Efficiency of the tissue procurement process: what evaluation tools?
Evaluation of the efficiency of tissue procurement (TP) requires appropriate indicators. We report the results of a survey on all in-hospital deaths in Tuscany performed to identify potential indicators of efficiency with regard to donor identification and evaluation. In January 2004, we established a regional, compulsory, prospective program to monitor all in-hospital deaths in Tuscany. Currently, in Tuscany TP is performed if donors are < or =75 years without evidence of infectious or malignant diseases. Between January 2004 and December 2008, we analyzed data on 75,921 in-hospital deaths, including 50,001 (66.9%) in subjects older than 75 years, while 25,920 (33.1%) were < or =75 years and thus considered for TP. Among the latter cohort, 11,657 (15.3%) presented with clinical contraindication(s), while 14,263 (18.8%) were fit for tissue donation. Of the latter population, tissue donation occurred in 3083 cases (ie, 4% of in-hospital deaths or 11.8% of potential tissue donors). Contraindications to tissue donation were identified in 9861 cases (12.9%) based on clinical files, and in 1796 (2.4%) after interview with the family. There was a great variability by regional hospital in the percent of contraindications identified after the family interview, from a low of 4% to a high of 45%. Based on our experience, implementation of efficiency parameters and improvement of the efficiency of the entire TP process requires compulsory reporting of in-hospital deaths by local transplant coordinators.
Saviozzi
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Coordinamento Locale alla Donazione e Centro di riferimento per il monitoraggio della qualità della donazione della Regione Toscana, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. a.saviozzi@ao-pisa.toscana.it
Bozzi
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G
De Simone
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Filipponi
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F
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy; D018579:Patient Selection; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000592:standards*