organizational framework for organ donation and tissue donation … · 2017. 8. 16. · organ...

ORGANIZATIONAL FRAMEWORK FOR ORGAN DONATION AND TISSUE DONATION SERVICES

JANUARy 2015

CONTRIBUTORS

Working groupLouis Beaulieu, Transplant Québec Gilles Beaupré, Héma-QuébecSuzanne Boivin, CSSS Richelieu-Yamaska Michel Carrier, Transplant QuébecLouis Couture, CHU de Québec (has since changed positions)Annick Lavoie, ACMDPQLucie Raymond, AQESSSHugues Villeneuve, Transplant Québec

With the collaboration of Denis Ouellet and Andréanne Trottierof the Direction de la biovigilance et de la biologie médicale, MSSS

Also consultedLyne Beauregard, CSSS Richelieu-Yamaska Mélissa Foucault, CSSS Richelieu-Yamaska Corinne Lajoie, CSSS Richelieu-Yamaska

PRODUCTION

Written by Louis Beaulieu, Executive Director, Transplant QuébecGilles Beaupré, Human Tissue Procurement Manager, Héma-Québec Annick Lavoie, Executive Director, ACMDPQLucie Raymond, Service Organization Advisor, AQESSS

With the collaboration of Sonia Amziane, Attorney, AQESSS, Brigitte Junius, Head of Communications and Public Relations, Transplant Québec, and Laurent-Paul Ménard, Director, Public Relations, Héma-Québec

French editing Rédaction Frédéric Desjardins inc.

Copy editing, graphic design and DTP Guénette + Delisle design et communication

English translation Anglocom

Revision James Cookson et Karin Montin, s.e.n.c.

DISTRIBUTION

Association québécoise d’établissements de santé et de services sociaux et autres 505 De Maisonneuve Boulevard West, Suite 400Montreal, Quebec H3A 3C2Telephone: 514-842-4861

© Association québécoise d’établissements de santé et de services sociauxLegal deposit – Q1 2015Bibliothèque et Archives nationales du Québec Library and Archives CanadaISBN 978-2-89636-206-6 (print) ISBN 978-2-89636-203-5 (PDF)

This document is available from the following websites: www.acmdp.qc.cawww.aqesss.qc.cawww.hema-quebec.qc.cawww.transplantquebec.ca

Excerpts may be reproduced for non-commercial use, provided that credit is given. Any partial reproduction must stay true to the original.

http://www.acmdp.qc.ca

http://www.aqesss.qc.ca/fr/accueil.aspx

http://www.hema-quebec.qc.ca/index.en.html

http://www.transplantquebec.ca/en


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FOREWORD

After death, a single donor can

•Saveasmanyas8livesbydonatingorgans •Give20-oddpeopleabetterqualityoflifebydonatingtissues

Theorganandtissuedonationprocessesrequireabest-effortsapproach.Bysteppinguptheseeffortsandimprovingandstreamliningthewayservicesareorganized,wecansavemorelivesandhelpmorepeoplegetoffdialysisandrecovertheirfullpotential.Wecanalsoachievesignificantsavingsforthehealth-caresystemandsocietyasawholewitheverysuccessfulorgantransplantandtissuegraft.

LedbyAQESSSandTransplantQuébec,ourfourorganizationsjoinedforcestoproducetheStandardizedOrganDonationProcedureandStandardizedTissueDonationProcedurein2012,oneyearafternewpro- visions in theActRespectingHealthServicesandSocialServices (ARHSSS)came intoeffect.Withanamendmenttosection204.1,theActreaffirmedtheneedforeveryestablishmenttohavesuchproceduresinplace.

Over time, itbecameclear thatdevelopinganorganizational framework fororgandonationand tissue donationservicesforestablishmentsandcouncilsofphysicians,dentists,andpharmacistswasnotonlyagoodidea,butessential.TheMinistèredelaSantéetdesServicessociaux[ministryofhealthandsocialservices,MSSS]joinedourworkinggroup.

ThisframeworkisalsoaconcreteresponsetotheMSSS’s2004report,Les dons et greffes d’organes et de tissus au Québec – Plan d’action[organandtissuedonationsandtransplantsinQuebec:actionplan]. Itspurposeistoprovideacriticalvisionoforgandonationandtissuedonation,eachofwhichhasitsownspecialrequirements.Theframeworkindicateshowservicescanbemoreefficientlyorganizedbothincasesofdeceaseddonorsandpotentialdonorsfacingimminentdeath,assetoutintheARHSSS.

Theendgoaloftheseeffortsistoincreasethenumberoftransplantsandgraftsand,asaresult,savelives,reducewaitingtimes,andhelppatientsregaintheirhealth,whilealsogeneratingsavingsforthehealth-caresystem.

Association des conseils des médecins, dentistes et pharmaciens du Québec

Association québécoise d’établissements de santé et de services sociaux Héma-Québec

Transplant Québec

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TABLE OF cOnTEnTs

n summARy 5

n AuDIEncE 8

n OBJEcTIVEs 9

n VALuEs 10

n BAcKGROunD AnD cuRREnT sITuATIOn 11

n ORGAn DOnATIOn 12

n CURRENTORGANDONATIONSITUATION(ASOFDECEMBER31,2013) 14– Dataonorgandonation 14– Characteristicsofpatientsonthewaitinglist 17– Characteristicsoftransplantrecipients 18– Economicissues 18

n TIssuE DOnATIOn 20

n CURRENTTISSUEDONATIONSITUATION(ASOFMARCH31,2014) 20– Eyetissues 21– Othertissues(heartvalves,skin,bone,andtendons) 22– Tissuetransplants 23

n LEGIsLATIVE FRAmEWORK 24

n GuIDInG PRIncIPLEs 27

n ORGAnIZATIOnAL ARRAnGEmEnTs 28

n mAnAGEmEnT cOmmITmEnT 28

n mAnAGEmEnT TEAm’s ROLEs AnD REsPOnsIBILITIEs 29

n TRAININGOFCLINICALTEAMS 29

n ORGANANDTISSUEDONATIONCOMMITTEE 30– Compositionandoperation 30

n FOLLOW-UPANDFEEDBACKMECHANISMS 31

n sPEcIAL POInTs TO TAKE InTO AccOunT 32

n ORGAnIZATIOn OF ORGAn DOnATIOn sERVIcEs 33

n ROLEs AnD REsPOnsIBILITIEs OF VARIOus PLAyERs 33

n ORGAnIZATIOn OF sERVIcEs 35

n EMERGENCYSERVICES(ANDOTHERCAREUNITS) 35

n INTENSIVECARE(INCLUDINGTHEHEARTANDNEONATOLOGYUNITS) 35

n DIAGNOSTICSERVICES 36

n MEDICALSERVICES 36

n PHARMACYDEPARTMENT 36

n OPERATINGROOM 36

n INTERESTABLISHMENTTRANSFERS 37

n MEDICALRECORDS 37

n CLINICALETHICSCOMMITTEE 37

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TABLE OF cOnTEnTs

n TRAnsPLAnT QuÉBEc suPPORT TO EsTABLIsHmEnTs 38

n MISSION,VALUESANDSTRATEGICPRIORITIESOFTRANSPLANTQUÉBEC 38

n SUPPORTPROGRAMFORORGANDONATIONDEVELOPMENTINQUEBECHOSPITALS 38

n ORGANDONATIONCOORDINATIONPROGRAMINQUEBECHOSPITALS 39

n ORGANDONATIONLIAISONANDRESOURCENURSES 40

n MEDICALMANAGEMENT 40

n TRAINING 40

n DOCUMENTATIONAVAILABLETOHEALTHPROFESSIONALSANDESTABLISHMENTS 42– TransplantQuébecwebsite 42– StandardizedOrganDonationProcedure 43– Standardizedorgandonationprocedureflowchart 43– OrganDonorandTissueDonor(OTD)binder 44– Donationprocesschecklist 44– Guidelines,policies,protocols,proceduresandforms 44

n PERFORMANCEINDICATORS 45

n ADVISORYCOMMITTEES 48

n SUPPORTFORESTABLISHMENTORGANANDTISSUEDONATIONACCREDITATION

(DECEASEDDONORS) 48

n COMMUNICATIONS 49

n FINANCIALSUPPORTFORDONORIDENTIFICATIONANDORGANPROCUREMENT 49

n ORGAnIZATIOn OF TIssuE DOnATIOn sERVIcEs 50

n ORGAnIZATIOn OF sERVIcEs 50

n RESPONSIBILITIESOFDEPARTMENTS 50

n CLINICALSERVICES 50

n MEDICALBIOLOGYSERVICES 54

n MORGUEANDPATHOLOGYLABS 54

n ADMISSIONSANDMEDICALRECORDS 54

n OPERATINGROOM 55

n HÉmA-QuÉBEc suPPORT FOR EsTABLIsHmEnTs 56

n MISSION,VALUESANDSTRATEGICPRIORITIESOFHÉMA-QUÉBEC 56

n HOSPITALDEVELOPMENTPROGRAM 57

n TISSUEDONATIONCOORDINATIONPROGRAMINQUEBECHOSPITALS 57

n AWARENESSPLAN 57– Classificationofestablishments 58

n SUPPORT 60

n TRAINING 60

n DOCUMENTATIONAVAILABLETOHEALTHPROFESSIONALSANDESTABLISHMENTS 60– Héma-Québecwebsite 60– StandardizedTissueDonationProcedure 60– Standardizedtissuedonationprocedureflowchart 60– Quickreferencecard 61– A Legacy of Life guide 61– Posters 61

n PERFORMANCEINDICATORS 62

n PREREQuIsITEs FOR succEss 63

n cOncLusIOn 64

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TABLE OF cOnTEnTs

n APPEnDIXEs 65

n APPEnDIX 1 65

n DISTINCTIONBETWEENNDDANDDCD 65

n APPEnDIX 2 66

n ORGANPROCUREMENTCENTRESANDORGANTRANSPLANTATIONCENTRES 66– Organprocurementcentres 66– Organtransplantationcentresandprograms 66– Establishmentsofferinglivingdonorprograms 66– Pediatricestablishmentsofferinglivingdonorprograms 66

n APPEnDIX 3 67

n ORGANDONATIONPROGRESSREPORT–ADDITIONALINFORMATION 67– Factsaboutorgandonors 67– PatientsonthewaitinglistandtransplantrecipientsinQuebec,byregion 67

n APPEnDIX 4 68

n TRANSPLANTQUÉBECSUPPORTFORESTABLISHMENTS–ADDITIONALINFORMATION 68– TransplantQuébecadvisorycommittees 68– Communicationsandpublicrelations 68

n FINANCIALSUPPORT–USEFULDEFINITIONS 68

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summARy

Theorganizational framework fororgandonationandtissuedonationservices isa referencedocument intendedforallhealthandsocialservicesestablishments,ineveryregionofQuebec,operatingahospitalwithamissiontoofferdiagnosticservicesaswellasgeneralmedicalandspecializedcare. Itsaimisto facilitate their operations by providing a structured approach aimed at developingmore effective and betterperformingorgandonationandtissuedonationservicesinordertobettermeettheneedsofpatientswaitingforanorganortissuetransplant.

Theframeworkisintendedprimarilyforestablishmentdirectors,managers,andmembersoftheCouncilofPhysicians,Dentists,andPharmacists(CPDP).Itpresentsthewinningconditionsforestablishingtheproperprocessandimplementingthemeanstosupportclinicalteamsintheirorgandonationandtissuedonationactivities.Itisareferencedocumentintendedforallplayersandparticularlyforphysicians,nurses,andrespiratorytherapists.

Firstitisessentialtostatethatthereareparticularitiesspecifictoorgandonation,andthesameistruefortissuedonation.Consequently,adaptedandspecificorganizationalarrangementsmustsupporttheimple-mentationof theproperpractices. Indeed,only1.4%ofpatientswhodie inhospitalarepotentialorgandonors,whichwouldhaverepresentedamaximumof344donorsin2009,ifalltheconditionsweremetineveryinstance.Bycontrast,some50%ofpeoplewhodiearepotentialtissuedonors,whichwouldamount,intheory,tomorethan30,000donorsperyear.Thismajordiscrepancyintermsofvolumeaswellasotherparticularitieshighlightstheneedforseparateapproachestoorgandonationandtissuedonation,inspiteofthefactthatanumberofconsiderationsaresimilar.

The framework targetsseveralobjectives thatwillhelp to improveoutcomesandperformanceand lead tobetteridentificationandreferralsoforgandonorsandtissuedonors.Theconsolidationoftheestablish-mentcultureoforgandonationandtissuedonationalsoaimstoachieveamoreeffectiveorganizationofservicesincompliancewithlegalobligationsandresponsibilitiestothepopulationserved.Therolesandresponsibilities of eachplayer are thereforepresented, including thoseof the establishment, TransplantQuébecfororgandonation,andHéma-Québecfortissuedonation.

Inordertoguidetheplayerswhoworktogethertostructureservicesmoreeffectively,theframeworkalsopresentsthevaluesassociatedwiththeachievementoforganandtissuedonationandtransplantation.Thus,thesystem’sultimateobjectivesaretosavelives(e.g.,ofpatientswaitingforaheart,liverorlung),improvequalityoflife(e.g.,ofpatientswaitingforakidney,corneaorothertissue),supportgrievingfamilies,andpromotetheexpressionofsocialsolidarity.Playersareguidedbythecorevaluesoffreeandinformedconsent,freeanduniversalcare,equityandanonymity.

Agreatdealofbackgroundinformationispresentedonthecurrentsituationregardingorgandonationandtissuedonation,includinginformationondonation,patientsonthewaitinglist,transplantrecipients,andfinancialconsiderations.

Intheareaoforgandonation,whiletheyear2013demonstratedthatitispossible,throughacollective effort, tosurpassthefigureof20donorspermillion inhabitants (dpmi)and,consequently, toachievea significant increase in the number of transplant recipients, together with a corresponding decrease in thelengthofthewaitinglist,thesegainscannotbetakenforgranted.Infact,theresultshaveremainedstableoverthelast10years(andbelowtheresultsobservedin2013).Québeccanobviouslydobetter.

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ORGANIZATIONAL FRAMEWORK FOR ORGAN DONATION AND TISSUE DONATION SERVICES TABLE OF cOnTEnTs

summARy

Thedataontissuedonation,meanwhile,indicatethatsignificantprogresshasbeenachieved,particularlyintermsofthenumberofcorneatransplants.Thishasasignificantimpact,inthatitreducesthenumberofpatientsonwaitinglists.Theneedforheart,skin,andbonetissue,aswellastendons,issogreat,however,thatconstantvigilanceisrequiredfromallstakeholders.

Theframeworkestablisheslinkstolegislation,regulations,andnormativeaspectsthatlendstructuretoorgandonationandtissuedonationprocedures,clearlysettingouttheobligationsofestablishmentsand,morespecifically,thoseofdirectorsofprofessionalservices(DPSs).

Inordertodirecttheactionsofestablishments,fiveguidingprinciplesaresetout.By emphasizing collaboration and coordination, these principles highlight the necessity of recognizing the shared responsi-bility and interdependence of establishments and organizations in order to ensure that organ dona-tions and tissue donations are carried out.Basedontherolesofeachestablishmentandthenatureoftheiractivities,theframeworkalsounderscorestheimportanceofensuringtheaccessibilityandavailabilityofservicesandresources,sharingknowledge,andsupportingresearch(withhelpfromTransplantQuébecandHéma-Québec),withtheobjectiveofimplementingbestpractices.

Attheheartofthisorganizationalframework,specificproceduresaresetoutfororgandonation(includingsupportfromTransplantQuébec)andtissuedonation(includingsupportfromHéma-Québec).Thisimpor-tantsection

• Explainsthecommitment,rolesandresponsibilitiesofthemanagementteam• Reiteratestherespectiveproceduresfororgandonationandtissuedonation• Emphasizesthecrucialnatureofformingclinicalteams• Specifiestherolesandresponsibilitiesoftheorganandtissuedonationcommittee,aswellasitscom- position

Inregardtoorgandonation,theimportanceofeachplayerinthesuccessofthedonationandtransplanta- tionchainisreiterated,specifying(dependingonwhethertheestablishmentisanidentification,procurementortransplantationcentre)theresourcesthattheestablishmentmustmobilizeandtheactionsitmustperformateachstageinthechain.Theframeworkthenexplainstherolesandcontributionsofeachdepartmentconcerned:emergencyservices,intensivecare(includingtheheartandneonatologyunits),diagnosticser-vices,medicalservices,pharmacy,andoperatingroom.Alsohighlightedisthenecessityofensuringtimelyandeffectiveinterestablishmenttransferseachtimetheyarerequired,andconsultationoftheclinicalethicscommitteewhereappropriate.ThesectionconcludeswithapresentationbyTransplantQuébecexplainingitsmission,roles,andprograms:trainingandsupportinthedevelopmentoforgandonation;coordinationofthedonationprocess;therespectiverolesoftheliaisonandresourcenursesandthemedicalmanage-mentteam;andsupportfortheaccreditationofestablishments.Inaddition,completedetailsareprovided onthedocumentationavailable tohealthprofessionalsandestablishments:TransplantQuébecwebsite;standardizedorgandonationprocedure;OrganandTissueDonorbinder;donationprocesschecklist;guides,policies,protocols,procedures,andforms.Informationonsupportforcommunicationsactivitiesinestab- lishmentsisalsoprovided,togetherwithdetailsonthefinancialsupportavailablefordonoridentificationandorganprocurement.

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summARy

Inregardtotissuedonation,theframeworkexplainsthenatureofthecollaborationrequestedfromclinicalservices,medicalbiologyservices(laboratories,pathology),admissions,medicalrecords,andoperatingroomsinestablishments,specifyingtheirrolesandexpectedcontributions,andlistingthestepstofollow,aswellasanswerstofrequentlyaskedquestions.ThesectionconcludeswithapresentationbyHéma-Québecexplainingitsmissionandcommitment,itsrolesandresponsibilitieswithrespecttotissuedonation,andtheimplementationofbestpractices.Thecoordinationprogramfortissuedonationinhospitalsispresented,togetherwiththeawarenessplanframingthepromotional,trainingandrecognitionactivities,basedontheclassificationofestablishments(targetedcentres,Category1,orCategory2centres)establishedinaccor-dancewiththevolumeofpotentialdonorsandthestrategiesdeployedinsupportofthisplan.Finally,docu- mentationissuggestedtohealthprofessionalsandestablishments(Héma-Québecwebsite,standardizedtissuedonationprocedure,quickreferencecard,guide,andposters).

Toroundouttheorganizationalframework,conditionsofsuccessareidentified:

• Thedevelopmentofatruecultureoforganandtissuedonationineachestablishment,reflectedinaformalcommitmentbytheboardofdirectorsandseniordirectorsoftheCPDP,andexpressedinstrongleader- shipbytheentiremanagementteam,medicalteamsandmanagers

• Propertrainingofphysiciansandclinicalstaffonhiring,andthedevelopmentandmaintenanceofcom- petencieswiththeobjectiveofconsolidatingbestpractices

• Therecognitionofinterdependenciesbetweenidentification,procurement,andtransplantationestablish-ments,andtheestablishmentofeffectivecoordinationmechanisms

• Theorganizationofcommunicationsactivitiesforallstaffattheestablishmentandthepublic• ActivecollaborationwithTransplantQuébecandHéma-Québec• Poolingofexpertiseandsupportforresearch

Thecommitmentofestablishments,directors,managers,physicians,clinicalteams,CPDPs,andorganandtissuedonationcommitteeswillmakeitpossibletoimproveorgandonationandtissuedonationoutcomes.Indoingso,eachwillplayadirectpart inensuringthatpatientsonthewaiting list receivemoretimelytransplants,whilegeneratingsavingsforthehealth-caresystem.

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https://www.hema-quebec.qc.ca/tissus-humains/professionnels-sante/index.en.html

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AuDIEncE

Thisorganizationalframeworkfororgandonationandtissuedonationservicesisprimarilyintendedfor directorsandmanagersofQuebecestablishmentswithgeneralorspecializedcaremissions.Itprovidesinformationtohelpthemcreateoptimumconditionsforimplementingprocessesandresourcestosupportclinicalteamsintheirorganandtissuedonationactivities.

Theframeworkwillalsobeofinteresttopotentialstakeholdersintheorganandtissuedonationprocesses,in- cludingphysicians,nursesandrespiratorytherapists,departmentheads,andmedicalprogramco-managers.Councilsofphysicians,dentists,andpharmacists(CPDPs)andestablishmentorganandtissuedonationcommitteesalsoplayakeyrole,asdootherhealth-careandsocialservicesprofessionals,suchasphar- macists,socialworkers,andnutritionists,aswellasspiritualcareadvisors.

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TABLE OF cOnTEnTs

OBJEcTIVEs

Thisframeworkhasanumberofobjectives, includingbetter identificationandreferralofpotentialorgandonorstoTransplantQuébecandpotentialtissuedonorstoHéma-Québecinordertoincreasethenumberoforganandtissuetransplantscarriedout.Theseobjectivesareasfollows:

• Strengthentheorganandtissuedonationculturewithinestablishmentstoactivelycontributetothecol- lectiveefforttosavelivesandimprovethequalityoflifeofpeoplewaitingforanorganortissuetransplant, wherevertheymaybe• Supportestablishmentsinorganizingorganandtissuedonationservicesaccordingtotheirstatus(for organs,anidentification,procurementortransplantationcentre;fortissues,atargetcentre,Category1 centreorCategory2centre)• Allowfortheidentificationandreferralofpotentialorganandtissuedonorswithinestablishments• Helpdirectorsofprofessionalservices(DPSs)performtheirdutieswithrespecttoorganandtissue donation• Clarifyanddefinetherolesandresponsibilitiesofestablishments,ofTransplantQuébecfororgandonation andofHéma-Québecfortissuedonation• Bolsterprocurementanddonormanagementinestablishmentsthatcarryouttheseactivitiesfororgan donation

Organizationalproceduresandproposedmechanismstoaidinachievingtheseobjectivesmusttakeintoaccounttheuniquenatureoforgandonationandtissuedonationsothatservicesareoptimallydeliveredinbothcases.

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VALuEs

Thereareanumberofvaluesunderpinningorganandtissuedonationandtransplantation.Thesevaluesguideestablishmentsinternally,intheirinteractionswithpatientsandfamilies,andintheiractivitiesinthebroadercommunityandsocietyasawhole.

Thevaluesoftheorganandtissuedonationandtransplantsystemareasfollows:

•Savelives•Improvequalityoflife•Supportfamiliesinmourning•Promotesocialsolidarity

Thesevaluesseektogivedueweighttoallimportantfactorsintheprocess.Thus

•Thepatient’sconsenttothedonationisvoluntary.•Familyandlovedonesagreefreely.•Theconsenttoorganortissuedonationrespectsthewishesmadeexplicitlyknownbythepatient(the donor).•Thedonationconsentisinkeepingwiththedonor’svalues,suchassharing,socialsolidarity,mutual assistanceandgenerosity.•Thedesireofdonors’familiestohonortheirlovedones’decisiontodonateorgansortissuesafterdeath isrespected.•Treatmentisatalltimesfair.•Thedonationisfree.•Thedonationisanonymous.

Withregardtoorgantransplantationandtissuegrafting,relatedconsiderationscontributeto

•Fairallocation•Anonymityand•Greatereffortstoincreaseorganandtissuedonation

Ineveryinstance,allpossiblemeasuresaretakentoprovideclearandinspirationalguidancetothestaffwhomakethedecisionsandperformthetasksinvolvedinthedonationandthegraftingortransplantationprocess.Nothingislefttochance,soastoearnthepublic’strust,andespeciallythetrustofdonors,griev- ingfamilies,andpatientswaitingforanorganortissuetransplantorgraft.

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TABLE OF cOnTEnTs

BAcKGROunD AnD cuRREnT sITuATIOn

Formattersrelatedtoorgandonation:Transplant Québec

Formattersrelatedtotissuedonation:Héma-Québec

GraphicreproducedwiththegenerouspermissionoftheKidneyFoundationofCanada

Theneedsfororganandtissuedonationaregreatandestablishmentsmustactivelycontributetomeetingthem.Tobeabletooffertherightservices,wemustallbeonthesamepageintermsofwhatthoseneedsentail.Therearealsofundamentaldifferencesbetweenorgandonationandtissuedonation.Thisorganiza-tionalframeworktakesthosedifferencesintoaccount.

Afterdeath,patientscansavemanylivesbydonatingtheirhearts,lungs,livers(whichcanbedividedinhalfandtransplantedtotworecipients),pancreasesandbowelsandcanimproveotherpeople’squalityoflifeandlifeexpectancybydonatingtheirkidneys.Fromthetimetheyareremoved,organscanbepreservedforvaryingperiods(e.g.,fourhoursfortheheart,sixtoeighthoursforthelungs,andabout15hoursforthekidneys),dependingontheirresistancetocoldischemia.

Tissuepreservationtimesalsovary.Sometissues,suchaseyetissue,mustbetransplantedwithin14daysofprocurement.Othertissues,suchasskin,heartvalves,tendons,andbone,maybepreservedforuptofiveyearsusingcontrolledfreezingandcryopreservation.

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BAcKGROunD AnD cuRREnT sITuATIOn – ORGAn DOnATIOn

8,116,133

7,304,520

3,652,260

31,755

445

165

Quebec’s population as of January 1, 2013. (Source: Bilan démographique du Québec, 2014 edition)

90% of adult Quebecers say they are in favour of organ and tissue donation.(Source: 2009 Impact Recherche survey)

Half of all Quebecers claim to have given their express consent to being organ donors. (Source: 2009 Impact Recherche survey)

Number of deaths in Quebec hospitals, all causes. (Source: CMQ, 2010)

1.4% of deaths in hospitals meet organ donation criteria.

Number of donors in 2013, for a rate of 20.2 donors per million inhabitants.

Source: Transplant Québec

In 2013,165 donors = 20.2 dpmi (donors per million inhabitants): Transplant Québec’s all-time high

1AccordingtoTransplantQuébecdata,therewere1,047patientsawaitingatransplantasofDecember31,2013,and1,250onthe samedatein2012.Overthepastdecade,thenumberofdeceaseddonorshasfluctuatedbetween119(2010)and165(2013). In2013therewere165deceaseddonors,comparedwith120in2012.

ORGAn DOnATIOn

Responding to the needs of patients awaiting organ transplants

Thenumberofpatientswaitingfororgantransplantshasincreasedsteadilyoverthepasttenyears,exceptfor2013when,forthefirsttimeineightyears,thewaitinglistactuallyshrankandthenumberofdonorsspiked.1Yetthenumberofdonorshasremainedstableoverthesameperiod,despitebesteffortsevery daybyphysicians,attendingteams,andTransplantQuébec.Progressisn’tjustpossible—it’snecessaryanditmustbesystem-wide. Thisdecade-oldimbalancehasseriousrepercussionsonthehealthofpatientsawaitingtransplants.Theiroverallconditiondeteriorates, theywithdrawsociallyand,all toooften, theydieaneedlesslyprematuredeath.Butestablishmentsdohavesolutionswithintheirreach.TheymustjoinforcestobetteraddresstheneedsofpeopleonwaitinglistsalloverQuebec.(SeeAppendix3,underPatientsonthewaitinglistandtransplantrecipientsinQuebec,byregion,p.67.) Theseeffortsmustfirstbedeployedlocally,bynetworkingwithotherestablishments,withthegoalofin-creasingthenumberoforgandonorsandtransplants.Theywillalsohaveapositiveimpactontheservicesthatmany patients need. For one,more andmore patientswill be able to stop dialysis treatment. Foranother,patientswaiting foranorganother thanakidneywillbe transplantedfaster,offeringtheaddedbenefitoffreeingupvaluablehumanandfinancialresourcesinclinicalintervention.

Organization of services

ORGAn

DOnATIOn: EVERyOnE’s

REsPOnsIBILITy.

BEcAusE

EVERy

cOnsEnT

cOunTs.

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TABLE OF cOnTEnTs


Potentialorgandonorsprimarilycomefromcriticalcareunits.Identificationofapotentialdonorsetsthedonationprocessinmotion.Thenextstepisreferral.Theentireorgandonationprocessisusuallycompletedin24to48hours.

Foranorgandonationtocometopass,certainconditionsmustbemettomaintainthehemodynamicstabilityof thedonorsotheorganscanberemovedandtransportedto transplantationcentres.AnunidentifieddonorwhoisnotrecommendedtoTransplantQuébeccanhavedisastrousconsequencesfornumerousrecipients. It’samatterof lifeanddeath forpatientsawaiting the transplantofavital organinatransplantationcentre.Consideringthelimitednumberoforgandonorsoverall—justover300potentialdonorsperyearinQuebecifallconditionsaremetineveryinstance—itisparamountthatalldonorsbeidentifiedandreferred.

Transplantrecipientshaveagoodchanceofsurvivalor,forkidneytransplants,ofnothavingtoreturntodialysis.

• 70%to80%ofheart,liver,orlungtransplantpatientsliveforatleastanotherfiveyears.• 80%ofkidneytransplantpatientsstillhavetheirgraftafterfiveyears.

Living donation

Whilesomeoftheconsiderationsdealtwithherecouldalsohaveapositiveimpactonlivingorgandonation,thisorganizationalframeworkdoesnotaddressthatformofdonation.

Itisimportanttonote,however,thattheoutcomesforlivingdonationinQuebec,especiallyforkidneys(butalso,lessoften,liverlobes),arewellabovetheCanadianaverageandhavebeenforanumberofyears.In2013,therewere16.8livingdonorspermillioninhabitants(549kidneystransplanted)forCanada,butonly6.7dpmi(53kidneysandtwoliverlobestransplanted)forQuebec.

Workstillneedstobedoneonlivingdonationsinclosecooperationwithexistinglivingdonationprograms,andaguidebookshouldbedevelopedforhealth-careestablishments.

ORGAn DOnORs

ARE A RARE

BREED: FEWER

THAn 1.4% OF

PEOPLE WHO DIE

In A HOsPITAL

cAn DOnATE.

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cuRREnT ORGAn DOnATIOn sITuATIOn (As OF DEcEmBER 31, 2013)

Data on organ donation

Forseveralyears,theCollègedesmédecinsduQuébec(CMQ)hasbeenconductingexternalindependentauditsontheoverallperformanceofthetransplantanddonationsystem,withdirectsupportfromindividualmedicalrecordsdepartments.

Themostrecentstudyavailable,Les donneurs potentiels d’organes dans les hôpitaux du Québec – Années 2000 à 2010[PotentialOrganDonorsinQuebec-BasedHospitalsfrom2000to2010],revealstwofindings:

• Thenumberofpotentialdonors isvastlydifferentfromthenumberofactualdonors.Accordingtothe CMQ’sestimate,therecouldhavebeen269to432donorsannuallybetween2000and2009(depending ontheyear)if all conditions had been met in every instance.• In2009therewere138deceaseddonors,whiletheCMQestimatedtherecouldhavebeenasmanyas 344:thisfigurerepresentsanadjustedsuccessrateof75%,includinganestimated432potentialeligible donorswith a neurological determinationof death (NDD) and20donors after cardiocirculatorydeath (DCD)forallofQuebec.2

number of deceased and potential donors in Quebec, 2000–2009

0

50

100

150

200

250

300

350

400

450

Deceased donorsPotential donors (if all conditions were met in every instance)

Data source: Organ Donors in Quebec-Based Hospitals in 2009, CMQ

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

348

135

324

136

269

125

315

142

292

136

356

136

401

139

410

140

430

151

432

138

2AccordingtotheCMQstudy,344donorswouldhavegeneratedarateof40.5dpmi,with1,290organspotentiallyprocured.The internationalbenchmarkis75%.

previous view

http://www.cmq.org/publications-pdf/p-1-2015-03-01-fr-donneurs-potentiels-organes-hopitaux-du-quebec.pdf

http://www.cmq.org/publications-pdf/p-1-2015-03-01-fr-donneurs-potentiels-organes-hopitaux-du-quebec.pdf


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TABLE OF cOnTEnTs


Donor identification

AccordingtotheCMQstudy,theidentificationratesinQuebechavevariedbetween66%(2000)and88%(2003),whilethetargetis100%.

Identification rates of potential donors in Quebec, 2000–2009

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

66%72% 75%

88%84% 85%

79% 78% 79% 82%

Data source: Organ Donors in Quebec-Based Hospitals in 2009, CMQ

Donor referral

Thenumberofdeceasedorgandonors(withalowof119in2010andahighof165in2013)andpatientswhowereabletoreceiveatransplant(withalowof360in2010andahighof503in2013)hasremainedstablesince2004,whilethenumberofpatientswaitingforanorganwentupnearly60%,risingfrom872 in2004to1,250in2012anddroppingto1,047in2013.

From2004to2013,thenumberofreferralstoTransplantQuébecfromhealth-careestablishmentsneverexceeded541,fluctuatingbetween388(2010)and541(2013).The2009CMQstudysetsthetheoreticalpotentialatover800accordingtothedefinitionofapotentialdonor—apersonofanyagewithseverebraindamagewhoisintubatedandonmechanicalventilation.Thebenchmarktargetis100%.

number of patients on the waiting list, recommended potential donors, transplant recipients, and deceased organ donors in Quebec, 2004–2013

0

200

400

600

800

1,000

1,200

1,400

2007 2008 2009 2010

Transplant recipientsRecommended potential donorsPatients on the waiting list

Deceased organ donors

418430403

432469423

1,1061,159

1,202

140 151 138

360

1,241

119

2011

384

1,264

137

2012 2013

364

388 414466

1,250

120

503

541

1,047

165

2004

380

872

136

2005

362

1,009

136

2006

399

449 456 439

1,040

139


previous view

http://www.transplantquebec.ca/en/statistics

16



Withrespecttothereasonsforreferralrefusalsin2013,overonethird(37%)wereduetofamilies’refusal togivetheirconsenttoorgandonation,whilemedicalreasons(medicalandsocialhistory,medicalcondi-tions,unconfirmedbraindeath,hemodynamicinstability,etc.)accountedfornearlytwothirds(63%).

In2013,thedonationratepermillioninhabitantsexceeded20forthefirsttimeever(20.2),whilethelow was14.9in2012.ThecountrieswiththehighestdonationratesincludeFrance(25),theUnitedStates(26)andSpain(35).

Rates of deceased donors per million inhabitants in Quebec, canada, spain, the u.s., and France, 2012 and 2013

0

10

20

30

40

5

15

25

35

2012 2013

Quebec Canada Spain U.S. France

15.4

20.2

35.2

26.224.5

15.514.9

34.7

25.724.3


Family consent to donate

AccordingtothesameCMQstudy,thefamilyconsentratesforallofQuebecrangefrom56%(2007and2009)to76%(2002),whilethetargetis80%.

Therearethreemainreasonsfamiliesrefuseconsent:

• Thepotentialdonordidnotgiveclearwrittenconsentorthefamilyisunawareoftheirlovedone’swishes.• Theorgandonationapproachwasnotfollowedproperly.Atwo-prongedapproach(firstannouncingthe irreversibleprognosisandthenproposingtheoptionoforgandonation)ispreferableinthesesituations.• Delaysentailedbythedonation,whichcanbecometaxingforafamilyincrisis.

Donationafterdeathrequirescarefulattention,anapproachtailoredtopotentialdonorsandtheir familiesandasensitivitytosocialandculturalfactors.

Becausefamiliesfacedwithasuddentragedyareinshock,theymustbetoldofthediagnosistactfullyandwithcompassion.

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TABLE OF cOnTEnTs


Number of organs per donor

Between2007and2013,theaveragenumberoforganstransplantedperdonorinQuebecrangedfrom3.4to3.8forNDDdonorsandfrom3.2to3.6foralldonors,thatis,thosegivenanNDDdiagnosisandthosewhodonatedafteraDCD.Thetargetsare3.75organsperdonor forNDDand2.75perdonor forDCD.Theseoutcomesdemonstratetheimportanceofperforminganadequateassessmentandoptimumdonormaintenance,twoprerequisitestomaximizingthenumberoforgansperdonor.(SeeAppendix1,DistinctionbetweenNDDandDCD,p.65.)

mean number of organs transplanted by donor in Quebec, 2007–2013

3.03.13.23.33.43.53.63.73.83.94.0

2007 2008 2009 2010 2011 2012 2013

3.43.4 3.43.5

3.6 3.63.7 3.7

3.6 3.6*

3.8

3.53.4

3.2


Mean number of organs per donor (NDD)Mean number of organs per donor (NDD and DCD) *Including 14 DCD for 31 organs transplanted

characteristics of patients on the waiting list

• Thelikelihoodsomeonewillneedanorgantransplantduringtheirlifetimegreatlyexceedstheiroddsof becominganorgandonorafterdeath.Dependingontheirage,men’soddsofneedingatransplantmay beasmuchassixtimeshigherthantheiroddsofbecominganorgandonor.Forwomen,theratioisfour toone.3

•Nearlythreequartersofthepatientsonthetransplantwaitinglistneedakidney.Thesepatientsareon dialysis.•In2013,38patientsdiedwhileonthewaitinglist.Ofthatnumber,anestimated20%diedforareason notdirectlyrelatedtotheirneedforatransplant.Therewere69suchdeathsin2012and59in2011.

number of patients on the waiting list by organ type, 2012 and 2013

ORGAn TyPE numBER OF PATIEnTs WAITInG

2012 2013

Heart 60 46

Lung 107 87

Liver 118 100

Pancreas 14 15

Kidney 923 782

Combinationoforgans4 28 17

Total 1,250 1,047

Source:TransplantQuébec

3S.D.Shemie,L.Hornby,J.Chandler,P.Nickerson&J.Burkell,Lifetimeprobabilitiesofneedinganorgantransplantversus donatinganorganafterdeath,American Journal of Transplantation,2011;11:2085–2092.4Combinationoforgansmeanskidney/pancreas,heart/lungandothercombinations.

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characteristics of transplant recipients

•Theaveragetransplantrecipientin2013wasnearly50yearsold.• From2008to2013,thenumberoftransplantrecipientsrangedfrom360(2010)to503(2013).

number of transplant recipients by organ type, 2012 and 2013

ORGAn TyPE numBER OF TRAnsPLAnT REcIPIEnTs

2012 2013

Heart 39 46

Lung 33 52

Liver 89 125

Pancreas 3 2

Kidney 187 265

Combinationoforgans5 13 13

Total 364 503


Economic issues

AccordingtotheDecember2012studybytheInstitutnationald’excellenceensantéetenservicessociauxduQuébec(INESSS)entitledAnalyse d’impact budgétaire d’une augmentation de la transplantation rénale au Québec[budgetimpactanalysisofincreasingkidneytransplantationinQuebec],basedontheassump-tionsmade,an increase in the number of deceased and living donors could save the health-care system substantial amounts of money—as much as $20 million over 10 years.Accordingtoanotherstudy,publishedinNovember2012byProfessorYvesRabeau,6basedonthesameassumptions,over $50 million could be saved over a 10-year period (for 1,000 transplants in 10 years), given that nearly half of all kidney transplant recipients return to work.ThefiguresgoevenhigherwhenyouaddinalltransplantsinQuebec.

• Kidneytransplantsaddvalue,specificallyintermsoftheeconomy(dialysis),thepatient,thepatient’s family,andsocietyasawhole.

–Oneyearofdialysis foronepatientcostsbetween$60,000 (basecost)and$80,000, ifallpotential associatedcostsareincluded. –Onekidneytransplantcansave$40,000tonearly$55,000peryearperpatient(variesbysource).

5Combinationoforgansmeanskidney/pancreas,heart/lung,andothercombinations.6 The Economics of Kidney Failure,YvesRabeauPhD,forTheKidneyFoundationofCanada–QuebecBranch,November2012.

previous view

https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/EtudeEconomique/INESSS_Analyse_impact_budgetaire_transplantation_renale.pdf

https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/EtudeEconomique/INESSS_Analyse_impact_budgetaire_transplantation_renale.pdf

http://kidney.ca/document.doc?id=3652

http://kidney.ca/document.doc?id=3652


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TABLE OF cOnTEnTs


“Becauseitimprovesthechancesofsurvivalandthequalityoflifeofthepersonwithkidneyfailure,kidneytransplantationisrecognizedworldwideasthemostcost-effectivetreatment.”7

—JuanRobertoIglesias,MD,MSc,PresidentandCEOoftheINESSS

“Theuseofgraftsislimitedbythenumberofavailableorgansandthelowernumberoflivingdonors,comparedwiththeexperienceobservedelsewhere;this gives rise to the need to further promote organ donation.”8

“Althoughthedifferentmeasuresdesignedtooptimizethemanagementofdeceased-donorkidneys,topromoteconsenttoorganremovalupondeathandtoincreasethenumberoflivingdonorsrequirefunds, this investmentwillbequicklyoffsetby thesavings resulting fromtheadditional transplantsperformedeachyear.”9

7 Analyse d’impact budgétaire d’une augmentation de la transplantation rénale au Québec [BudgetImpactAnalysisofIncreasing KidneyTransplantationinQuébec],Institutnationald’excellenceensantéetservicessociaux,December2012.8Ibid.,p.52.9Ibid.,p.52.

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20


BAcKGROunD AnD cuRREnT sITuATIOn – TIssuE DOnATIOn

0

2,000

2004-20052003-2004

103

2005-2006

202

2006-2007

240

2007-2008

318

2008-2009

311

2009-2010

821

2010-2011

1,187

2011-2012

1,583

2012-2013

1,571

2013-2014

1,926 1,917

200

400

600

800

1,000

1,200

1,400

1,600

1,800

Source: Héma-Québec

TIssuE DOnATIOn

cuRREnT TIssuE DOnATIOn sITuATIOn(As OF mARcH 31, 2014)

High demand

Familieswhohaveconsentedtotissuedonationareunanimousinsayingthatthedonationgavemeaningtotheirlovedone’sdeathand,insomecases,evenhelpedtheminthegrievingprocess.A large percent- age of Quebec’s population claims to be in favour of donation and expects health-care professionals to bring the subject up when the time comes.Whenfamiliesareinshockfollowingthedeathofalovedone,theyareunlikelytotaketheinitiativethemselvestosuggestmakingadonation,soit isuptothe health-careprovidertoraisethematterifdonationispossible.

Patientsawaitingtissuegraftsarecountingondonorgenerosity.Itisthedutyofhealth-careprofessionals toidentifypotentialdonorsandmakereferralstoHéma-Québecsothatthisvaluabledonationcanbecar-riedoutaccordingtothecriteriasetoutintheStandardizedTissueDonationProcedure.

Althoughpotentialdonorreferralsareincreasingyearoveryear,thedemandfortissueissohighthatthesituationrequiresconstantvigilanceonthepartofallstakeholders.

number of potential donor referrals, 2003–2014

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TABLE OF cOnTEnTs


Eye tissues

Héma-Québec acts as the sole distributor of eye tissue acrossQuebec. In concrete terms, thismeans corneal surgeons identify the needand specify the typeof tissue required for the scheduled surgery. Héma-Québecisresponsibleformakingtherequestedproductavailablebythetimerequired.

number of donors (eye tissue), 2008–2014

0

100

200

300

400

500

600

700

800

2008-2009 2009-2010 2010-2011 2011-2012 2012-2013


225

491

704 722 713

2013-2014

649

TheQuebecwaitinglistforcorneatransplantshasbeencutbymorethanhalfsince2011.Intwoyears,itdroppedfrom704to328.ThisprogresswasduetoanewprocurementprocessandcooperationwithoureyebankpartnersinMontrealandQuebecCity.

Patients awaiting cornea transplants, 2011–2013

numBER OF PATIEnTs On WAITInG LIsT sHORTEnInG OF WAITInG LIsTs (%) As OF As OF As OF As OF 4/30/2012 TO 2/8/2011 TO 2/8/2011 11/1/2011 4/30/2012 3/20/2013 3/20/2013 3/20/2013

Montreal* 506 380 360 207 ▼43% ▼ 59%

CUO-QC** 198 156 131 121 ▼ 8% ▼ 39%

Total 704 536 491 328 ▼ 33% ▼ 53%

*Montreal:QuebecEyeBankinMontreal**CUO-QC:Centreuniversitaired’ophtalmologieduCHUdeQuébec,HôpitalSaint-Sacrementsite

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22



Other tissues (heart valves, skin, bone, and tendons)

AlthoughHéma-QuébecisQuebec’sonlydistributorofeyetissue,suchisnotthecaseforothertypesoftissue.Whetherforheartvalves,skin,tendons,orbonetissue,hospitalscanuseanysuppliertomeettheirneeds.Héma-Québec’smission,itshouldbenoted,istoefficientlymeettheneedsoftheQuebecpopula-tionforoptimal-qualityhumantissues.

number of donors (heart valves, skin, bone, and tendons), 2004–2014

Héma-Québecmakesanongoingeffort topromotethevariousproductsandservices itprovidesto theprovince’shospitalsand ispleased that therehasbeenasteady,marked increase indemand forgraftsalongwithahighrateofusersatisfaction.

Theuseofhumantissueforgraftinghasgrownsteadily inrecentyears.Theemergenceofnewsurgicaltechniques,anagingpopulation,andnewtherapeuticindicationsforcertaintypesoftissuegraftsarejustafewofthefactorsthathavecontributedtothisgrowth.

Distribution of tissues by Héma-Québec, 2007–2014

0

50

100

150

200

250

2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013

69

98

124

164 162

202

162174 175

2013-2014

215


0

4,500

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014


Linear (Series 1)Series 1

737

1,604 1,712

2,732 2,802

3,369

3,895

previous view


23

TABLE OF cOnTEnTs


Tissue transplants

Inanallograft,orallogeneictransplant,apatientreceivesagraftoftissuefromanotherperson.

Inmostcases,thepurposeofthetissuetransplantistoimproverecipients’qualityoflife,althoughinthecaseofheartorskintissue,itmaywellhelpsavetheirlife.

Allograftsarelife-changingforthousandsofpatients.Someexamplesofallograftsareprovidedbelow, accordingtosurgicalspecialization.

Eye allograft.Eyetissueisremovedfromadeceaseddonor,evaluatedandpreservedforvaryingperiods(14daystooneyear).Eyetissuetransplantscanbeusedtotreatavarietyofpathologicalconditions,suchasthese:

• Keratoconusandbullouskeratopathy–Corneareplacement•Cornealperforation–Useofapartofthecorneaorawholecornea•Glaucoma(surgery)–Valveimplantthatmustbecoveredbyasclera•Pterygiumoraneyetumour(ablation)–Useoflamellae(frozentissue)torebuildtheeyesurface

cardiac allograft.Theaorticorpulmonicvalvesandtheirrespectivearteriesareremovedfromadeceaseddonor,processedandcryogenicallypreservedforuptofiveyears.Allograftsareimplantedtocorrectcertaincongenitalheartdefects:

•SomeformsoftetralogyofFallot•Completetranspositionofthegreatarteries(TGA)withventricularseptaldefect(VSD)andsubpulmonary stenosisorpulmonaryatresia(Rastelliprocedure)•Severepulmonaryvalvestenosis•Aorticvalvestenosis

skin allograft.Skinallograftsareremovedfromadeceaseddonor,processedandcryogenicallypreservedforuptofiveyears.

Skinallograftscanbeusedtotreat

•Severeburns–Thegraftservesasatemporarydressingtoreducefluid lossandasabarrieragainst infection•Otherconditions(e.g.,toxicepidermalnecrolysis)

Bone or tendon allograft.Boneandtendonallograftsareremovedfromadeceaseddonor,processedandcryogenicallypreservedforuptofiveyears.Theycanbeusedfor

•Hiprevisionsurgery•Kneerevisionsurgery•Replacementofamassivebonesegmentincertainosteosarcomacancercases•Replacementofatendonaftertrauma

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24


LEGIsLATIVE FRAmEWORK

AnActtoFacilitateOrganandTissueDonation(SQ2010,c.38)enteredintoeffectonFebruary28,2011,amendingthefollowingthreeacts:

1.ActRespectingLabourStandards(CQLR,c.N-1.1)2.ActRespectingtheRégiedel’AssuranceMaladieduQuébec(CQLR,c.R-5)3.ActRespectingHealthServicesandSocialServices(CQLR,c.S-4.2)

ThisdocumentdoesnotaddresstheActRespectingLabourStandardsortheActRespectingtheRégiedel’AssuranceMaladieduQuébecbecausetheydonotapplytothedirectorsofprofessionalservices(DPSs)athealth-careestablishmentsandbecausethisframeworkonlycoversdonationondeath,whetherimmi-nentorrecent.

CertainprovisionsoftheCivilCodeofQuébec(CQLR,c.C-1991)applytoorganandtissuedonation.Thesewill bediscussedbelow.Thepotential donor’s consent canbe recordedwith theRégiede l’Assurance MaladieduQuébec(RAMQ),whichmustmaintainaregistry(since2011),orwithanotarywhomustinformtheChambredesNotairesduQuébec,whichhasalsomaintainedaconsentandrefusalregistrysince2005.Potentialdonorsmayalsoindicatetheirconsentonthebackoftheirhealthinsurancecardbysigninganddatingthestickerandaffixingitinthespaceprovided.

Nomatterwhatoptiontheychoose,potentialdonorsmayrevoketheirconsentwithouthavingtoprovideareason.Ifadonorhaschosenmorethanoneoption,theonemademostrecentlymustbeused.Intheeventpotentialdonors’wishesareunknownandtheyareunabletogivetheirconsent,alternativeconsentmay beobtainedfromapersonindicatedinarticle15oftheCivilCodeofQuébec,providedtheorderofprioritysetoutinthatarticleisfollowed.

Section204.1oftheARHSSSdefinesthedonoridentificationandreferralresponsibilitiesofDPSsofestab- lishmentsthatoperategeneralandspecializedhospitals(GSHs).Subjecttoconsentbythepotentialdonororsomeone representing thepotentialdonor, thesection imposes theobligation tosendany required medical informationaboutthepotentialdonorandtheorgansortissuesthatmayberemoved,asappli-cable,toTransplantQuébec(organs)orHéma-Québec(tissues).Moreover,theestablishmentmusthaveanorganortissuedonationprocedurefortheDPStofollow.EstablishmentsshouldrefertotheStandardizedOrganDonationProcedureandStandardTissueDonationProcedure thatweredevelopedbyorganandtissuedonationpartners.

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25

TABLE OF cOnTEnTs


n Act Respecting Health services and social services, cQLR, c. s-4.2

AsPEcTs OF THE LAW

Diligent identification and referral of potential donors in situations of imminent or recent death

Verification of consent for organ or tissue removal

communication of medical information

Family support

WORDInG

Wheninformedoftheimminentorrecentdeath ofapotentialorganortissuedonor,thedirector ofprofessionalservicesofaninstitutionoperating ageneralandspecializedhospitalshalldiligently:

verify,withoneoftheorganizationsthatcoordinateorganortissuedonationsandaredesignatedbytheMinisterundersection2.0.11oftheActrespectingtheRégiedel’assurancemaladieduQuébec(ChapterR-5),whetherthepotentialdonor’sconsentforthepost-mortemremovaloforgansortissuesisrecordedintheconsentregistriesestablishedbytheOrdreprofessionneldesnotairesduQuébecandtheRégiedel’assurancemaladieduQuébec,inordertodeterminethedonor’slastwishesexpressedinthisregardinaccordancewiththeCivilCode;and

sendtosuchanorganization,iftheconsenthasbeengiven,anynecessarymedicalinformationconcerningthepotentialdonorandtheorgans ortissuesthatmayberemoved.

sTAKEHOLDERs

GsH • DPS • Physicians •Health-careprofessionals

•Transplant Québec(organdonation)10

•Héma-Québec(tissuedonation) •RAmQ(registry) •chambre des notaires du Québec (registry)

GsH • DPS • Physicians •Health-careprofessionals •Medicalrecords •Transplant Québec(organdonation) •Héma-Québec(tissuedonation)

GsH • Careteam •Organdonationliaisonnurseor resourcenurse(whereapplicable) •clinical coordinator/advisor with Transplant Québec (organdonation) –tosupportteams •coordinator with Héma-Québec (tissuedonation)

sEcTIOn

204.1

(1)

(2)

10TransplantQuébecandHéma-QuébecaredesignatedbyOrderoftheMinisterofHealthandSocialServicesconcerningthelist oforganizationsensuringthecoordinationoforganortissuedonations,M.O.2011004: www.ramq.gouv.qc.ca/SiteCollectionDocuments/citoyens/en/autres/arrete-ministeriel-don-organes-en.pdf

previous view

http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=/S_4_2/S4_2_A.html

http://www.ramq.gouv.qc.ca/SiteCollectionDocuments/citoyens/en/autres/arrete-ministeriel-don-organes-en.pdf

26



n civil code of Québec, cQLR, c. c-1991

AsPEcTs OF THE LAW

consent given by

– Adult – minor 14 or over– Holder of parental authority (minor under age 14)

consent given by a third party

Attestation of death and removal of donations or tissues

AsPEcTs OF THE LAW

cause of death

•not established by the physician

•As a result of negligence•In obscure or violent circumstances

WORDInG

Apersonoffullageoraminor14yearsofageorovermay,formedicalorscientificpurposes,givehisbodyorauthorizetheremovaloforgansortissuestherefrom.Aminorunder14yearsofagemayalsodosowiththeconsentofthepersonhavingparentalauthorityorofhistutor.Thesewishesareexpressedverballybeforetwowitnesses,orinwriting,andmayberevokedinthesamemanner.Thewishesexpressedshallbefollowed,unlessthereisacompellingreasonnottodoso.

Apartofthebodyofadeceasedpersonmayberemoved,ifthewishesofthedeceasedarenotknownorcannotbepresumed,withtheconsentofthepersonwhowasorwouldhavebeenqualifiedtogiveconsenttocare.Consentisnotrequiredwheretwophysiciansattestinwritingtotheimpossibilityofobtainingitinduetime,theurgencyoftheoperationandtheserioushopeofsavingahumanlifeorofimprovingitsqualitytoanappreciabledegree.

Nopartofthebodymayberemovedbeforethedeathofthedonorisattestedbytwophysicianswhodonotparticipateeitherintheremovalorinthetransplantation.

WORDInG

Everyphysicianwhocertifiesadeathforwhichheisunabletoestablishtheprobablecausesorwhichappearstohimtohaveoccurredasaresultofnegligenceorinobscureorviolentcircumstancesshallimmediatelynotifyacoronerorpeaceofficer.

sTAKEHOLDERs

•Adult•minor 14orover•Holder of parental authority (minorunderage14)•GsH•RAmQ(registry)•chambre des notaires du Québec (registry)

If the wishes of the deceased are not known,hisorherlegalrepresentativeasdefinedinart.15oftheCCQ

In the absence of a representative,aperson,byorderofpriority,identifiedinart.15oftheCCQ

In emergency situations,twophysi-cians

Twophysicianswhodonotparticipateintheremovalortransplantation

sTAKEHOLDERs

• Physician•Coroner• Peaceofficer•Transplant Québec(organdonation)•Héma-Québec(tissuedonation)

Underthissection,anestablishmentmaynotproceedwithremovinganorganortissuefromadeceasedpersonuntilthecoronerhasauthorizedit,subjecttoconsentobtainedaccordingtotheprovisionsoftheCivilCode(the deceased person having given consent while alive, or in the absence of such consent, a legal representative, and if no legal representative has been appointed, a person, by order of prior- ity, identified in article 15 of the civil code).

sEcTIOn

43

44

45

sEcTIOn

34

n Act Respecting the Determination of the causes and circumstances of Death, cQLR, c. R-0.2

previous view

http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=/CCQ_1991/CCQ1991_A.html

http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=/R_0_2/R0_2_A.html


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TABLE OF cOnTEnTs

GuIDInG PRIncIPLEs

Anumberofprinciplesstemmingdirectlyfromthevaluessetoutabovemayproveuseful inguidingtheactionsofhealth-careestablishmentsandproviders:

•Consultandcooperatewithotherstakeholderstopromoteanincreaseinorganandtissuedonations tomeetdemand.

•Acknowledgethesharedresponsibilityandinterdependencebetweendifferentorganizationsinvolvedinvariousorganandtissuedonationprocessesandensurecoordinationandcommunicationbetweenpart-ners.

•Makesureservicesandresourcesareaccessibleandavailablewhenneededintheorganandtissuedonationprocesses.

•Recognizetheroleofeachestablishmentaccordingtothenatureofitsactivities,inlinewiththepopu- lationitserves.11

•Fosterknowledgesharingbetweendonationorganizationsandestablishmentsandsupportresearch inthefieldwiththesupportofTransplantQuébecorHéma-Québecforthepurposeofdevelopingand implementingbestpractices.

11Organdonationactivitiesarediscussedbelowseparatelyforidentification,procurementandtransplantationcentres.Fortissue donation,eachestablishmentmaybeconsideredapotentialprocurementcentre.

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ORGAnIZATIOnAL ARRAnGEmEnTs

Establishmentsmustsupportclinical teams inofferingrequiredorganandtissuedonationservices. It isimportantthatmanagementadoptanorganizationalvisionandculturepromotingorganandtissuedonationtoguidedecisionmakingonhowservicesaretobeorganizedwithintheestablishment.Acommitmenttoorganandtissuedonationfromalllevelsofmanagementtogetherwiththeactiveinvolvementofphysiciansandotherhealth-careprofessionalswillhelpfostersuchanorganizationalculture.

EstablishmentsmustalsomeetAccreditationCanadastandardsforsafe,high-qualitycareandservices.MonitoringandevaluatingoutcomesoftheorganandtissuedonationprocesseswillallowthenecessaryadjustmentstoreachQuebec’sorganandtissuedonationtargets.Tothatend,itishighlydesirablethatoutcomesshouldbemonitoredbyclinicalteamsdirectly,alongwithmanagementteamsandboardsof directors.

Theorganizationalpoliciestobefollowedwithinestablishmentstosupporttheorganandtissuedonationprocessesaresetoutbelow.Somearesimilarwhileotherspresentseveraldifferences.

mAnAGEmEnT cOmmITmEnT

•Adoptacommonandsharedvisionwithintheestablishmentsothatclinicalteamsbegintakingorgan andtissuedonationconcernsintoaccountasamatterofcourse.

•Developanorganizationalculturethatpromotesorganandtissuedonation.•AlignactionswithSafetyofHumanCells,TissuesandOrgans forTransplantationRegulationsand AccreditationCanadastandardsfordonationortransplantation,asapplicable.

•Incorporate theorganand tissuedonationvisionandculture intodecisionsabout theorganizationofservices.

•Ensureengagementfromclinical,medicalandadministrativeteamsinorganandtissuedonation.•Monitororganandtissuedonationoutcomesusingacontinuousimprovementapproachtoqualityandclinicalandorganizationalperformancemeasurement.

•Buildpartnershipswithorganandtissuedonationorganizationsandwithotherestablishmentswhen required.

•Craftanorganandtissuedonationcommunicationplanthatincorporatesthefollowing:

– AnawarenesscampaigntargetingemployeesandphysiciansincooperationwithTransplantQuébec andHéma-Québectoencourageregistrationwithconsentregistries –Increasedawarenessamongclinicalstaff –Providinginformationabouttheorganandtissuedonationtoolsthatareavailable –Localandregionalawarenessandeducationinitiativesondonation,transplantationandgrafting

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TABLE OF cOnTEnTs


mAnAGEmEnT TEAm’s ROLEs AnD REsPOnsIBILITIEs

Themanagement teamassumessharedresponsibility for theestablishment’sorganandtissuedonationactivitiesandforfactoringthemintohowservicesareorganized.

TheARHSSSassignsspecificresponsibilitiestotheDPS,whomustbesupportedbythemanagementteam.

TheDPS’sspecificresponsibilitiesincludethefollowing:

•Ensuringtheapplicationofsection204.1oftheARHSSSaccordingtotheorgandonationprocedureandtissuedonationprocedure(SeeLegislativeframework,p.24.)

•Ensuringtheproperfunctioningoftheorganandtissuedonationcommitteeincooperationwiththees-tablishment’sotherdivisions

•WorkinconjunctionwiththeCPDPinitsroleinassessingthequalityofprocedures

Establishmentsmustimplementmechanismsandallocatethenecessaryresourcestosupportorganandtissuedonationactivitiesatalllevels.Identifyingoneormoreproponentswithintheestablishmentwillmakeiteasiertomonitortheseactivities.Thesearesomeofthekeymeasurestobeimplementedfirst:

•Applicationoftheorgandonationprocedureandtissuedonationprocedure•Trainingofclinicalandmedicalteams,especiallythoseworkingwithincriticalcareunits•Formationofanorganandtissuedonationcommittee•Useofmonitoringandfeedbackmechanismswithaneyetowardcontinuousimprovement,withthehelpoftherecordsdepartment

OrganandtissuedonationpoliciesandproceduresaredesignedtosupporttheDPSandclinicalteamsintheireffortstoidentifyasmanypotentialdonorsaspossible,aswellasinthefollowingsteps:referraltotheappropriatedesignatedorganization,communicationofthediagnosisandprognosistothefamily,proposalofthedonationoption,assessmentandeligibilityofthedonorandremovaloftheorgansortissues.

Themanagement teammustdisseminate theseprocedures andensure they are followedbyall clinicalteamsconcerned.

TRAInInG OF cLInIcAL TEAms

The training of clinical teams is key to achieving desired organ and tissue donation outcomes.Themanagementteammustthereforeplanappropriatetrainingactivitiestosupporttheminthisregard. It is alsoimportanttoensurenewemployeesaretrainedwhentheyarehired.Thisappliestoallcriticalcarestaff(e.g.,nurses,respiratorytherapists,physicians,socialworkersandspiritualcareadvisors).

Continuoustrainingactivitiesmustbeplannedtoensurethatorganandtissuedonationknowledgeby clinicalteamsisuptodate.

TransplantQuébecandHéma-Québeccancontributeactively to these trainingactivities inavarietyofways.Establishmentscancontacttheseorganizationsforsupportandassistance.

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ORGAn AnD TIssuE DOnATIOn cOmmITTEE

Organand tissuedonationcommitteesplayakey role inensuring theadvancementofdonationwithin establishments.

ThespecificresponsibilitiesofDPSsaresetoutintheARHSSS.DPSscannotbeexpectedtoknowfromdaytodayoratanygiventimehowthingsstandintermsofidentifyingpotentialorganandtissuedonors,referralstoTransplantQuébecorHéma-Québec,donormaintenanceandorganandtissueprocurement.ThispointstotheneedforaninterdisciplinaryorganandtissuedonationcommitteetosupporttheDPS andmanagementteaminperformingtheirduties.

EveryestablishmentshouldthereforehaveanorganandtissuedonationcommitteethatreportsdirectlytotheDPSoradesignatedrepresentative.Dependingoncircumstancesandspecificneeds,thecommittee’sresponsibilitiesmaybedelegatedtoanotherexistingcommitteerelatedtocriticalcare(emergency,inten-sivecare,heartunits),giventhenatureoforganandtissuedonationactivities.Thecommittee’smaindutiesareto

•Promoteorganandtissuedonationwithintheestablishment•Promotethetrainingofhospitalstaff,especiallydoctors,nursesandrespiratorytherapistsworkingincriticalcare

•Monitorandevaluatetheprofessionalactivities thataffectsteps in theorgandonationprocedureandtissuedonationprocedure

•Analyzeperformanceandqualityindicatordata•Makerecommendationstoresolveproblemsthataffectstepsintheorgandonationprocedureandtissuedonationprocedure,specificallybysuggestingwaystooptimizetheprocessandmakeongoingimprove- ments

•Produceanorganandtissuedonationprogressreportatleastonceayearformanagementlistingkeychallengesandsettingoutappropriaterecommendations

•Ensurerecommendationsareimplementedandevaluatetheresults

composition and operation

Inadditionto theDPSordesignatedrepresentative, thecommitteeshould includeprofessionalsworking inthecriticalcaredepartmentswheremostofthepotentialorganandtissuedonorsarelocated.Amem- berof theexecutiveboardof theCPDPshouldalso jointhecommittee. It isalsorecommendedthat theTransplantQuébecclinicalcoordinator/advisor,aHéma-Québecrepresentativeand,whereapplicable,anorganandtissuedonationliaisonnurseorresourcenurseactivelyparticipateonthecommitteetoprovideasmuchsupportaspossible.Anarchivistmayalsohelpthecommitteeinitsworkasneeded.

Thenumberofcommitteemembersandmeetingsmayvarybyestablishmentaccordingtothevolumeandnatureoforganandtissuedonationneeds.

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TABLE OF cOnTEnTs


FOLLOW-uP AnD FEEDBAcK mEcHAnIsms

Toensurecontinuousimprovement,itisimportanttohavemonitoringandfeedbackmechanismsinplacetomeasureoutcomesandmakeanynecessarychanges.Establishmentsmustalso takecare tooffer qualityservices thatmeetstandardsofexcellence. In this regard theymustmeetAccreditationCanadastandardsfororganandtissuedonation.

AccreditationCanadarecognizestheimportanceofproperlyorganizingservicestoachievethebestpos-sible results inorgandonationand tissuedonation.Organand tissuedonation standards fordeceaseddonorshavebeencoveredbytheAccreditationCanadaprogramsince2010.Theapplicablestandardsareasfollows:

•OrganandTissueDonationStandardsforDeceasedDonors•CriticalCare(Standard8)•EmergencyDepartment(Standard9)•OrganandTissueTransplantStandards

TransplantQuébecofferssupportservicestoguideestablishmentsthroughtheaccreditationprocess. It hasalsodevelopeda referencedocument,Soutien et accompagnement des établissements de santé et de services sociaux du Québec relativement aux normes d’Agrément Canada[supportandassistanceforQuebechealthandsocialserviceagencieswithrespecttoAccreditationCanadastandards].

Onthetissuedonationside,Héma-Québeccanprovideinformationonregulatoryrequirementssoestab- lishmentscanbesuretheyconformtoAccreditationCanada’sstandards.

Furthermore,establishmentsmusthaveaccesstocompilationtoolstomeasureandevaluateoutcomes.Dashboardsareusefulformonitoringoutcomesandsupportingthedonationcommitteeandmanagementteamwithregardtoorganandtissuedonationorganizationalmatters.Annualprogressreportsfortheboardofdirectorsarealsorecommended.

TransplantQuébecoperatesaninformationsystemtodocumentorgandonationactivities,specificallythroughtheorgandonationqualityindicatorsproject.Pilotprojectsinseveralestablishmentshavedemon- strateditsworth.Theinformationsystemprovidesestablishmentswithquickinformationonorgandonationoutcomesintheirareasotheycanevaluatetheirperformanceandadjusttheirstrategiesaccordingly.

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https://accreditation.ca/organ-and-tissue-donation-standards-deceased-donors

https://accreditation.ca/critical-care

https://accreditation.ca/emergency-department

https://accreditation.ca/organ-and-tissue-transplant-standards

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sPEcIAL POInTs TO TAKE InTO AccOunT

Theservicesavailableandhowtheyaredeliveredarenotthesamefororgandonationandtissuedonation.Establishmentsmustthereforeconsiderthespecificcharacteristicsofeachdonationtypeandadaptser-vicesaccordingly.

Theinformationbelowlistspointstoconsiderinorganandtissuedonation.Thatwayclinicalteamscanfollowclearguidelineswheninteractingwithpatientsandtheirfamiliesinsituationsofimminentorrecentdeath.

Inaddition,bothTransplantQuébecandHéma-Québecsupportestablishmentsbyguidingthemthroughthecontinuumofcaretobeprovidedinorganandtissuedonationactivities.

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TABLE OF cOnTEnTs

ORGAnIZATIOn OF ORGAn DOnATIOn sERVIcEs

Arangeofservicesmustbeaccessibleandavailablewithintheidentifyingestablishment,usuallyinclosecooperationwithasecondestablishment(theprocurementcentre)andpotentiallyathird(thetransplanta-tioncentre).Forasuccessfulorgandonationprocess,servicesmustbeorganizedsoastotakethefol-lowingspecialfactorsintoaccount:

•Thelimitednumberofannualdonorsoverallandperestablishment•Howdonorsareidentifiedandmaintained•Howtheorgandonationproposalispresentedtothefamily•Timelyaccesstoabedinintensivecare•Timelyaccesstotheoperatingroom,oftenaftercoordinatingmultiplesurgicalteamsfromanumberofspecialties

•Trainingofattendingteamsincriticalcareunits(onhiring,duringonboardinginanewdepartment,andaspartofcontinuoustraining)

Facts on the organ donation process

•Theprocessvariesintermsoflength(duetotheunexpectednatureoforgandonation,whichusually occursintheemergencyroomorintensivecare),occurswhenthefamilyisinastateofshock,and requirestheinvolvementofalargernumberofpeople.•Whenanorganisdonatedafterdeath,100to150peopleareinvolved.•Organdonationcanhappenanytime,24/7.•Detailedlogisticalproceduresmustbefollowedtoensuresuccess.•Thenumberofdonorsmayvaryfrom0to10inasingleweekforallofQuebec.•Tendonorscanresultin30to40transplants,requiring40to50intensivecarebedsplusoperating roomsforallthesecases.

ROLEs AnD REsPOnsIBILITIEs OF VARIOus PLAyERs

Organ donation and transplantation chain

Routine training of critical care staff(ER and intensive care)

+ awareness/educational activities for staff and the public

DONATION CHAIN TRANSPLANTATION CHAIN

Eligibility

Follow-up with patient on the waiting list

Access to the transplant

Follow-up with recipientFormation of an organ donation committee

Identi�cation and referral of the potential donor

Communication with the family and consent

Organ allocation

Removal

Organ distribution

Post-donation follow-up

Communication and donor maintenanceand organ preservation


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Theorgandonationandtransplantationchainisonlyasstrongasitsweakestlink.Ongoingmobilizationofstakeholderswillfacilitateeffortsrequiredatalllevels.ThisrequiresthatestablishmentsmakeaconcertedeffortwithTransplantQuébectoensuretheyarefulfillingtheirresponsibilitieseverytimeitisrequired,fromidentificationtoorganremoval,andforeverydonor.

Itisalsoimportanttosupporttheorganizationofservicesattheregionalandinterregionallevels.Itmaybenecessarytoestablishcorridorsofservice inordertopoolresources.Factorstoconsider inorganizing organtransplantserviceswillbecoveredinfurtherdetailgiventhespecificnatureoftransplantactivities.Onlyeightestablishmentswithhighlyspecificprogramsareaffected.

Anumberofcommunitypartnersandassociationsarealsoinvolvedintheorgandonationprocess.

cEnTRE By AcTIVITy TyPE

Identification centres

Activities in the donation chain may be carried out by the identification or procurement centre, or by both at the same time

Procurement centres

All procurement centres are identification centres

Transplantation centres

As a general rule, transplantation centres are identification and procurement centres

cOmmEnTs

Centreswithanemergencyroomandtheabilitytoofferintensivecare

CurrentlyonlyahandfulofestablishmentsinQuebecremoveorgans.

ForDCDcases,TransplantQuébecmayperformtheremovalinanestablishmentwithwhichithasanagreement.

ThenumberoftransplantprogramsinQuébecisasfollows:

-7forthekidneys (including2pediatric programs)- 3fortheheart- 2fortheliver(pediatric)- 1forthelungs

sTEPs In THE ORGAn DOnATIOn AnDTRAnsPLAnTATIOn cHAIn

• Identificationofpotential organdonor• Referralofpotential organdonorto TransplantQuébec• communicationof diagnosis/prognosis tofamily• Proposal oftheorgan donationoption• Donorevaluation and maintenance

Inadditiontothestepssetoutabove:

• Organremoval and preservation

Inadditiontothestepssetoutabove:

• Evaluation of eligibility ofpatientonatransplant waitinglist• Transplantation•Follow-up withrecipient

n centres by activity type and establishment categories as they relate to the steps in the organ donation chain

EsTABLIsHmEnT cATEGORIEs

Allestablishmentswhosemissionsinvolvegeneralandspecializedcare

PRAcTIcEs PRAcTIcEs RELATED TO RELATED TO nDD AnD DcD TO DcD OnLy

Establishments thatcanproceed accordingly

(SeeApp.2,p.66.)

(SeeApp.2,p.66.)

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TABLE OF cOnTEnTs


ORGAnIZATIOn OF sERVIcEs

Organizationofservicesmustbetakenintoaccountaccordingtotypeofactivityandestablishmentcate-gory.Thepointstoconsiderwillvarydependingonwhethertheestablishmentisapotentialdonoridenti- ficationcentre,procurementcentreortransplantationcentre.Thisframeworkcoversdonoridentification,referralandmaintenance,andorganprocurementfortheseestablishments.Inaddition,theDCDprotocol issetoutsothatestablishmentsthatdonotcurrentlyperformorganremovalcanevaluatetheimpacts associatedwiththatparticularactivity.

Organ donation requires working in partnership and poses a networking challenge.Establishmentsmusttherefore identify partners and specify corridors of service and coordination processes andproceduresnecessaryfortheproperconductofactivitiesincooperationwithTransplantQuébec.

EmERGEncy sERVIcEs (AnD OTHER cARE unITs)

•Followorgandonationprocedures,particularlyforidentification,referralandfamilycommunication.•Afteridentifyingapotentialdonor,verifythedonor’seligibilitywithTransplantQuébecbeforetransferringthedonortotheestablishment’sintensivecareunit.

•Makesurephysiciansandclinicalteamshaveaccesstoequipment(e.g.,respirators).•Maintainthehemodynamicstabilityofthepotentialdonor.•Takethenecessarystepsinorganizingthedonation:applicableclinicalexaminationswithintherequiredtimeframes,transferringthepatienttoanotherestablishmentifneeded,etc.

•Facilitateandsupporttheseactivities.•Supportthefamilythroughouttheprocessandavoidproposingthedonationoptionintheemergencyroomwheneverpossible.

InTEnsIVE cARE (IncLuDInG THE HEART AnD nEOnATOLOGy unITs)

•Followallstepsintheorgandonationprocess.•Makesurethepotentialdonorisadmittedtointensivecare(accesstoabedandtoequipmentsuchas arespirator).

•Maintainthehemodynamicstabilityofthepotentialdonor.•Takethenecessarystepsinorganizingthedonation:applicableclinicalexaminationswithintherequiredtimeframes,transferringthepatienttoanotherestablishmentifneeded,etc.

•Declarebraindeathaccordingtocurrentprotocols.•Performclinicalexamstoconfirmneurologicaldeathordonationaftercardiocirculatorydetermination ofdeath,takingintoaccounttheprovisionsofarticle45oftheCivilCodeofQuébec.(SeeLegislativeframework,p.26.)

•Helpevaluatethedonorandthequalityoftheorgans.•Seetoitthatthefamilyissupportedthroughouttheprocess.

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DIAGnOsTIc sERVIcEs

•Performtherequiredanalysesandexaminationsquickly:laboratories(serologyandvirologyinparticular),pathology (biopsy),medical imaging (general radiography, tomodensitometry,angiography,coronary angiography,ultrasound,etc.)andhistocompatibilitylaboratory.

•Ensureaccesstootherdiagnosticserviceswhenrequired(electrophysiology,etc.).

Ifadiagnosticserviceisnotavailableorifitcannotbeperformedinanestablishment,theexaminationwillbedoneattheprocurementcentre.

mEDIcAL sERVIcEs

•Takeintoaccountthemedicalspecialtiesbroughtintoplayinthedonationprocessandassesstheim-pactsontheirclinicalpractice(imaging,pathology,surgery,neurology,cardiology,pulmonology,etc.).

•Encouragephysicianstogetinvolvedintheorgandonationprocess: –Sendtherequiredinformationontheorgandonationprocesstothephysiciansworkingintheestab- lishmentwhomaybebroughtinatvarioustimesintheprocess.

–Supportandencouragephysicianandresidenttraining. –Encouragephysicianparticipationontheorganandtissuedonationcommittee.•Ensure that theCPDPcontrols andproperly assesses thequality of themedical andpharmaceuticalproceduresinvolvedintheorgandonationprocess.

•Forprocurementcentresonly,grantprivilegestophysiciansfromotherestablishmentsorprovinces.

PHARmAcy DEPARTmEnT

•Supportmedicalteamsandclinicsinmaintainingdonorsandduringorgan(heartandlung)recruitmentproceduresintermsofpharmaceuticalservicesandcare,withtheaimofachievingoptimalorganfunc-tiontoincreasethenumberoftransplantations.

OPERATInG ROOm

•Maketheoperatingroomavailablefororganremovalonaflexiblebasis,takingintoaccounttheavail- abilityofrooms,clinicalteamsandprocurementphysicians.

•AssessthespecificimpactsassociatedwithDCD(deathofthepatientintheoperatingroomwhentreat-mentorend-of-lifecare isstopped,withthefamilyusually inattendance)andtakethemintoaccountwhenimplementingthisservice.

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TABLE OF cOnTEnTs


InTEREsTABLIsHmEnT TRAnsFERs

•Promotecollaborationbetweenestablishments,primarilythoseofferingspecializedneurology,neuro- surgeryandtraumatologyservicesandtheestablishmentsthatdonot.Itisimportanttokeepthenumberof transfers for organdonationpurposes to aminimumand remember their impact on lovedones.TransplantQuébecseekstooptimizedonormovementinordertominimizethenumberofpatienttrans-fersinthedonationprocess.

Forexample,whenapatientmeetstheidentificationcriteriaandmustbetransferredtoanotherestab- lishmentforaspecialtyconsultation,itisrecommendedthatthepatientremainattheestablishmentheorshehasbeentransferredto,eveniftreatmentisnotpossible,whenthepatientislikelytobeapotentialorgandonor.Thedonationprocesscanthuscontinueatthatestablishment.Suchmethodsavoidpoint-lesstransfersandreducetheinconvenienceandcost.Ifapatientneedstoreturntotheoriginalestab- lishment(e.g.,patient’sdeath,organdonation ineligibilityorthefamily’swish),TransplantQuébeccanprovidefinancialaidforthetransfer,ifneeded.(SeeAppendix4,underFinancialsupport,p.68.)

•Proceedasprearrangedwiththeestablishmentsinvolved,especiallyasconcernsdonormanagement(aspectsofdonormaintenanceororganprocurement).

•Schedulethestaffneededtotransferthedonor(intubatedpatient)toaprocurementcentre.Fororganremoval,ensurethedonoristransferredtotheprocurementcentreselectedbyTransplantQuébec.

mEDIcAL REcORDs

•Discloseinformationfromtherecordasneeded.•HelpcollectdatafortheTransplantQuébecperformanceindicators,primarilybyreviewingtherecords ofpeoplewhodiedincriticalcareunits,inordertoprovideinformationthatcanbeusedwhenassessingthequalityoftheestablishment’sorgandonationprocess.

•Serveonthedonationcommitteeatleastonceayearorasneeded.

cLInIcAL ETHIcs cOmmITTEE

•Assistwiththeimplementationoforgandonationpracticesintheestablishment,asneeded.•Helptoclarifytheethicalaspectsoforgandonationandserviceorganization.

Manyorgandonorsarealsotissuedonors.Insuchcases,theorgandonationprocedureapplies,andTransplantQuébectransfersanorgandonorwhoispotentiallyalsoatissuedonortoHéma-Québec,whichtakeschargeofthetissuedonationprocess.

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TRAnsPLAnT QuÉBEc suPPORT TO EsTABLIsHmEnTs

mIssIOn, VALuEs AnD sTRATEGIc PRIORITIEs OF TRAnsPLAnT QuÉBEc

TransplantQuébecisthesoleorganizationinchargeofcoordinatingorgandonationafterdeathinQuebec.ItreportstotheMinisterofHealthandSocialServices.

Transplant Québec’s mission

InsupportofQuebecers’collectiveefforttosavelivesandimprovethehealthofpeopleindesperateneedoforgans,TransplantQuébec

•Coordinatestheorgandonationprocessleadingtotransplantation,ensuringthegreatestpossible availabilityofqualitydonororgans.•Ensuresthatorgansareallocatedfairly,basedonstringentethicalandclinicalcriteria.•Helpsimproveclinicalpracticesininstitutionalsettingsbyholdinghospitaltraininganddevelopment activitiesandparticipatingindonation-andtransplant-relatedteachingandresearchactivities.•Actsasacatalysttocreateinterdependencieswithinthedonation/transplantationsystemandserves asafacilitatortaskedwithfosteringdiscussionandmobilizingstakeholders.•Promotespro-donation,pro-transplantationvaluesofsolidarityamongthegeneralpublic,health-care professionalsandestablishmentsconcerned.

TransplantQuébecisactivelyengagedsothatthegreatestnumberofQuebecerswaitingfororganscanreceivetransplants.

suPPORT PROGRAm FOR ORGAn DOnATIOn DEVELOPmEnT In QuEBEc HOsPITALs

AspartofTransplantQuébec’shospitaldevelopmentprogram,eachestablishmentofferingcriticalcareservicesisassignedaTransplantQuébecclinicalcoordinator/advisor,whocanhelptheinstitutiondevelopandimplementorgandonationbestpractices.

ORGAn

DOnATIOn: TOGETHER

FOR LIFE

QuALITy

sAFETy

TRAnsPAREncy

FAIRnEss

cOLLABORATIOn

cOnsuLTATIOn

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TABLE OF cOnTEnTs


Roles and responsibilities of the clinical coordinator/advisor

•MaintaintiesbetweentheestablishmentandTransplantQuébec•Provideassistancetocreateandsupportanorgandonationcommittee•Helpupdatereferencematerials•Helpdispenseorgandonationtrainingaccordingtoidentifiedneeds•Cooperatewiththeestablishment’smedicalrecordsdepartmenttocollectqualityindicatorinformation,inaccordancewiththeStandardizedOrganDonationProcedure

•Helporganizeorgandonationawarenessandeducationalactivities•Serveasanorgandonationresourceperson•ProvidesupportduringtheAccreditationCanadaprocess

Formoreinformation TransplantQuébecHospitalDevelopmentandEducationDepartment Telephone:1-855-373-1414.Press7tohearthemessageandthenpress2.

ORGAn DOnATIOn cOORDInATIOn PROGRAm In QuEBEc HOsPITALs

A teamofclinicalcoordinator/advisorsavailable24/7alsocoordinates theorgandonationprocess.Theentireprovinceisservedby20clinicalcoordinator/advisorsbasedinMontrealandQuebecCity.

Theclinicalcoordinator/advisoractsasaclinicaladvisorandprovides thesupportcare teamsneed. Incollaborationwithphysiciansandallotherprofessionals,theclinicalcoordinator/advisorisinvolvedateachstageoftheorgandonationprocess:

•Identificationofthepotentialorgandonor•Referralofthepotentialdonor•Managementandmonitoringofthedonor•Discussionswiththefamily•Assessmentandacceptanceofthedonor•Donortransfertoaprocurementcentre•Assessmentoftransplantorgans•Organallocation•Organremovalandpreservation•Organandmedicalteamtransport•Follow-upwithstakeholders,includingthedonor’sfamily

Additionally,theTransplantQuébecclinicalcoordinator/advisoroverseesthemaster listofpatientswait- ing fora transplantaccording to the rulesestablishedby theorganization,aswellas thepost-donationfollow-upfordonorrecords.

Formoreinformation TransplantQuébecClinicalServices Telephone:1-855-373-1414.Press7tohearthemessage,press4andthenpress2.

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ORGAn DOnATIOn LIAIsOn AnD REsOuRcE nuRsEs

Sixteenestablishmentswithanannualpotentialof8to20donorshaveadedicatedtissueandorgandona-tionteammadeupofliaisonandresourcenurses.

Theorganandtissuedonationliaisonnurse12andresourcenurse13organizeorgandonationsincooperationwiththeorganandtissuedonationcommittee,oftenunderthedirectionoftheestablishment’sprofessionalservices.Theyplanandorganizetrainingforhealth-careprofessionalstoincreasethenumberofreferralsandthefamilyconsentratebyidentifyingandreferringdonorstoTransplantQuébecearlyintheprocess.

Theyactasresourcepeopleforthestakeholdersinasharedinterventionmodelateverystageoftheorgandonationprocess.Theirroleincludesallofthefollowing:

•Meetwiththemedicalteamtodecideonhowtoapproachthegrievingfamily•Ensurebestpracticesarefollowedwhentheorgandonationoptionispresented•Offerthegrievingfamilyongoingsupport•Answerthefamily’squestionsincollaborationwiththeattendingteam

Formoreinformation TransplantQuébecHospitalDevelopmentandEducationDepartment Telephone:1-855-373-1414.Press7tohearthemessageandthenpress2.

mEDIcAL mAnAGEmEnT

TransplantQuébec’soperationsaresupportedbythemedicalmanagementteam,whichismadeupofsixphysicians,includingthemedicaldirectorandthedeputymedicaldirector.Together,theyformtheon-callmedicalteamthatisavailable24/7to

•Makenecessarymedicaldecisions•Guidetheclinicalaspectofcoordination•Actasthego-toresourcepeopleforphysiciansworkinginestablishments•Speakatinformationortrainingactivities•Helpdevelopandreviseorganizationalprocesses,policiesandprocedures

TRAInInG

Currently,Quebechealth-careandsocialservicesprofessionalsreceiveverylimitedpreliminarytraininginorgandonation.Itisimportanttomaintainandprovideorgandonationtrainingforcriticalcaredepartmentprofessionals(physicians,nursesandrespiratorytherapists)ateachestablishment,especiallyduringorien-tationsessions.

12OrganandtissueanddonationliaisonnursesareTransplantQuébecemployeeswhoworkinanestablishment.In2013there werefourliaisonnursesbasedateightestablishments(10sites)whosharedround-the-clockdutyfortheMontreal,Montérégie andLavalareas.13Organandtissuedonationresourcenursesareemployedbytheestablishmentswheretheywork.Underthehospitalmanage- mentprogramadministeredbyTransplantQuébec,halfoftheirsalariesispaidbyTransplantQuébecandtheotherhalfbythe establishment.In2013therewere15resourcenursesat10establishments(19sites)throughoutQuebec.

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TABLE OF cOnTEnTs


TransplantQuébecanditsteamofclinicalcoordinator/advisors(whoareallnurses),organdonationliaisonnursesandphysiciansofferawidevarietyof trainingactivities forhealth-careandsocialservicesprofessionals,especiallythoseworkingincriticalcare.

AnumberoftrainingsessionsbyTransplantQuébecareaccreditedbyeducationalinstitutionsorprofes- sionalorganizationsandentitleparticipantstotrainingcredits.

Thesetrainingsessionscoverthefollowing:

•Theorgandonationprocess,aswellastherolesandresponsibilitiesofhealth-careprofessionals•Maintainingthehemodynamicstabilityoforgandonors•Breakingbadnewsandproposingtheorgandonationoption

Examplesofaccreditedtraining

•Standardizedorgandonationprocedure(1to1.5hours)•Approachingandsupportingthefamilyinorgandonationsituations(13hours)•Maintainingthehemodynamicstabilityoforgandonors(1hour)•Discussingandsuggestingorgandonation(1hour)

Examplesofnon-accreditedtraining

•OrgandonationinQuebec(presentationforprofessionals,3hours)•OrgandonationinQuebec(presentationforthegeneralpublic,1hour)

TransplantQuébecoffersaccreditedonlinetrainingonitswebsite.Thistraining,developedincollaborationwiththeQuebecSocietyofIntensivists,isintendedforphysicians,nursesandrespiratorytherapists,espe-ciallythoseworkingincriticalcareunits.

Bytheendofthistraining,theparticipantswillknowthekeystagesintheStandardizedOrganDonationProcedureandhaveabetterunderstandingofhow important it is toactivelyparticipate in thedonationprocess.Participantswillbeableto

•Identifytheirrolesintheorgantransplantationanddonationchain•IdentifypotentialorgandonorsandreferthemtoTransplantQuébec

Onceparticipantshaveviewedthetrainingmaterialandpassedthetest,theyareentitledtoatraining credit.

TransplantQuébecalsooffers training in the formof talksatmanyCEGEPsanduniversitiesaspartof preliminarytrainingprogramsinnursing,respiratorytherapyandmedicine.

Organ donation saves lives!

Your work is important, thank you for your commitment!

Online learning on organ donation*Learning credit – free

www.transplantquebec.ca/professionnels/formationenligne

*French version only

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http://www.transplantquebec.ca/sites/default/files/depliant_formations_8x11.pdf

http://www.transplantquebec.ca/en/webinars

http://www.transplantquebec.ca/en/webinars

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DOcumEnTATIOn AVAILABLE TO HEALTH PROFEssIOnALs AnD EsTABLIsHmEnTs

TransplantQuébecprovidesallhealth-careandsocialservicesprofessionalswhoworkincriticalcarewithreferencematerialsthatwalkthemthroughtheprocess,fromidentifyingpotentialorgandonorstoorganremoval.Herearesomeexamples:

•TransplantQuébecwebsite•StandardizedOrganDonationProcedure•Standardizedorgandonationprocedureflowchart•OrganandTissueDonor(OTD)binder•Donationprocesschecklist•Guides,policies,protocols,procedures,andforms,includingtheadultandpediatricdonormanagement guidelines

Formoreinformation Clinicalcoordinator/advisorfortheestablishmentor TransplantQuébec’sHospitalDevelopmentandEducationDepartment Telephone:1-855-373-1414.Press7tohearthemessageandthenpress2.

Transplant Québec website

TheTransplantQuébecwebsite,especially theHealthProfessionalssection,providesawealthofusefulinformation.Thesection isdedicatedentirely toprofessionals in institutionalsettingsand isdesignedtoexplaintheorgandonationprocessandsimplifytheirwork.

www.transplantquebec.ca

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standardized Organ Donation Procedure

Versionforhospitalswithdedicatedorgandonationpersonnel

PROCÉDURE TYPE POUR LE DON D’ORGANES

PROCÉDURE TYPE POUR LE DON DE TISSUS

EN RELATION AVEC L’ARTICLE 204.1 DE LA LOI SUR LES SERVICES DE SANTÉ ET LES SERVICES SOCIAUX

MARS 2012

Centre hospitalier avec personnel dédié en don d’organes

Versionforhospitalswithoutdedicatedorgandonationpersonnel




MARS 2012

Centre hospitalier sans personnel dédié en don d’organes

Thepurposeof thisprocedure is tosupportorganandtissuedonation inestablishmentswithaviewtobetteridentificationandmoresystematicreferralsofpotentialorgandonors.Bothversions(withandwithoutdedicatedorgandonationpersonnel)areintendedprimarilyforDPSs,membersoforganandtissuedona- tioncommitteesandcriticalcareprofessionals.Theproceduregoesalongwaytofacilitatingtheirwork,whilealso improvingoutcomes in theestablishmentandensuringservicesmeetAccreditationCanada’snew(deceaseddonor)organdonationstandards.

standardized organ donation procedure flow chart

Versionforhospitalswithdedicatedorgandonationpersonnel

© Transplant Québec 2012

STANDARDIZED ORGAN DONATION PROCEDURE IN REFERENCE TO ARTICLE 204.1 (LSSSS)

Patient with a prognosis of impending death

Hospital with a liaison/resource nurse assigned to organ donation

DO NOT OFFER THE OPTION OFDONATION TO THE FAMILYBEFORESTEP 4

End of the referral to Transplant Québec

ACTIVE MEDICAL TREATMENT

The patient satisfies the criteria for being a potential organ donor: • A person of any age • Has experienced a severe neurological insult (post-resuscitation, cerebral anoxia, CVA, cerebral haemorrhage, encephalopathy, traumatic brain injury, Glasgow score < 5 ...) • Requires mechanical ventilation

Depending on the situation, a decision is made to continue or stop active medical treatment

Diagnosis of neurological determination of death (NDD)Potential donor (NDD)

Severe and irreversible prognosisConsider withdrawing life-sustaining therapy (WLST)Potential donor for donation after cardiocirculatory death (DCD)

The patient’scondition improves

Contact the liaison/resource nurse of your hospital to verify the donor’s eligibility

When the organ donor is also a tissue donor, Transplant Québecwill communicatewith Héma-Quebec.

Yes

IDENTIFICATION

REFERRAL

PRIOR TO OFFERING THE OPTION OF ORGAN DONATION TO THE FAMILY

The liaison/resource nurse assigned to organ donation contacts Transplant Québec

to verify the patient’s inscription in the registries of the RAMQ andthe Chambre des notaires du Québec

COMMUNICATIONOF DIAGNOSIS / PROGNOSIS

Announce and explain the poor and irreversible prognosis

Discuss withdrawing life-sustaining therapies (WLST)

Provide the time necessary to absorb the information

Ensure that the family understands the prognosisBe prepared to repeat the information as often as needed

• Provide a quiet and private space

• Be empathic and attentive to the family’s needs

• Ensure that family support personnel are present

• Use of visual aids (i.e. brain scan)

OFFER / TEAM APPROACH

PRESENT THE OPTION OF ORGAN AND TISSUE DONATIONAsk the family to respond based on the KNOWN expressed wishes of the patient as indicated by • the inscription(s) in the RAMQ and the Chambre des notaires du Québec registries OR • the signature on the back of the health insurance card OR • a prior verbal consentOR if the wishes are NOT KNOWN, have the family decide by considering the person’s values and beliefs

Offer to involve the Transplant Québec coordinator to answer any questions the family might have

Ascertain the family’s decision

Allow sufficient time for a period of reflection Be attentive to the family’s needs, answer questions and address concerns

Reference tools: www.transplantquebec.ca and the following documents (available upon request at [email protected]): Trousse Pensez don (can be found in the intensive care units and the emergency departments) and pocket size donor guideline card

Communicate the family’s decision to Transplant Québec

Consent Refusal

CONTINUE DONOR MANAGEMENT Provide all available information concerning the donor to the Transplant Québec coordinator

Begin the donor evaluation and eligibility phase in collaboration with the medical team and the Transplant Québec coordinator

NDD

Continue to providefamily support

End-of-life care

DCD

Diagnosis of neurological determination of death completed by 2 physicians

Transfer to the operating room*

Organ procurement

Transfer to the operating room

WLST and end-of-life care

Diagnosis of death by cardiocirculatory criteria completed by 2 physicians

Organ procurement

Death does not occur

Continue end-of-life care

* For hospitals that do not carry out procurements: Depending on the situation, the donor will be transferred to a procurement center as soon as possible.

1

2

3

4

5EVALUATION, ELIGIBILITY ANDPROCUREMENT

No

Continuation of active medical treatment

Depending on thesituation, continue or stop medical treatment

With the collaboration of

Versionforhospitalswithoutdedicatedorgandonationpersonnel

© Transplant Québec 2012

STANDARDIZED ORGAN DONATION PROCEDURE IN REFERENCE TO ARTICLE 204.1 (LSSSS)

Patient with a prognosis of impending death

Hospital without a liaison/resource nurse assigned to organ donation

DO NOT OFFER THE OPTION OFDONATION TO THE FAMILYBEFORESTEP 4

End of the referral to Transplant Québec

ACTIVE MEDICAL TREATMENT

The patient satisfies the criteria for being a potential organ donor: • A person of any age • Has experienced a severe neurological insult (post-resuscitation, cerebral anoxia, CVA, cerebral haemorrhage, encephalopathy, traumatic brain injury, Glasgow score < 5 ...) • Requires mechanical ventilation

Depending on the situation, a decision is made to continue or stop active medical treatment

Diagnosis of neurological determination of death (NDD)Potential donor (NDD)

Severe and irreversible prognosisConsider withdrawing life-sustaining therapy (WLST)Potential donor for donation after cardiocirculatory death (DCD)

The patient’scondition improves

ContactTransplant Québec to verify the potential donor’s eligibility

1 888 366-7338 option 1

When the organ donor is also a tissue donor, Transplant Québecwill communicatewith Héma-Quebec.

Yes

IDENTIFICATION

REFERRAL

PRIOR TO OFFERING THE OPTION OF ORGAN DONATION TO THE FAMILY

Contact Transplant Québec: 1 888 366-7338, option 1to verify the patient’s inscription in the registries of the RAMQ andthe Chambre des notaires du Québec

COMMUNICATIONOF DIAGNOSIS / PROGNOSIS

Announce and explain the poor and irreversible prognosis

Discuss withdrawing life-sustaining therapies (WLST)

Provide the time necessary to absorb the information

Ensure that the family understands the prognosisBe prepared to repeat the information as often as needed

• Provide a quiet and private space

• Be empathic and attentive to the family’s needs

• Ensure that family support personnel are present

• Use of visual aids (i.e. brain scan)

OFFER / TEAM APPROACH

PRESENT THE OPTION OF ORGAN AND TISSUE DONATIONAsk the family to respond based on the KNOWN expressed wishes of the patient as indicated by • the inscription(s) in the RAMQ and the Chambre des notaires du Québec registries OR • the signature on the back of the health insurance card OR • a prior verbal consentOR if the wishes are NOT KNOWN, have the family decide by considering the person’s values and beliefs

Offer to involve the Transplant Québec coordinator to answer any questions the family might have

Ascertain the family’s decision

Allow sufficient time for a period of reflection Be attentive to the family’s needs, answer questions and address concerns

Reference tools: www.transplantquebec.ca and the following documents (available upon request at [email protected]): Trousse Pensez don (can be found in the intensive care units and the emergency departments) and pocket size donor guideline card

Communicate the family’s decision to Transplant Québec

Consent Refusal

CONTINUE DONOR MANAGEMENT Provide all available information concerning the donor to the Transplant Québec coordinator

Begin the donor evaluation and eligibility phase in collaboration with the medical team and the Transplant Québec coordinator

NDD

Continue to providefamily support

End-of-life care

DCD

Diagnosis of neurological determination of death completed by 2 physicians

Transfer to the operating room*

Organ procurement

Transfer to the operating room

WLST and end-of-life care

Diagnosis of death by cardiocirculatory criteria completed by 2 physicians

Organ procurement

Death does not occur

Continue end-of-life care

* For hospitals that do not carry out procurements: Depending on the situation, the donor will be transferred to a procurement center as soon as possible.

1

2

3

4

5EVALUATION, ELIGIBILITY ANDPROCUREMENT

No

Continuation of active medical treatment

Depending on thesituation, continue or stop medical treatment

With the collaboration of

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http://www.transplantquebec.ca/sites/default/files/procedure_doc_sanspersonnel.pdf

http://www.transplantquebec.ca/sites/default/files/standardized_procedure_with.pdf

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Organ Donor and Tissue Donor (OTD) binder

TheOrganandTissueDonorbinderguidesthecareteamthrougheverystageoftheorgandonationprocess.Thebinderhasbeendistributedtoallhospitalsandmustbeavailableinallcriticalcaredepartments.Itcon-tainssevenchaptersonthefollowingtopics:

•Identificationofpotentialorgandonors•Supportingandapproachinggrievingfamilies•Neurologicaldeterminationofdeath(NDD)anddonationaftercardio- circulatorydeath(DCD)•Consentforms•Assessmentandmanagementofpotentialdonors•Donortransfertoaprocurementcentre•ActtoFacilitateOrganandTissueDonation,inforcesinceFebruary 2011

Criticalcareteamsdonothavetoworryaboutupdatingthistoolbecausethisistheresponsibilityofeachestablishment’sclinicalcoordinator/advisor.

Donation process checklist

Thispocket referenceguidescriticalcareprofessionals through theor-gandonationprocess.ThechecklistisbasedontheStandardizedOrgan DonationProcedure. Itprovidesagreatdealofvaluable informationontheorgandonationprocess.

Copiesofthechecklistareavailablefromtheestablishment’sTransplantQuébec clinical coordinator/advisor or the hospital development andeducationdepartment.

Guidelines, policies, protocols, procedures and forms

TransplantQuébecprovidesnumerousguides,policies,protocols, andprocedures forphysiciansand health-careprofessionals.Forinstance,theHealthProfessionalssectionoftheorganization’swebsitein-cludesthefollowingresources:

•OrganDonorAssessmentandManagementGuidelines–Adults•Protocolederecrutementcardiaqueetpulmonaire [cardiacandpulmonaryrecruitmentprotocol]•OrganDonorAssessmentandManagementGuidelines–Pediatrics•Protocoletypedestinéaudond’organesaprèsdécèscardiocirculatoire(DDC) [standardizedprotocolfordonationaftercardiocirculatorydeath]

TheorgandonationclinicalproceduresandformsarealsoavailableontheTransplantQuébecwebsiteatwww.transplantquebec.ca/en/professionnels.

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http://www.transplantquebec.ca/sites/default/files/eva-gui-001a_v2.pdf

http://www.transplantquebec.ca/sites/default/files/eva-gui-002_v4.pdf

http://www.transplantquebec.ca/sites/default/files/eva-gui-005a_v1.pdf

http://www.transplantquebec.ca/sites/default/files/protocole_type_destine_au_don_dorganes_apres_deces_cardiocirculatoire_ddc_2011_02_03.pdf

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TABLE OF cOnTEnTs


PERFORmAncE InDIcATORs

Organization chart with organ donation quality indicators

Critical care staff- Physicians- Nurses- Respiratory therapists

DPS

Organ and tissuedonation committee

+Transplant Québec

clinical coordinator/advisor

Hospital generalmanagement

Transplant QuébecAnalyze �les upon receipt

Medical recordsStudy records and forms

of people who diedin critical care units

Quality indicator report - Identi�cation rate - Referral rate - Consent rate - Number of organs per donor - Action plan

Action planExample: Training withemergency department

staff

Assessment reporton the records included

in the study


FourkeyperformanceindicatorssetoutanddescribedintheStandardizedOrganDonationProcedureareusedtomonitororgandonationintheestablishment.

n Establishment with dedicated organ donation personnel

Theseindicatorsfromtheorgandonationquality indicator (ODQI)systemareavailablefromtheorgandonationliaisonorresourcenursesworkingattheestablishmentandareobtainedthroughtheretrospec-tivestudyoftherecordsofpeoplewhodiedprimarilyintheestablishment’scriticalcaredepartments.

n Establishment without dedicated organ donation personnel

TheODQIsystemisavailabletoprovidequalityindicatorsfirsttoestablishmentswithoutdedicatedorgandonationstaff.

Withtheparticipationoftherecordsdepartmentofestablishmentswithgeneralandspecializedcaremis-sions,thenewsystemdrawsontheorgandonationworkCMQhasconductedformorethan10years.

Health-careprofessionals,DPSsandorganandtissuedonationcommitteeswillfindthedataveryuseful inassessingprogress inorgandonationsand,asneeded,developingactionplans toaddress identifiedproblems.

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Thefour(4)performanceindicatorsareasfollows:

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ADVIsORy cOmmITTEEs

TransplantQuébechasanumberofadvisorybodies,includingamedicalscientificadvisorycommitteeandorgan-specificsubcommitteesthatactivelyparticipateinallocationprocedureandcriteriadevelopment, aswellasotheractivities.Physiciansandtransplantsurgeonsininstitutionalsettingsalsocontributeto thiswork.TransplantQuébec’sethicscommitteemakesrecommendationsonanumberofissuesrelated to theorganization’smission, insupportofQuebec’s transplantanddonationsystem. (SeeAppendix4,underTransplantQuébecadvisorycommittees,p.68.)

suPPORT FOR EsTABLIsHmEnT ORGAn AnD TIssuE DOnATIOn AccREDITATIOn (DEcEAsED DOnORs)

SinceApril2010TransplantQuébechasofferedestablishmentshelpwithorganandtissuedonationaccreditationfordeceaseddonors.Itsdocu-mentSoutien et accompagnement des établissements de santé et de services sociaux du Québec[supportandassistanceforQuebechealth-careandsocialservicesestablishments]goesoverAccreditationCanada’sstandardsfor

•Organandtissuedonation(deceaseddonors)•Intensivecaredepartments(Standard8)•Emergencyrooms(Standard9)

Inconcreteterms,TransplantQuébeccan

•AnswerpartnerqueriesconcerningHealthCanada’sSafetyofHumanCells,TissuesandOrgansforTransplantationRegulationsandtheAccreditationCanadastandards

•Helpdevelopstandardizeddocumentsforvariousaspectsofstandards (policies,standardizedproce-duresandothertools)

•AssistinpreparingdocumentationdescribinghowrolesandresponsibilitiessetoutinthestandardsaresharedbetweenestablishmentsandTransplantQuébecorotherparties,includinglaboratories,withaviewtosigningrequiredagreements

•Supportgroupeffortstopromotetheimplementationofbestpracticesandadapttoolsincooperationwiththeestablishments

TransplantQuébec can also help establishmentswith livingdonor donationprogramsensure their pro-cessesarecompliantwithHealthCanada’sSafetyofHumanCells,TissuesandOrgansforTransplantationRegulations.(SeeAppendix2,underEstablishmentsofferinglivingdonorprograms,p.66.)

TransplantQuébeccanalsoact as anadvisorwithin its fieldof competence, supportinghospitalswith general and specialized caremissions that offer organ transplantation services subject toAccreditationCanada’sQmentumProgramOrganandTissueTransplantStandards.(SeeAppendix2,underOrgantrans- plantationcentresandprograms,p.66.)

Les normes sur le don d’organes et de tissus (donneurs décédés)Services des urgences (Norme 9)Services de soins intensifs (Norme 8)

SOUTIEN ET ACCOMPAGNEMENT DES ÉTABLISSEMENTS DE SANTÉ ET DE SERVICES SOCIAUX DU QUÉBEC RELATIVEMENT AUX NORMES D’AGRÉMENT CANADA

Novembre 2012

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http://www.transplantquebec.ca/sites/default/files/25e_comite_ethique.pdf

http://www.transplantquebec.ca/sites/default/files/soutien_et_accompagnement_des_etablissements_sssq_2012-11-27.pdf

http://www.transplantquebec.ca/sites/default/files/soutien_et_accompagnement_des_etablissements_sssq_2012-11-27.pdf


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Under themandate it received fromMSSS in 2010, TransplantQuébecmay contact establishments to informthemofitsnewresponsibilitiesandofferthemsupport.However,TransplantQuébecmustinterveneonlyasrequiredtomeetneedsexpressedbyestablishments.

Formoreinformation TransplantQuébecComplianceandQualityDepartment Telephone:1-855-373-1414.Press7tohearthemessageandthenpress7.

cOmmunIcATIOns

Establishments are urged to organize informational and educational activities on organ donation andtransplantation—topicsinwhichthepublichasshownagreatdealofinterest—particularlyregardingthosewaitingfortransplantsorrecipients,theirfamiliesanddonors’families.Themedia,especiallyatthelocalandregionallevels,oftentakeaninterestintheseissues.

EstablishmentsoftenworkwithTransplantQuébeconcommunicationsandpublicrelationsactivitiesinthecommunity.

TransplantQuébec’scommunicationsandpublicrelationsdepartmentwillprovideasmuchassistanceas itcanwithcommunicationsactivitiesininstitutionalandpublicsettings.

TransplantQuébecalreadyorganizesandsupportsanumberofcommunicationsandpublicrelationsinitia-tivespromotingorgandonationtothegeneralpublicandspecifictargetaudiences,particularlyhealth-careandsocialservicesprofessionals,youngerandolderpeople,andsoonculturalcommunitiesaswell.(SeeAppendix4,underCommunicationsandpublicrelations,p.68.)

Formoreinformation TransplantQuébecCommunicationsandPublicRelationsDepartment Telephone:1-855-373-1414.Press7tohearthemessageandthenpress3.

FInAncIAL suPPORT FOR DOnOR IDEnTIFIcATIOn AnD ORGAn PROcuREmEnT

TransplantQuébecmanagesanorgandonationfundforthecostsincurredfordeceaseddonors.Thepro-gramprovidesfixedsumsfortheestablishment’sidentificationandprocurementcentresandcoverstravelcosts for teams, transportationcosts forprocuredorgansand for returning thebody,andcertainblood testsinaccordancewithTransplantQuébec’sIdentificationandPaymentPolicyforOrganDonationfromDeceasedDonors.(SeeAppendix4,underFinancialsupport,p.68.)

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ORGAnIZATIOn OF TIssuE DOnATIOn sERVIcEs

ORGAnIZATIOn OF sERVIcEs

Héma-Québeclookstogeneralandspecializedhospitalsandtheirvariousdepartmentstoensureidenti- ficationand referralof allpotential tissuedonors.Afterapotential tissuedonorhasbeen referred, the Héma-Québeccoordinatortakeschargeofthedonationprocessandtriestominimizetheimpactonmed-icalpersonnel.However,thecooperationofthefollowingdepartmentsisessentialforasuccessfuldonation:

•Clinicalservices•Medicalbiology(laboratory)services,includingpathology(pathologylabandmorgue)•Admissions•Medicalrecords•Operatingroom

REsPOnsIBILITIEs OF DEPARTmEnTs

•Identifypotentialtissuedonors•ContacttheHéma-QuébeccoordinatorondutytochecktheRAMQandChambredesnotairesduQuébecconsentregistries

•Facilitateandsupporttheseactivities

cLInIcAL sERVIcEs

MedicalstaffareresponsibleforidentifyingandreferringpotentialtissuedonorsaccordingtothecriteriasetoutintheStandardizedTissueDonationProcedure–RecentPatientDeath.Recentdeathmeansacardio-pulmonarydeathwithout life supportthatmayleadtoahumantissuedonation.

n If consent is recorded in the registries

•Medical records

Ifconsenthasbeengiven,additionalinformationonthedeceased’smedicalhistorywillberequiredsotheHéma-Québeccoordinatorcanperformaproperassessmentofthepotentialdonor’ssuitability.Hos-pitalmedicalstaffmustbeinformedandprovidetheinformation.

•Communication with the family

Generally,thefamilyandHéma-Québecspeakbyphone.TheHéma-Québeccoordinatorisresponsibleforexplainingthetissuedonationprocess.Ifthefamilywantstoleavethehospitalbeforespeakingto thecoordinator,medicalstaffmustobtain thephonenumberwhere the familycanbe reachedwithin anhourofleaving.

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n If consent is not noted in the registries or the back of the health insurance card has not been signed

DonationmustbesuggestedtothefamilyandsupportfromtheHéma-Québeccoordinatormustbeoffered.Ifthefamilyconsentstotissuedonationorhasquestionsaboutthedonationprocess,themedicalprofes-sionalactsasthelinkbetweenthecoordinatorandthefamily.Oncethecoordinatorhasbeeninformedofthesituation,heorshewillbeabletotakeoverand

•Givethefamilytheusualexplanations•Receiveconsentfortissueremoval•Fillinthedonoreligibilityquestionnaire•Handleformalitiesforthetransferofthedonor’sbodytothefuneralhome

n How are tissues procured?

•Unlikeorgans,humantissuescanberetrievedforseveralhoursafterbloodcirculationsstops.•Thedonor’sbodyistreatedwithcareandrespectbyateamofprofessionalsspecializingintissuepro- curement.Procurementisdoneinspeciallydesignedfacilities,inaHéma-Québecestablishment,orinahospitaloperatingroom,accordingtostringentproceduresandincompliancewithHealthCanadaandvariousrecognizedregulatoryagencystandards.

n When does the tissue donation process begin?

•Thedonoreligibilityprocessbeginsassoonasconsenttotissuedonationisobtained.Ideally,removalshouldbedoneasquicklyaspossibleafterdeathtomaximizethequalityoftheprocuredtissues.

n Are screening tests performed during tissue donation?

•Bloodiscollectedtodeterminethedonor’sserologicalprofileandensuretherecipient’ssafety.

n What is the age limit to be a tissue donor?

Theagecriteriondependsontissuetype:

•Cardiactissue–Birthto60years•Skinandbonetissue–15to70years•Tendons–15to60years•Eyetissue–2to85years

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n What about confidentiality?

•Theresultsofserologicalanalysesremainconfidential,butaresenttothepublichealthagencyifanoti-fiablediseaseispresent.

•All information obtained during the donor eligibility process is protected by law.14 Allmedical record assessment information remains strictly confidential and is used only to determine the eligibility of a potentialdonor.

•Iftissueremovaldoesnottakeplaceorthetissuesarenotusedfortransplantationbecauseofinforma- tioninmedicalorhospitalrecords,informationcannotbedisclosedduetolawsprotectingthemedicalinformationofdeceasedpersons.

•Someretrievedtissuesmaybesenttoanexternallaboratorytobeprocessedandconserved(QuebeceyebankinMontrealandCentreuniversitaired’ophtalmologieduCHUdeQuébec,HôpitalSaint-Sacrementsite).

•Thecoronercanasktotakebloodsamplesforanalysisorrequestcopiesofcertaindocuments.•Ifthedonor’sbodyisautopsiedaftertissueremoval,thepathologistmayrequestcopiesofcertaindocu-ments.

n What happens to the tissues after they are removed?

•Bacteriologicaltestsareperformedonremovedtissuesinordertoensureasafe,optimumqualitygraftforthepotentialrecipient.Tissuesareprocessedandconserved(freezingorcryopreservation,dependingonthetypeoftissue)untiltheyaregrafted.

•Tissuesintendedfortransplantcanbeconservedforalongtimewithoutanydeteriorationorchangeinquality.However,theproperconservationmethodsmustbeused.Certaintissuescanthereforebekeptforuptofiveyears.However,withtheever-growingneedfortransplanttissues,theyarerarelykeptsolong.

n How many people can receive a transplant from a single tissue donation?

Dependingonthetypeofremovalandthequalityofthetissuesremoved,atissuedonorcanhelpupto 20recipients.Althoughitcansavelivesjustlikeorgandonationdoes,inmostcases,thepurposeofhumantissuedonationisabovealltomaintainorimprovequalityoflife.Aheartvalvedonationcannotonlyhelppatients return to leadingnormal lives,butalso incertaincaseseliminate theneed formorecomplex surgery.Andbonetissuedonationsallowrecipientstomaintainornoticeablyimprovetheirmobility.

n can a potential tissue donor be excluded under certain circumstances?

Currentlythereisstillalackofknowledgeabouttissuedonation,leadingtoshortagesinpotentialdonorsidentifiedandreferredtoHéma-Québec.Sometypicalscenariosaredescribedbelow.

• The donor’s medical history is complicated “Theoreticallythetissuedonor’sclinicalpicturedoesnotappeartosatisfythedonationrequirements.” ItisbettertoreferthepotentialdonortoHéma-Québecratherthanrefusetoohastily.Thepotentialdonormustbeexcludedautomaticallyifoneofthediagnoseslistedinsection1ofthetissuedonationproce-durehasbeenmade.

14ActRespectingAccesstoDocumentsHeldbyPublicBodiesandtheProtectionofPersonalInformation,CQLR.,c.A-2.1. (www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=/A_2_1/A2_1_A.html)

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•The potential tissue donor is not on a respirator Humantissuedonationdiffersfromorgandonationinanumberofways.Oneimportantdistinctionisthattissueslikebones,heartvalves,skin,tendons,andeyetissuesaremuchlesscomplexstructuresthanorgansliketheheartandkidneys.Unlikeorgans,tissuescanbedeprivedofoxygenforacertainperiodoftimewithouttheirqualitybeingaffected.Itisthereforepossibletoremovethemevenafterthedonor’sbloodhasstoppedcirculating.However,removalneedstotakeplaceassoonaspossibletoavoidthedeteriorationofsomemorefragiletissues.

•The potential donor is in cardiorespiratory arrest and his or her pulse does not resume Deathmustbecertified.Thetissuedonornolongerhasaheartbeat.

•The potential donor was found dead, rigor mortis has set in and the time of death is unknown Rigormortis is not a reason to exclude a potential tissue donor. TheHéma-Québec coordinatorwill determinewiththefamilymembers,thecoronerora lawenforcementofficer, ifappropriate,whenthedeceasedwaslastseenalive.Thistimewillbeusedasthetimeofdeath.

•The potential donor is under the guardianship of a public trustee Apotentialdonorwhoisundertheguardianshipofapublictrusteecanbeatissuedonor.TheHéma- Québeccoordinatorwillcontactthetrusteeandconducttheusualchecks:

–Presenceorlackofconsent –Authorizationfromthetrustee –Presenceorabsenceofapersonwho is familiarwith thedeceased’ssocialandmedicalhistory to completetheeligibilityquestionnaire

•The potential donor is known to have MRSA15 or VRE16

ApotentialdonorwhoisknowntohaveMRSAorVREbutdoesnotshowsignsofanactiveinfectionatdeathcanundergotissueremoval.TheHéma-Québeccoordinatorhasaccesstoadonorassessmentmanualandwillconsulthisorhermedicaldirector,whenappropriate.

•No family comes to the hospital ThepotentialtissuedonorisrecommendedtoHéma-Québecwhetherthedeceased’sfamilyispresent ornot.TheHéma-Québeccoordinatorwillconduct theusualchecks in theexisting registriesand, ifconsenthasbeengiven,maycontactthefamilytoexplainthedonationprocess.

•The case comes from a coroner Toooftenstill,medicalstaffincorrectlybelievethatacasefromacoronercannotendintissuedonation.Fortraumaticdeathoradeathinvestigatedbythecoroner,theHéma-Québeccoordinatormustconducttheusualcheckswiththecoroner,whomayrequestanautopsyorcertainassessmentsthatwillshed lightonthecauseofdeath.Generally,tissueremovalispossible,andthecoronercomestoanagreementwithHéma-Québeconhowtoproceed.

• An autopsy is required This type of scenario does not prevent tissue removal at all. After the referral toHéma-Québec andconsent for tissue removalhasbeenobtained, theHéma-Québeccoordinatorwill give the family theusualexplanationsandmakeanyrequiredarrangementswiththepathologistonrecord.

15Methicillin-resistant Staphylococcus aureus. 16Vancomycin-resistant enterococci.

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mEDIcAL BIOLOGy sERVIcEs

Medicalbiology(laboratory)servicescanbecalleduponinthefollowingsituations:

n Availability of a blood sample.Foreachdonor,theHéma-Québeccoordinatorneedstocalculatetheplasmadilution.Ifthedonorishemodiluted,theHéma-Québecrepresentativewillcontactthelaboratorytofindoutwhetherapre-infusion/pre-transfusionsampleisavailable.Ifasampleisavailable,itmayberequiredfortheprescribedserologicalanalyses.Theseanalysesarecontractedouttoanoutsidelabo- ratory.

n Blood bank.Fromtimetotime,theHéma-Québeccoordinatormayspeaktoapersonatthehospitalbloodbanktoobtaintheexactvolumesofthetransfusionsadministeredtothedonorinordertocalcu- latetheplasmadilution.

mORGuE AnD PATHOLOGy LABs

Apathologylabisusedforthefollowingsteps:

•Comprehensivephysicalexaminationofthedonor•Preparationofthedonorforremoval(shavingthesurgicalsite,preoperativewashingofthedonor)•Removalofeyetissues.Thistypeofremovalgenerallytakesplaceinthesettingfromwhichthereferraloriginates.Theremovalcanbedoneinthedeceased’sroomorinthepathologylab,dependingonavail- ability.Notethatthisdoesnotapplytoothertypesoftissues.Toensureoptimumasepsiscontrol,theremoval of tissues such as skin, bone tissues, tendons and the heart for valvesmust bedone in an operatingroomoraHéma-Québecestablishment.

ADmIssIOns AnD mEDIcAL REcORDs

Thehospital’sadmissionsormedicalrecordsservicesmaybecalleduponforthereasonssetoutbelow.

n medical record assessment

AHéma-Québecstaffmemberwillneedtoassesstheeligibilityofatissuedonorwhohasbeenrecom-mendedandforwhomdonationconsenthasbeenobtained.Todothis,thestaffmemberwillgodirectly totheestablishmentfromwhichthereferralcameorwillaskforcertainmedicalrecordstobefaxed.

•On-site record assessment by a Héma-Québec staff member TheHéma-Québeccoordinatorwillmakesurethatthedonor’smedicalrecordisavailableandwilldirecthisorhercolleaguetothedepartmentinquestion(e.g.,admissions,records,careunit).Photocopiesofcertaindocumentswillbemadeandappendedtothedonor’seligibilityfile.

•Off-site record assessment TheHéma-Québeccoordinatorfrequentlycontactsthemedicalrecordsdepartmenttoobtaincopiesofdocuments in thedeceased’smedical records.Thedocumentationmustbe faxed to thenumber thecoordinatorgivesthedepartment,incompliancewiththeinformationdisclosurerulesforpatientrecords.

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n Transfer of the body to the Héma-Québec establishment or a procurement centre

Eye tissuesareusually removedat theestablishmentwhere thedeathhasoccurred.Forother typesof tissues,thedonor’sbodyistransferredtoaHéma-Québecestablishment.Familiesmustgivepriorconsentforbodytransfers.Thisformalityiswidelyaccepted.TheHéma-Québeccoordinatorinformstheestablish-ment’sadmissionsdepartmentthatafuneralhomeistakingthedonor’sbodyandhandlingthetransfer.Afterthetissueremoval,thebodywillusuallybesenttothefuneralhomeselectedbythefamilyortotheestablishmentperformingtheautopsy,ifapplicable.NotethatthecostsassociatedwithmovingthebodyarecoveredbyHéma-Québec.

n Review of the deceased’s records in relation to the number of potential tissue donations

Héma-Québeccanaskforthemedicalrecordsdepartment’scooperationinobtainingdataonthenumberofpotentialdonorsintheestablishment.

OPERATInG ROOm

Héma-QuébechasagreementswithanumberofestablishmentstouseanoperatingroominsituationswherethefamilyrefusestoallowthebodytobetransferredtoaHéma-Québecestablishment.

•Theprocurementteamusestheoperatingroomwithoutcallingontheservicesofhospitalstafforusinghospital equipment. TheHéma-Québec coordinator comes to an agreementwith the operating roommanagertosettheremovaltimeanddecidewhichroomwillbeused.

•Thetissuesareremovedaccordingtotheplannedoperatingscheduleortheavailabilityoftheroom.

IfthereisnoagreementbetweentheestablishmentandHéma-Québec,thecoordinatorwillspeakto hospitalmanagementtoseewhetheranoperatingroomcanbeused.

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HÉmA-QuÉBEc suPPORT FOR EsTABLIsHmEnTs

mIssIOn, VALuEs AnD sTRATEGIc PRIORITIEs OF HÉmA-QuÉBEc

Héma-Québecistheorganizationresponsibleforcollecting,processinganddistributinghumantissuesinQuebec.InOctober2001,theMinisterofHealthandSocialServicesauthorizedHéma-Québectoexpanditsmissiontocoverhumantissues.Atthesametime,theministerrecognizedHéma-Québec’sexpertise inhumantissueprocessinganddistributionandauthorizedittotakethenecessarystepstocarryoutits newmission.

Withthisnewmandate,Héma-Québecreformulateditsmissiontoincorporateitsnewresponsibilities.

Héma-Québec’smissionistoefficientlymeettheneedsoftheQuebecpopulationforsafe,optimal- qualitybloodandbloodproducts,humantissues,cordblood,mother’smilk,andcellularproducts;todevelopandprovideexpertise and specialized, innovative services in the fieldof humanbiologicalproducts.

Asinthecaseofbloodproducts,Héma-Québecappliesthehigheststandardsandusesthelatesttech- nologiesinordertoensureasafeandadequatesupplyofhumantissue.ItscommitmentistoensurethattransplantphysiciansinQuebechospitalshaveaccesstosafeproductsforhumantissuetransplants.

Héma-QuébecisbetterknownforitsroleasthesolemanagerofQuebec’sbloodsupply,buthasalsoactedasthesupplierofhumantissuesfortransplantsinceDecember2001.Inadditiontotheremovalofeyetissuefor corneal transplants, the organization provides hospitalswith skin grafts, heart valves andmusculo- skeletaltissuesuchastendonsandbones.Quebecthushasanorganizationsupplyingsafe,highqualityhumantissueforrecipients.

Héma-Québec’sbusinessdevelopmentrepresentativesareavailabletopublicizethehumantissueprod-uctsandservicesHéma-Québecoffersandsupporthealth-careprofessionalswhowouldlikemoreinfor-mationonanyoperationalaspects,fromidentifyinggraftstoreportingadversereactions.

Formoreinformation Héma-QuébecBusinessDevelopmentManager Telephone:514-832-5000,ext.385

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HOsPITAL DEVELOPmEnT PROGRAm

AspartofHéma-Québec’shospitaldevelopmentprogram,allestablishmentsareentitledtosupportandassistance toensure theydevelopand implement tissuedonationbestpractices. In that regard,Héma- Québec’srolesandresponsibilitiesareasfollows:

•MaintaintiesbetweentheestablishmentandTransplantQuébec•Provideassistancetocreateandsupportanorgandonationcommittee•Helpupdatereferencematerials•Helpdispensetissuedonationtrainingaccordingtoidentifiedneeds•Helporganizetissuedonationawarenessandeducationalactivities•Serveasatissuedonationresource•ProvidesupportduringtheAccreditationCanadaprocess

Formoreinformation Héma-QuébecProcurementDepartment Telephone:418-780-4362,ext.2271

TIssuE DOnATIOn cOORDInATIOn PROGRAm In QuEBEc HOsPITALs

InQuebec,coordinationoftissuedonationishandledbyHéma-Québec’steamofcoordinators,whoareavailable24/7.

Theon-callcoordinatorhandlespotentialdonorreferralsand isable toguidemedicalstaff throughallstagesoftissuedonation:

•Identificationofthepotentialtissuedonor•ReferralofthepotentialdonortoHéma-Québec•Discussionswiththefamily•Assessmentandacceptanceoftissuedonor•Donortransfer•Follow-upwithstakeholders,includingthedonor’sfamily

AWAREnEss PLAn

Generalandspecializedcareestablishmentshaveperformedareviewoftheirdeathrecordsinrecentyearsanddiscoveredthatnearly50%ofdeathscouldhaveresultedintissuedonation.Inlightofthegreatnum- ber of potential donors,Héma-Québechasdevelopeda strategy aimedat concentrating its awareness effortsinafewtargetedhospitals.

Thisplansuggestspromotional,training,andrecognitionactivitiesformedicalstaffbasedontheestab- lishment’sclassification.Thoseestablishmentswhosenamesdonotappearinanycategorycancontact Héma-Québecforinformationontheprocess.

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classification of establishments

•Targetcentres•Category1centres•Category2centres

n Target centres

IntheQuebecCityandMontrealareas,14hospitalsweretargetedbasedoneorallofthefollowingcriteria:

• ProximitytoHéma-Québecfacilities• VolumeofreferralstoHéma-Québec• Management’swillingnesstofosteratissuedonationcultureinthefacility

Planned activities

• Quarterlyvisitstocareunits(day,eveningandnight)• Monthlycallstomedicalstaff(day,eveningandnight)• Trainingdays–Customizedorbasedonidentifiedneeds• Recognitionactivitiesformedicalstaff–Eachquarter,Héma-Québeccelebratesthecontributionofthosewhohavereferredpotentialtissuedonors

List of target establishments (14 centres)

montreal and other areas

- HôpitalMaisonneuve-Rosemont- HôpitalduSacré-CœurdeMontréal- CSSSdeLaval,HôpitaldelaCité-de-la-Santésite- CHUM,HôpitalNotre-Damesite- CSSSduCœur-de-l’Île,HôpitalJean-Talonsite- CSSSduSuddeLanaudière, HôpitalPierre-LeGardeursite- CSSSd’AhuntsicetMontréal-Nord, HôpitalFleurysite

Quebec city and chaudière-Appalaches areas

- CHUdeQuébec,Hôpitaldel’Enfant-Jésussite- Institutuniversitairedecardiologie etdepneumologiedeQuébec- CSSSAlphonse-Desjardins,Hôtel-DieudeLévissite- CHUdeQuébec,HôpitalSaint-Françoisd’Assisesite- CHUdeQuébec,CHULsite- CHUdeQuébec,HôpitalduSaint-Sacrementsite- CSSSdeBeauce,HôpitaldeSaint-Georgessite

n category 1 centres (8 centres)

Planned activities

• Monthlycallstomedicalstaff(day,eveningandnight)• Trainingdays–Customizedorbasedonidentifiedneeds• Recognitionactivitiesformedicalstaff(annually)–Eachyear,Héma-Québeccelebratesthecontribution ofmedicalstaffwhohavereferredpotentialtissuedonors

List of Category 1 establishments

montreal and montérégie areas

- CSSSdeSaint-Jérôme, HôpitalrégionaldeSaint-Jérômesite- CSSSChamplain—Charles-LeMoyne, HôpitalCharles-LeMoynesite- CSSSPierre-Boucher,HôpitalPierre-Bouchersite- CHUM,HôpitalSaint-Lucsite

Quebec city and other areas

- CHUdeQuébec,Hôtel-DieudeQuébecsite- MaisonMichel-Sarrazin- CSSSdelarégiondeThetford, HôpitaldeThetfordMinessite- CHUS,HôpitalFleurimontand Hôtel-DieudeSherbrookesites

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n category 2 centres (20 centres)

Planned activities

• Monthlycallstomedicalstaff(day,eveningandnight)• Trainingdays–Customizedorbasedonidentifiedneeds

List of Category 2 establishments

n Other suggested methods

• Toensurereferralofalltissuedonorsintheestablishment

– DistributionofTissueDonationposterstoallcareunits(nursingstation,familyrooms) – Standardizationofpost-mortemdocumentation – Awarenessactivitiesfordepartmentheadandmedicalstaff

• Topromotecollaborativemethods

– DesignationofaresourcepersonatHéma-Québectofollowupwiththepersoninchargeoforganand tissuedonation – Personalizedfollow-upwiththemedicalstaffintheeventofareferralandafterwardifnecessary – Recognitionofmedicalstaffthroughadhocactivities

• Topromoteoutcomemeasurementandensurecontinuousqualityimprovement

– Maintenanceofadepartmentalstatisticsregistry – Maintenanceofahospitalstatisticsregistry – Developmentofperformanceindicators

• To support and assist the clinical and administrative teamshandling organ and tissuedonations in establishments

– Héma-Québectraining – Distributionofdocumentation –Visitstopatientcareunits

montreal and other areas

- CSSSRichelieu-Yamaska, HôpitalHonoré-Merciersite- CSSSPierre-DeSaurel,Hôtel-DieudeSorelsite- MUHC,MontrealGeneralHospitalsite- CSSSJardins-Roussillon,HôpitalAnna-Labergesite- CHUSainte-Justine- MontrealHeartInstitute- CSSSHaut-Richelieu-Rouville, HôpitalduHaut-Richelieusite- MUHC,RoyalVictoriaHospitalsite- CHUM,Hôtel-DieudeMontréalsite- JewishGeneralHospital- Maisondesoinspalliatifs(Saint-Jean-sur-Richelieu)- MUHC,MontrealNeurologicalHospitalsite- CSSSduSud-Ouest–Verdun,HôpitaldeVerdunsite

Quebec city and other areas

- CSSSdeQuébec-Nord, HôpitalSainte-Anne-de-Beauprésite- CSSSdeChicoutimi,HôpitaldeChicoutimisite- CSSSdeJonquière,HôpitaldeJonquièresite- CSSSdeRimouski-Neigette, HôpitalrégionaldeRimouskisite- CSSSdeLac-Saint-Jean-Est,Hôpitald’Almasite- CSSSduNorddeLanaudière, HôpitaldeJoliettesite- CSSSduSuroît,HôpitalduSuroîtsite

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suPPORT

Acoordinatorisavailable24/7ontheorganandtissuedonorreferrallineat1-888-366-7338,option2.

TRAInInG

Héma-Québecrepresentativesmakethemselvesavailabletoexplaintheprocessforidentifyingandrefer-ringpotential tissuedonors.Training iscompletely freeandequipsprofessionals for thisaspectof theirwork.

Formoreinformation Héma-QuébecProcurementManager Telephone:418-780-4362,ext.2271

DOcumEnTATIOn AVAILABLE TO HEALTH PROFEssIOnALs AnD EsTABLIsHmEnTs

Héma-QuébecprovidesQuebecestablishmentswithspeciallydesigned tools thatsimplifyand facilitateidentificationandreferral.

Héma-Québec website

VisittheHumanTissuessectionoftheHéma-Québecwebsite:www.hema-quebec.qc.ca

standardized Tissue standardized tissue donation Donation Procedure procedure flow chart




MARS 2012

Centre hospitalier sans personnel dédié en don d’organes

ThispublicationisavailableontheHéma-Québecwebsite

NE PAS OFFRIR L’OPTION DU DON ÀLA FAMILLE AVANT L’ÉTAPE 3

Prise en charge du processus par Héma-Québec, incluant l’enregistrement d’un consentement téléphonique avec la famille

• VIH-VHB-VHC • Infection systémique active et non traitée • Cancer sanguin (lymphome, leucémie, maladie de Hodgkin) • Alzheimer, Parkinson, démence d’étiologie inconnue

PRÉSENCE D’UN CONSENTEMENT

Colliger : • Formulaire AH 224 • Formulaire SP3 (Déclaration de décès) • Formulaires de transport ambulancier (AS-810 et AS-803P) • Notes au dossier du donneur (48 dernières heures) • Résultats de laboratoire (culture, hémoculture)

ABSENCE D’UN CONSENTEMENT

Présenter l’option du don à la famille et le soutien par un coordonnateur d’Héma-Québec

Consentement Refus

Non Oui

Communiquer avec Héma-Québec :

1 888 366-7338, option 2

Fin de laréférence àHéma-Québec

Fin de laréférence àHéma-Québec

Transmettre les informations médicales nécessaires à Héma-Québec pour la quali�cation du donneur

Réfrigérer le corps (le plus rapidement possible)

1 DONNEUR POTENTIEL DE TISSUS

Personne de 85 ans et moins, vérifier si présence de :

AVANT D’OFFRIR L’OPTION DU DON À LA FAMILLE

■ Vérifier si la carte d’assurance maladie est signée

■ Communiquer avec Héma-Québec :

1 888 366-7338, option 2 Transmettre les informations suivantes : • Nom • Date de naissance • Numéro d’assurance maladie

Héma-Québec fera la véri�cation de la présence d’un consentement aux registres des consentements au don d’organes et de tissus de la Chambre des notaires du Québec (CNQ) ou de la Régie de l’assurance maladie du Québec (RAMQ).

3

2

IDENTIFICATION

RÉFÉRENCE

APPROCHE

4QUALIFICATIONDU DONNEUR ET PRISE EN CHARGE

PROCÉDURE TYPE POUR LE DON DE TISSUS EN RELATION AVEC L’ARTICLE 204.1 (LSSSS)

Patient en mort récente

Outils de référence : www.hema-quebec.qc.ca, section Hôpitaux - Tissus humains Publication Un héritage pour la vie et af�ches disponibles sur le site Web

ThispublicationisavailableontheHéma-Québecwebsite

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http://www.hema-quebec.qc.ca/tissus-humains/index.en.html

http://www.hema-quebec.qc.ca/userfiles/file/Procedure_Doc_SansPersonnel.pdf

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Quick reference card

Medicalstaffreceiveaquickreferencecardlistingtissuedonoreligibilitycriteria.

A Legacy of Life guide

Whenapersondieswithoutmakingknownhisorherdesiretodonateorgansortissues,thedecisionfallstothefamily.A Legacy of Life is intendedforthose families. Ithelps themconsider the requestandmakeaninformeddecision.

Posters

Aseriesofposterswith short personal accounts fromamedical professional, adonor’s family anda recipient’sfamilystressestheimportanceoftissuedonationinhospitalsettings.

Thispublication isavailableontheHéma-Québecwebsite.

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PERFORmAncE InDIcATORs

Totracktissuedonationinestablishments,theStandardizedTissueDonationProcedurehasthreeper- formanceindicators.

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PREREQuIsITEs FOR succEss

Thereareseveralprerequisitestoimprovedorganandtissuedonationperformanceandoutcomes:

•A formalcommitmentby theboardofdirectors,generalmanagement,and theCouncilofPhysicians,Dentists,andPharmacistsingeneralandspecializedcareestablishmentswitharealcultureoforganandtissuedonationtopromotingdonationforthebenefitofpatientsonwaitinglistsandofthecommunity asawhole

•Strongleadershipfromthewholemanagementteam,activelysupportedbythegeneraldirectorandthedirectorofprofessionalservices,withtheparticipationofmedicalteamsandcriticalcareunitmanagers,aswellasadulymandateddonationcommitteethatisactivelysupportedbytheestablishment

•Sufficientorganandtissuedonationtrainingforphysiciansandclinicalstaff,withprioritygiventonursesand respiratory therapistsworking incritical care—firstwhen theyarehired,duringdepartmentalon- boarding,andthenthroughcontinuingprofessionaldevelopmentandskillsmaintenance

•Acommitmenttointroducingbestpracticesfororganandtissuedonation,aswellasoptimalorganizationofservices,includingregular,ongoinganalysisoftheestablishment’soutcomesandperformance

•Recognitionoftheinterdependenciesbetweenidentification,procurement,andtransplantationcentresandestablishmentofthemechanismsneededtoensurecoordinationofdonorservicesateverystage oftheprocessatthelocal,regional,andinterregionallevels

•Communicationsactivities, includingawareness trainingandeducational initiativesdirectedat institu- tionalmanagers,physicians,andstaff,aswellasthecommunityandthegeneralpublic

•ClosecooperationwithTransplantQuébecandHéma-Québectocarryoutorganortissuedonationsfortransplantsorgrafts

•Poolingofexpertiseandsupportforresearch

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cOncLusIOn

Thisorganizationalframeworkfororgandonationandtissuedonationservicesconstitutesaseriouseffortto guide establishments to better structure donation activities and improve outcomes locally and inter- dependentlywithotherestablishments. Improving theperformanceof individualestablishmentsand theentirenetworkwillrequireafirmcommitmentfromboardsofdirectorsandmanagementtodevelopingagenuinedonationculture.Carewillbeneededandsufficientresourceswillhavetobeprovidedinordertoorganizeorganandtissuedonationactivitiesinlinewitheachestablishment’sresponsibilities.Theestab- lishmentwillneedtotakelocalspecificitiesthatapplytoorganandtissuedonationintoaccount.

Ongoingeffortdedicatedtotraining,improvementofpractices,ongoingresultsassessment,clearcoordi-nation,andcontinuedteamengagementwillberequiredtoimproveperformanceandhelpestablishmentsmeetaccreditationrequirements.ClosecooperationwithTransplantQuébecandHéma-Québecwillalso beakeytosuccess.Indoingthis,establishmentswillagainshowtheircommitmenttoservingtheircom-munitiesandfulfillingaresponsibilitytothepublic.

Collectively,wewillbetteraddresstheneedsofwaitingpatientswhilehonouringthewishesofmillionsofQuebecerswhohaveagreedtodonationaftertheirdeaths.Theseeffortswillsavelivesandimprovethequalityoflifeofthousandsofpeople.Byactivelytakingonthissocialresponsibility,generalandspecializedcareestablishmentswillhelptosavethelivesofpeoplewaitingforhearts,lungs,andlivers.Theywillalsomakeskingraftspossibleforpeoplewithsevereburnsandeyetissuegraftstorestorepeople’ssight.Andtheywillenablemanytostopdialysistreatment,generatingsubstantialsavingslocallyandforthesystemasawhole.Thebenefitsforindividuals,families,andsocietyasawholewillbenumerous.

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APPEnDIXEs

APPEnDIX 1

DIsTIncTIOn BETWEEn nDD AnD DcD


Formore informationaboutdefinitions, identificationandeligibility, visit theTransplantQuébecwebsite:transplantquebec.ca/en/identification-and-eligibility

nEuROLOGIcAL DETERmInATIOn OF DEATH (nDD)

91.5% of donors in 2013

MeetstheNDDcriteria

Vitalfunctionsartificiallymaintained(removalwillcausecirculationtostop)

Potentialremovalof8organs(heart,lungs,liver[potentialbipartition],pancreas)

▼

▼

▼

▼

▼

▼

DOnATIOn AFTER cARDIOcIRcuLATORy DEATH (DcD)

8.5% of donors in 2013

Noneurologicaldeathandwithdrawaloflife-sustainingtherapy(LST),regardlessoforgandonation

LSTwithdrawninacontrolledenvironment(operatingroom)

Deathdeclaredfiveminutesaftercardiacarrest

Potentialremovalof6organs(kidneys,liver,lungs,pancreas)

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APPEnDIXEs

Organ procurement centres

InQuebec,ninehealthandsocial servicesestablishmentsat 12sitesaredesignatedasprocurementcentres:

• Centrehospitalierdel’UniversitédeMontréal(CHUM)– HôpitalNotre-DameandHôpitalSaint-Luc•McGillUniversityHealthCentre(MUHC)– RoyalVictoriaHospital,MontrealChildren’sHospital andMontrealGeneralHospital•CHUSainte-Justine•HôpitalMaisonneuve-Rosemont•HôpitalduSacré-CœurdeMontréal•CentrehospitalieruniversitairedeSherbrooke(CHUS)•CHUdeQuébec•CSSSdeChicoutimi•CSSSLesEskersdel’Abitibi

Removalcanalsooccurinothergeneralandspecializedcareestablishmentswhereapotentialorgandonorhasbeeniden- tified,particularlyaftercardiocirculatorydeath.

Organ transplantation centres and programs

InQuebec,eightestablishmentsofferorgantransplantationprogramsat10sites

n Centrehospitalierdel’UniversitédeMontréal(CHUM)– HôpitalNotre-Dame• Lungtransplants•Heart-lungtransplants•Kidneytransplants(includinglivingdonors)•Pancreastransplants

n Centrehospitalierdel’UniversitédeMontréal(CHUM)– HôpitalSaint-Luc• Livertransplants(includinglivingdonors)

n McGillUniversityHealthCentre(MUHC)– RoyalVictoriaHospital• Hearttransplants•Heart-lungtransplants•Livertransplants•Pancreastransplants•Kidneytransplants(includinglivingdonors)

n McGillUniversityHealthCentre(MUHC)– MontrealChildren’sHospital• Hearttransplants•Kidneytransplants(includinglivingdonors)

n HôpitalMaisonneuve-Rosemont• Kidneytransplants(includinglivingdonors)

n CHUSainte-Justine• Hearttransplants•Livertransplants(includinglivingdonors)•Kidneytransplants(includinglivingdonors)

n MontrealHeartInstitute• Hearttransplants

n CentrehospitalieruniversitairedeSherbrooke(CHUS)– HôpitalFleurimont• Kidneytransplants(includinglivingdonors)

n CHUdeQuébec–Hôtel-DieudeQuébec• Kidneytransplants(includinglivingdonors)

n Institutuniversitairedecardiologieetdepneumologie deQuébec• Hearttransplants

Establishments offering living donor programs

• CHUdeQuébec–Hôtel-DieudeQuébec(kidney)•CHUS(kidney)•MUHC–RoyalVictoriaHospital(kidney)•HôpitalMaisonneuve-Rosemont(kidney)•CHUM–HôpitalNotre-Dame(kidney)•CHUM–HôpitalSaint-Luc(liver)

Pediatric establishments offeringliving donor programs

• CHUSainte-Justine(kidney)•MUHC–MontrealChildren’sHospital(kidney)

APPEnDIX 2

ORGAn PROcuREmEnT cEnTREs AnD ORGAn TRAnsPLAnTATIOn cEnTREs

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APPEnDIXEs

Patients on the waiting list and transplant recipients in Quebec, by region, 2013

TOTAL (ALL ORGAns) KIDnEy

PATIEnTs On TRAnsPLAnT PATIEnTs On TRAnsPLAnT WAITInG LIsT REcIPIEnTs WAITInG LIsT REcIPIEnTs

ADmInIsTRATIVE REGIOn POPuLATIOn % OF (n=1,047) % (n=503) % (n=782) % (n=265) %By REGIOn* QuEBEc

POPuLATIOn

01Bas-Saint-Laurent 199,834 2 % 23 2.2 % 7 1.4 % 18 2.3 % 5 1.9 %

02Saguenay–Lac-Saint-Jean 273,009 3 % 26 2.5 % 18 3.6 % 15 1.9 % 7 2.6 %

03CapitaleNationale 707,984 9 % 76 7.3 % 36 7.2 % 45 5.8 % 14 5.3 %

04-17Mauricie–Centre-du-Québec** 498,274 6 % 38 3.6 % 19 3.8 % 33 4.2 % 6 2.3 %

05Estrie 315,487 4 % 37 3.5 % 14 2.8 % 29 3.7 % 11 4.2 %

06Montréal 1,981,672 25 % 360 34.4 % 162 32.2 % 284 36.3 % 95 35.8 %

07Outaouais 372,329 5 % 39 3.7 % 21 4.2 % 24 3.1 % 12 4.5 %

08Abitibi-Témiscamingue 146,753 2 % 14 1.3 % 9 1.8 % 14 1.8 % 5 1.9 %

09Côte-Nord 95,647 1 % 13 1.2 % 2 0.4 % 9 1.2 % 1 0.4 %

10Nord-du-Québec 42,993 1 % 9 0.9 % 3 0.6 % 7 0.9 % 1 0.4 %

11Gaspésie–Îles-delaMadeleine 92,536 1 % 10 1.0 % 5 1.0 % 8 1.0 % 1 0.4 %

12Chaudière-Appalaches 408,188 5 % 30 2.9 % 12 2.4 % 23 2.9 % 10 3.8 %

13Laval 409,718 5 % 57 5.4 % 27 5.4 % 47 6.0 % 10 3.8 %

14Lanaudière 476,941 6 % 39 3.7 % 21 4.2 % 32 4.1 % 10 3.8 %

15Laurentides 563,139 7 % 63 6.0 % 23 4.6 % 47 6.0 % 14 5.3 %

16Montérégie 1,470,252 18 % 175 16.7 % 100 19.9 % 125 16.0 % 53 20.0 %

OutsideQuebecorinformationnotsentbyhospitalfortheregion 38 3.6 % 24 4.8 % 22 2.8 % 10 3.8 %

Total 8,054,756 100 % 1,047 100 % 503 100 % 782 100 % 265 *** 100 %

*Source:StatisticsCanada,adaptedbyInstitutdelastatistiqueduQuébec,February6,2013.**Centre-du-Québecisregion17,butthedatahavebeencombinedwithregion04.***Kidneyanddoublekidneytransplant.

Facts about organ donors

• Potentialorgandonorsareararebreed,accountingforonlyabout1.4%ofpatientswhodieinhospital.

•Adeceasedpotentialdonorwhoisnotidentifiedcanresult inthedeathsofseveralpeople.

•Adeceasedpersoncandonatehisorherheart,liver,lungs,kidneys,pancreas,andintestines.

•Thecauseofdeathfororgandonorsisassociatedwith –Acerebrovascularaccident(CVA)(50%) – Headtrauma(25%) –Cerebralanoxiaorothercause(25%)•Organ donors come from all walks of life and all cultures.Eachdonorisassessedatthetimeofdonation,regardless ofsex,sexualorientation,ethnicorigin,orreligion.

•Organdonorsare foundthroughout theprovinceandatallestablishments,rangingfromonetoseveraldonorsperyear.

• InQuebec,theoldestdeceasedorgandonorwas88yearsold and the youngest, barely 48 hours old. A76-year-old donorsavedfivelives.

•Theaveragedonorin2012was50.1yearsold.In10years,theaveragedonoragehas increasedbysixyears from44 tojustover50.

•Organdonationoftengivesdonors’familiesacertainsenseofcomfortandgivesmeaningtotheworkofmedicalstaff.

•A livingorgandonorcangiveonekidney,a lobe fromthe liver,andoccasionallyalobefromalung.

Patients on the waiting list and transplant recipients in Quebec, by region

Thetablebelowshowsthe2013statisticsforallorgansandjustkidneys,expressedinabsolutenumbersofpeopleandinpercentagesoftheQuebecpopulation.

APPEnDIX 3

ORGAn DOnATIOn PROGREss REPORT – ADDITIOnAL InFORmATIOn

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APPEnDIXEs

Transplant Québec advisory committees

The medical scientific advisory committee consists of 11physiciansfromeachhospitalcentre,universityinstitute,oruniversity-affiliated hospital centre performing transplants orinvolved in transplantation, anduniversity-affiliatedhospitalcentreinvolvedinorgandonation,aswellasthemedicaldirectorofTransplantQuébec.Thecommitteeistaskedwithreviewingandstandardizingmedicalandscientificstandardsandrecom-mendingtotheboardofdirectorspoliciesandproceduresforidentifyingandmanagingdonors,andorganremovalandallo-cation.

Thiscommitteeisassistedbythreesubcommittees(chest,liver,andkidney-pancreas)madeupof representatives fromeachtransplantprogramandonerepresentativeforQuebec’shisto-compatibility laboratories.Theprimary roleof thesesubcom-mittees is to propose state-of-the-art allocation proceduresthattakescientificandmedicaldataintoconsideration.

Theethics committeehaseightmembers.Itspurposeistopromoteethicalreflectionwithintheorganizationontheethicalissuesraisedbyorgandonationandbythepoliciesandproce-duresassociatedwithorganallocation.Thecommitteeregularlyprovidesadvicetotheboardofdirectors,towhichitreports.

FInAncIAL suPPORT – usEFuL DEFInITIOns

• Accepted but not used donor – Deceaseddonorforwhomthe

assessmentandorgandonation processwasinitiatedbutwho,for medicalorotherreasons,couldnot continuetotheorganprocurement stage

• Accepted, retrieved from an invalidated donor – Deceaseddonor

whoisinvalidatedintheoperating roomandfromwhomnoorganswere removedortransplanted

Formoreinformation,refertoTransplantQuébec’sidentificationandpaymentpolicyfororgandonationfromdeceaseddonors.

• Identification centre –Establishment (hospital)thatrecommendedanorgan donorwhowasacceptedbyTransplant Québec

• Procurement centre –Establishment (hospital)whereallstepsleadingupto andincludingorganprocurementtake place

• Accepted organ donor – Deceased donorwho,afteranassessmentbya TransplantQuébecclinicalcoordinator/ advisor,meetsthemedicolegaland logisticalcriteriafororgandonation

• Accepted and used donor – Deceased donorfromwhomatleastoneorgan hasbeentransplanted

APPEnDIX 4

TRAnsPLAnT QuÉBEc suPPORT FOR EsTABLIsHmEnTs – ADDITIOnAL InFORmATIOn

Thefollowingfixedsumsarepaidtoestablishments:

n Identificationcentres• $1,000foreachorgandonoraccepted byTransplantQuébec(sinceMay17, 2013;previously$500)

n Procurementcentres• $7,000foreachorgandonoraccepted andused(sinceMay17,2013; previously$4,500)• $1,000foreachorgandonoraccepted, retrievedfromandinvalidated

TransplantQuébecpaysthesesumstoeachestablishmentannuallyinthesummerfollowingthefiscalyear.

communications and public relations

Activitiesareorganizedthroughouttheyear,including

•Comparisonofstatisticsforthecalendaryearwiththoseof thepreviousyear(mid-February)•NationalOrganandTissueDonationWeek(lastfullweekin April)•WorldOrganDonationandTransplantationDay(mid-October)

AdditionallyTransplantQuébecregularlypublishestheliaisonnewsletterAu cœur du don to informconcernedparties andpartners of initiatives in establishments and communities, aswellastrainingactivitiesandtheavailabilityofnewtools.Thenewsletter can be downloaded from the TransplantQuébecwebsitetransplantquebec.ca/en/publications.

Thewebsiteprovidesawealthofinformation,includingstatis-tics.It isareferencesourceforthepublicandmedia,aswell asprofessionals.

Theorganization’sannualreport isalsoavaluablesourceofinformation on donation inQuebec, year by year. Annual re-portsforrecentyearscanbeviewedattransplantquebec.ca/en/annual-reports.

Formoreinformation,contactTransplantQuébec’scommuni-cationsandpublicrelationsDepartment.

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http://transplantquebec.ca/en/publications

http://transplantquebec.ca/en/annual-reports

http://transplantquebec.ca/en/annual-reports