos. El objetivo de este estudio fue evaluar la capacidad de optimizar la donación de tejidos tras la detección activa de fallecidos y la revisión exhaustiva de las causas de muerte de acuerdo con los estándares internacionales y locales de bancos de tejidos. Material y método. Desde el año 2002 se instauró un procedimiento de detección activa y precoz de fallecidos hospitalarios. Se estudió el incremento de potencialidad de donación modificando los criterios: edad (80 a 85 años), aceptación de facoemulsiones corneales, enfermedades autoinmunitarias y reevaluación de las sepsis. En la década 2002-2011 se mantuvieron los mismos criterios de exclusión absoluta. Se analizó la tasa de conversión de potenciales donantes a donantes reales de uno o varios tejidos. Resultados: Analizamos 16.531 fallecidos en parada cardiorrespiratoria. Cumplían criterios de exclusión absoluta 11.191 casos. La modificación de criterios incrementó los potenciales donantes: un 10,4% la edad, un 4,5% las enfermedades autoinmunitarias/facoemulsión y un 11,8% el criterio de sepsis (p < 0,00), con un incremento global del 16% (p < 0,00) al final del período de estudio. Se generaron un total de 2.371 donantes efectivos. La efectividad de generar donantes pasó del 11 al 21% durante la década (p < 0,00). Conclusiones: La combinación de un sistema de detección proactiva del fallecimiento y la revisión continua de los criterios de aceptación para cada tipo de tejido permite, en un medio hospitalario, incrementar el número de potenciales donantes (AU)

Background and objective: The demand of tissue for transplants requires a continuous effort in detecting potential donors and assessing the causes of death. We aimed to assess the capacity to optimise tissue donation rates with the implementation of an active detection system of hospital deaths alongside a comprehensive assessment of the causes of death according to current international and local tissue banks’ standards. Material and method: An early and pro-active detection programme of hospital deaths was implemented in 2002. The potential increase in donation was analysed according to modified criteria: age (80 to 85 years), acceptance of corneal phacoemulsification, autoimmune diseases, and sepsis reassessment. During the 2002-2011 decade, the criteria for absolute exclusion remained the same. The conversion rate from potential donors to actual donors of one or more tissue types was analysed. Results: A total of 16.531 cases of cardiac arrest were analysed, and 11.191 of the cases fulfilled criteria of absolute exclusion. The modification of criteria led to an increase of potential donors: 10.4% age factor, 4.5% autoimmune diseases/phacoemulsification factor, 11.8% sepsis factor (P < .00). The study indicated a total increase of 16% (P < .00). A total of 2.371 successful donations were generated. The efficiency to generate donors increased from 11 to 21% during the aforementioned decade (P < .00). Conclusion: A pro-active detection system of hospital deaths combined with a continuous re-assessment of the acceptance criteria for each tissue type in the hospital setting leads to an increase in the potential donors’ rate (AU)

[Optimising tissue donation process in a university hospital: 10 years of experience]. / Optimización del proceso de donación de tejidos en un hospital universitario: 10 años de experiencia.

BACKGROUND AND OBJECTIVE: The demand of tissue for transplants requires a continuous effort in detecting potential donors and assessing the causes of death. We aimed to assess the capacity to optimise tissue donation rates with the implementation of an active detection system of hospital deaths alongside a comprehensive assessment of the causes of death according to current international and local tissue banks' standards. MATERIAL AND METHOD: An early and pro-active detection programme of hospital deaths was implemented in 2002. The potential increase in donation was analysed according to modified criteria: age (80 to 85 years), acceptance of corneal phacoemulsification, autoimmune diseases, and sepsis reassessment. During the 2002-2011 decade, the criteria for absolute exclusion remained the same. The conversion rate from potential donors to actual donors of one or more tissue types was analysed. RESULTS: A total of 16.531 cases of cardiac arrest were analysed, and 11.191 of the cases fulfilled criteria of absolute exclusion. The modification of criteria led to an increase of potential donors: 10.4% age factor, 4.5% autoimmune diseases/phacoemulsification factor, 11.8% sepsis factor (P<.00). The study indicated a total increase of 16% (P<.00). A total of 2.371 successful donations were generated. The efficiency to generate donors increased from 11 to 21% during the aforementioned decade (P<.00). CONCLUSION: A pro-active detection system of hospital deaths combined with a continuous re-assessment of the acceptance criteria for each tissue type in the hospital setting leads to an increase in the potential donors' rate.