Local Coordinator Institute transplants in hospitals, which led to the Spanish “miracle” of transplantation and was adopted by many countries that now compete with Spain in terms of organ donation, our country is trying to realize. FROMDraft law of the Ministry of Health on transplantation, submitted by “K”, and which was recently approved by the Council of Ministers and is expected to be put out for public comment shortly, for the first time a local transplant coordinator, i.e. a health worker who will be admitted to the intensive care units of hospitals and whose sole purpose will be to promote organ donation and transplants.

As stated in “K” Professor of Pathology – Nephrology, Faculty of Medicine EKPA, Chairman of the Board of Directors. from the Onassios Center for Cardiac Surgery and the head of the group that drafted the bill, Ioannis Boletis, the local transplant coordinator will be hired by the EOM and the hospital will not be able to hire him for another job. He will identify potential brain-dead donors and, together with the ward doctor, will tell the family about the possibility of organ donation. Then, and if the family agrees, he will take over the entire process of organizing operations and the overall coordination of organ procurement. This in itself will remove a large bureaucratic burden from the ICU staff, which in the difficult NHS environment is an obstacle to advancing transplants. The local transplant coordinator will report to the EOM. Each potential donor will report whether their relatives were asked about the possibility of organ donation and, if their answer was negative, how they justified it.

Already as a pilot application, with the financial support of the Onassis Foundation, since April last year, five transplant coordinators have been placed in the intensive care units of the hospitals of CAT, Evangelismos, Sotiria, Hippocrates of Thessaloniki, the University of Ioannina (two more were in early January 2023 in Papanikolaou and the University of Heraklion ) with very encouraging results. In the first half of the year, reports of brain death from potential donors quadrupled and the number of donors doubled. It is worth noting that there have been attempts in the past to appoint ICU physicians as informal transplant coordinators, however this action never got the momentum needed by the transplant sector as it was a staff that already had an extremely busy schedule.

Data

The goal is clear: to increase organ donation and therefore the number of transplants in our country. Last year in Greece, the number of organ donors was 6.6 per million population, while in Spain they reach 40 per million population per year, and in Portugal and Croatia about 30 per million population. Also last year, 246 transplantations of parenchymal organs were performed in our country, of which 83 were from a living donor (kidney transplantation). Although the Greek figures are much lower than those of most European countries, the momentum in our country is favorable. There were just 4.7 donors per million population in 2021 (up from 6.6 in 2022), and the 69 deceased donors whose organs were donated last year is the most in a decade. In the first 24 days of 2023, seven deceased donors have already been recorded, thanks to which 21 transplantations were carried out. In addition, the coverage over the past two months by local and national media of cases of organ donation, such as 21-year-old Emma in Thessaloniki, six-year-old Thomas in Grevena, 19-year-old Grigoris in Agrinio, 22-year-old Dimitris from Patras, serves as an example for both citizens, as well as for doctors.

The state will try to take advantage of this dynamic. “The long-term backlog of the country in the field of organ transplantation is known to all. Many attempts have been made to change the landscape and increase organ donation, but they have always been fragmented and lacked duration, planning and adequate support. However, in recent years, and even in recent times, the situation seems to be changing,” says Mr. Boletis. According to the professor, “the new bill came as a result of the mobility that exists around transplantation, which began in 2018 with the unanimous decision of Parliament to establish the Onassis Transplant Center and continued with actions funded by the Onassis Foundation, such as the preparation of a national plan for organ donation and transplantation. under the coordination of professors Ilias Mosialu and Vassilis Papalua, the Organoulides program and the support of seven hospitals with transplantation coordinators.”

The local transplant coordinator will identify potential brain-dead donors and, if their family agrees, take over the organization of the operations.

Plan

According to Mr. Boletis, “the proposed institutional structure provides for changes to the EOM, which is renamed the Hellenic Organization for Transplantation, from the National Organization for Transplantation, and acquires autonomy, flexibility, a modern organizational structure and financial means to carry out its work. . This gives him the authority to regulate and oversee the entire transplantation system, without requiring the approval of the Ministry of Health for every decision, he gets the opportunity to independently recruit employees, while departments are added that modernize his work, such as the statistics department. analysis and digital support with the prospect of a complete digitization of the system.

The bill also makes changes to the way the system is funded. As Mr. Boletis points out, “For each hemodialysis session reimbursed by EOPYY, it is proposed to withhold one euro for the benefit of the EOM, and for each patient undergoing peritoneal dialysis, 144 euros annually. The money will be returned to EOM from the mandatory refund deduction paid by EOPYY dialysis facilities. The profit of EOPYY is that the money goes towards transplantation, which is a better and cheaper treatment for patients with end-stage chronic kidney disease compared to dialysis.” Considering that approximately 12,000 patients in our country are undergoing this treatment, the EOM has an estimated income of 1.7 million euros, the amount with which the Organization will finance its operating expenses, including the salaries of its staff and local transplant coordinators, its development program , actions to promote transplantation and digitize the system.

Each year, the EOM will submit its budget to the ministry for approval, and if it has a development program that requires more funding, it will be able to apply for an additional grant. It is noted that today the EOM receives an annual state grant, which does not exceed half of the amount it will receive under the new method of funding. And the amount he receives is not the same every year.

“The way the EOM works, its funding and the local transplant coordinator is a big part of the bill. The other part concerns the quality and safety of the entire system and the work of the transplantation departments, as well as the departments involved in transplantation, such as, for example, immunological – histocompatibility,” notes Mr. Boletis. In this context, the bill provides that, in addition to the director of each department, the director of medical services and the administrator of the respective hospital will be jointly responsible for the legality and quality of the transplant program. Thus, hospital administrations are also obliged to help transplants. Transplantation centers and hospitals will be required to digitally report to the EOM on the progress of the program based on specific indicators (program outcomes, mortality rates, patient health progress, etc.), which should be verified by their operating centers and informed the Ministry of Health accordingly.

Mr Boletis concluded by saying that “accordingly, the Minister of Health should submit a report on transplant every two years to the plenary session of Parliament on the results of the program, identified potential problems and plans for the next two years.” years to correct them.