Transplant Coordinators' Opinions Regarding the Decreasing Indicator of Organ Donation From Deceased Donors in Poland.

Despite the good overall condition of Polish transplantation medicine there is a shortage of organs for transplantation. Health care is also in a stage of development with problems including insufficient funding and lack of personnel. In 2015 the number of deceased organ donors in Poland was 526, which was distinctly lower than in 2014 when it reached 594. The aim of this paper was to collect, elaborate on, and summarize the opinions of transplant coordinators regarding the decrease of donation indicators in Poland. MATERIALS AND METHODS: The opinions of the transplant coordinators were collected during training meetings and questionnaires performed in 2016. The questionnaires targeted coordinators of active hospitals (above 5 retrievals a year) and less active donor hospitals. RESULTS AND DISCUSSION: Transplant coordinators indicated a number of factors that influence donor hospital activity, such as changing roles of intensive care units, changes in hospital flow of patients in critical condition, lack of nurses and anesthesiologists resulting in work overload, changes in forms of doctors' employment, low basic income of health professionals, difficulties in determination of brain death, decrease in engagement of transplant centers in cooperation with donors' hospitals, inadequate in-hospital training meetings, undermining of authority of doctors and medical personnel, change of attitude towards transplantation medicine (treated as profitable, regular specialty), insufficient funding of hospitals and personnel for deceased donor recruitment, and disobeying the rules of personnel remuneration for their engagement in donation and retrieval. CONCLUSIONS: Analyzing the opinions of the coordinators, we can state the following: 1. support of the hospital or hospital unit management is crucial for effective donation programs, 2. there is a need to build and implement a hospital quality systems covering each stage of donor recruitment as well as hospital trainings, 3. there should be a transplant coordination team rather than a single coordinator, 4. transplantation centers should maintain good cooperation with donor hospitals, and 5. intensive care unit personnel identification with their own hospital, which is less likely in the case of "locum" employment, is one of the major factors supporting donation programs.

Present data on organ donation and transplantation in Poland.

At present, organ transplantation activity in Poland is located in the middle among European Union countries. There are appropriate law regulations, well-organized legal structures, well-educated transplant teams, good transplantation results, and case registries. There are 24 organ transplant teams in 20 centers, including 46 programs. Since 1966, over 18,000 organs have been transplanted 14,300 kidneys; 1800 livers; 1700 hearts; 250 kidney/pancreases and 30 lungs. Every year almost 1500 organs are procured from about 500 cadaveric heart-beating donors (9-14 per million people [pmp]) with 50 from living donors: 800 to 1000 kidneys (21-28 pmp); over 200 livers (5-6 pmp); and 60 to 100 hearts (1.6-2.7 pmp). National transplant registries are maintained in Poltransplant including a central registry of refusals (the policy of presumed consent with registered objection on donation after death is implemented), waiting lists, a cadaveric and living donor registry, and a transplant registry. There are still some actions that should be undertaken to strengthen the transplantation system in Poland, to increase organ availability, to enhance the efficiency and accessibility of transplantation systems, and to improve quality and safety: namely, increasing deceased donations to their full potential, appointing transplant coordinators in every hospital where there is the potential for organ donation, promoting quality improvement programs, and promoting living donation.

Viral hepatitis B and C markers in the population of deceased donors in Poland.

In the years 2001 to 2005 in Poland, 3146 potential deceased donors were referred with 2583 (82%) organs procured and 57 (2%) donors not used due to positive viral markers. According to Polish rules, in every case of possible organ harvest from a deceased donor we test viral markers of anti-HIV I/II, HBsAg, and anti-HCV. Organs from HBsAg-positive donors (the rule accepted in Poland a few years ago) are not transplanted; kidneys from anti-HCV(+) donors are transplanted into matched recipients. According to donor hospital capabilities, other viral tests are performed: anti-HBs, anti-HBc, HBeAg, and anti-HBe. We calculate the frequency of positive serological tests for viral markers among the population of deceased donors, for HBsAg it was 1.1% (from these donors 10 kidneys and 1 liver were transplanted); and for anti-HCV it was 2.6% (from these donors 78 kidneys were used). Anti-HBc-positive deceased donors, particularly liver donors (due to the high risk of viral transmission and de novo infection), are a major problem in transplantation, which reduced the number of used organs. Only 17 of 86 (20%) of the HBc-positive donors became liver donors compared with 257 of 524 (49%) donors from the HBc-negative group. But anti-HBc was checked only in 24% of potential donors (positive in 16.6% of cases), which means that 506 of 780 transplanted livers (65%) were obtained from donors of unknown anti-HBc status, 257 (33%) from anti-HBc-negative subjects and 17 (2%) from anti-HBc-positive subjects.