Objectives: to report the results of evaluation regarding changes in the number of potential donor referrals, actual donors, and conversion rates after the implementation of an in-house organ and tissue donation for transplantation coordination project. Methods: epidemiological study, both retrospective and transversal, was performed with organ donation data from the Secretariat of Health for the State and the in-house organ donation coordination project of a beneficent hospital. The data was compared using nonparametric statistical Mann-Whitney test, and the Student's t-test, considering a significance level of 5% (p <0.05). Results: there were statistically significant differences (p < 0.05), before and after the implementation of the project on the number of potential donor notification/month (3.05 - 4.7 ), number of actual donor/month (0.78 to 1.60) and rate of conversion ( 24.7 to 34.8 %). The hospitals 1, 2, 7 and 8 had significant results in potential donor, actual donor or conversion rate. Conclusion: the presence of an in-house coordinator is promising and beneficial, the specialist is important to change the indicators of efficiency, which consequently reduces the waiting lists for organ transplants.
OBJECTIVE To evaluate the viability of a professional specialist in intra-hospital committees of organ and tissue donation for transplantation.METHODS Epidemiological, retrospective and cross-sectional study (2003-2011 and 2008-2012), which was performed using organ donation for transplants data in the state of Sao Paulo, Southeastern Brazil. Nine hospitals were evaluated (hospitals 1 to 9). Logistic regression was used to evaluate the differences in the number of brain death referrals and actual donors (dependent variables) after the professional specialist started work (independent variable) at the intra-hospital committee of organ and tissue donation for transplantation. To evaluate the hospital invoicing, the hourly wage of the doctor and registered nurse, according to the legislation of the Consolidation of Labor Laws, were calculated, as were the investment return and the time elapsed to do so.RESULTS Following the nursing specialist commencement on the committee, brain death referrals and the number of actual donors increased at hospital 2 (4.17 and 1.52, respectively). At hospital 7, the number of actual donors also increased from 0.005 to 1.54. In addition, after the nurse started working, hospital revenues increased by 190.0% (ranging 40.0% to 1.955%). The monthly cost for the nurse working 20 hours was US$397.97 while the doctor would cost US$3,526.67. The return on investment was 275% over the short term (0.36 years).CONCLUSIONS This paper showed that including a professional specialist in intra-hospital committees for organ and tissue donation for transplantation proved to be cost-effective. Further economic research in the area could contribute to the efficient public policy implementation of this organ and tissue harvesting model.
Our findings highlight the importance for the development of quality initiatives in identifying gaps and weaknesses in the process that should be corrected or even restructured, therefore maximizing the number of donors and organs transplanted. Hospitals that participate in the NOP process met 61% of the quality indicators proposed by ODEQUS. Identification of potential donors, family consent, conversion, and sudden cardiac arrest rates are areas that did not conform to ODEQUS standard and revealed a great opportunity for improvement.
O transplante hepático revolucionou a expectativa de vida dos pacientes com doença hepática em estágio avançado, tornando-se muitas vezes a única modalidade terapêutica efetiva para uma variedade de doenças hepáticas crônicas ou agudas irreversíveis.1-4Deve-se a C. S. Welch as primeiras tentativas de transplante hepático experimental em cães, em 1955.5 Embora a técnica de transplante hepático em humanos tenha sido descrita inicialmente em 1960,6,7 o primeiro transplante de fígado no homem foi realizado em 1963 na Universidade do Colorado em Denver (EUA) por Thomas Starzl8 em um paciente de três anos de idade com atresia de vias biliares e que foi a óbito no transoperatório por sangramento. O primeiro transplante hepático realizado em humanos com sucesso foi alcançado por esta mesma equipe em 1967 em uma criança de um ano e meio com carcinoma hepatocelular.1Desde então a técnica operatória tem sido constantemente modificada e aprimorada, sendo necessárias quase duas décadas para que o transplante hepático se consolidasse como uma alternativa terapêutica cientificamente comprovada.O Brasil entra precocemente na era dos transplantes de fígado. Em 1965, o grupo de metabologia cirúrgica da Faculdade de Medicina da Universidade de São Paulo produz as primeiras pesquisas experimentais sobre transplante de fígado em cães. No dia 5 de agosto de 1968, foi realizado com sucesso técnico o primeiro transplante de fígado da América Latina no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), em um doente com 52 anos de idade, portador de cirrose hepática e carcinoma hepatocelular...
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