Proposal of a management and standardization protocol for organ procurement in Chile Background: Organ donation rates for transplantation are low in Chile and there is a paucity of a technical-structured-normalized procurement process. Aim: To design a protocol to standardize the organ procurement process based on the Chilean reality. Material and Methods: After a first phase of bibliographic reviews and analyzing de Chilean legislative and normative frame, a proposal was elaborated in collaboration with five expert coordinators. In the second phase, two Delphi rounds with the local coordinators of the organ procurement centers were carried out. Their responses were analyzed and the stages and criteria to standardize the organ procurement process were determined. Results: The expert defined organ procurement process, validated by local coordinators, comprised nine stages and 36 criteria. The expert opinion coincidence was high and significant (Cronbach's alpha > 0.8, p < 0.01). Conclusions: The protocol describing the procurement process, constructed and validated by experts, will allow to standardize a clinical protocol contributing to a successful national organ procurement.
RESUMEN Introducción: En Chile, los coordinadores de procuramiento son mayoritariamente enfermeras y la tasa de donación es muy baja respecto a su población. Objetivo: Analizar la coherencia entre el perfil del enfermero/a coordinador de procuramiento definido por el Ministerio de Salud y el observado en los coordinadores chilenos. Material y Método: Estudio descriptivo, cuantitativo, muestreo no probabilístico, de enfermeras que se desempeñaban cómo Coordinadores de Procuramiento en servicios asistenciales públicos y privados de Chile. Las Variables estudiadas fueron de carácter sociodemográficas, de caracterización profesional, de capacitación, estructura de la unidad de procuramiento, y de requisitos del cargo de coordinador. Datos recolectados en el mes de octubre del año 2017, en el III Encuentro Nacional de Coordinadores de Procuramiento y Trasplantes, a través de un cuestionario estructurado, que permitió contrastar el perfil obtenido con el perfil definido por el Ministerio de Salud (MINSAL) Resultados: Los coordinadores de procuramiento, son en un 82.4% de sexo femenino, promedio de edad de 36+ 11 años .El 90.2% se desempeña en un Hospital Público. El 100% tiene título enfermera acreditada, un 30 % entre 1 y 4 años de egresados, y un 37 % menos de 5 años de experiencia laboral. Sin experiencia clínica en cuidados de alta complejidad, como unidades de Urgencia (82.3%) o cuidados intensivos (58.8%). El 66,5% consideró que la formación inicial, fue suficiente para asumir el cargo. Conclusiones: En los aspectos estudiados, el perfil profesional de los enfermeros coordinadores locales difiere del perfil definido por la autoridad de salud.
Critical analysis of the low organ donation rates in ChileThe highest organ donation rate in Chile was 10 donors per million population in 2017, which is low compared with other countries. Local experts attribute the low rate to population's lack of education and generosity, distrust in procurement/allocation system, inadequate legislation and insufficient encouraging campaigns, although without much empirical support: None of the countries from the OECD is also an organ donation leader. Latin Americans who migrate to Spain improve their donation rates, suggesting that the possible explanation is trust in the system where personalities do not have fast access to organs and common people do not have a sense of inaccessibility. Legislation changes in Chile did not have the expected results. Mega campaign did not reduce family refusal, but increased actual donors, probably due to health personnel sensitization. Real problems are inefficiencies in search and procurement processes, because procurement coordinators do not have enough time, dedication or priority to detect possible donors. Eighty seven percent of the latter are not notified to the procurement coordinator. Also, the services that care for possible donors are not adequately aligned. Procurement nurses do not have enough empathy or communication abilities and do not fulfil the professional profile required by the national coordination entity, which is unable to demand for results. The management of procurement coordinators should be improved, and their operational limitations should be visualized. Tools should be provided to the national agency in charge of organ procurement to have more political influence and credibility. Information technologies could ease warns, control and standardize, in real time, the procurement process.
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