Croatia’s Efforts to Improve

Donation

Mirela Bušić, MD National Transplant Coordinator Institute for Transplantation and Biomedicine Ministry of Health The Republic of Croatia

South Eastern

Europe

The term Balkan is painted in a negative meaning:

violence, religious and ethnic intolerance, the overall

backwardness, corruption and division.

MINISTRY OF HEALTH AND SOCIAL WELFARE

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100

1.

kvartal

4.

kvartal

Istok

Zapad

Sjever

CROATIA

• 4,29 million inhabitants • GDP per capita $15 636 (HALF) compared the EU average $36 663 • 33 acute hospitals (28 county and 5 university) • 5 transplant centers • 10 transplant programs

33.5 pmp donor rate (utilized donors) 93 pmp total transplant rate

GOOD LEADERS?

How can a good leader be

recognized?

• Person is viewed as a guru?

• Satisfied colleagues?

• Admired and respected?

• Charismatic personality, good speaker?

• Outcome and results?

What Are Characteristics of Good

Leaders?

• Vision?

• Organization/managerial skills?

• Passion?

• Creativity?

• Persistance ?

• Supportive/positive thinking?

• Commitment ?

The Four Basic Leadership Styles

• Directing The leader provides specific direction and

closely monitors task accomplishment.

• Coaching The leader continues to direct and closely monitor accomplishments, but also explains decisions, solicits suggestions, and supports progress.

• Supporting The leader facilitates and supports people’s efforts toward task accomplishment and shares responsibility for decision-making with them.

• Delegating The leader turns over responsibility for decision-making and problem-solving to people.

Where I started (11 years ago)?

• Charismatic personality ?

• Managerial skills ?

• Communication skills ?

• Formal training to work in the field - ZERO

• Experience in the field - NONE

• No opportunity to communicate/share/discuss problems

• Lack of knowledge and (self)confidence

• Facing real life situations that are not written nor which can be learned from manuals

Leaders in organ donation and transplantation field that influenced my work

Francis Delmonico TTS Compassionate, friend and guardian angel, diplomatic,

“can do” attitude

Dr. Marti Manyalich Head transplant coordinator of clinical hospital Barcelona Friend, great teacher, passionate,

innovator

Rafael Matesanz, Director ONT .Genuine, level headed, a genius with the media

What is the common denominator

among all these leaders?

• Great people, personally and professionally

• Respected professionals

• Visionaries

• Passionate and dedicated to the their mission

• Committed

• Open-minded

• Humble and willing to help others

How do I lead?

• Women’s intuition

• Vision (Looking at the big picture)

• By being flexible and reasonable

• Passionate yet realistic

• Supportive, inspiring/challenging my colleagues to do their best

• Commited to obtain a goal, no matter how big, small, or impossible as it may seem

• “My way is not always the best way,” I value my trusted advisors/teachers/partners

• Make desicion, act, take responsibility!

The only real valuable thing is intuition."

- Albert Einstein

LEADERSHIP SKILLS

PARTNERING

Evaluation and Monitoring

17

THE CONDITION TEN YEARS AGO

Transplant surgical technique developed but programs almost not active Organ shortage Donor rate bellow 3 pmp Long and outdated waiting lists:

Aprox. 900 patients on the national kidney waiting list Waiting time for a kidney tx ranging beetween 7-15 years

Total lack of organisation (NTO) and administration support No funds alloted to the transplant program Vague organ allocation criteria (heart, liver) Faulty legislation

0

10

20

30

40

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60

70

80

90

CROATIAN TRANSPLANT PROGRAM Transplant Annual rate pmp 1999

How to increase donor rate?

Minister's Instruction in 1998 proposed the following measures:

• defining the structure (organization) for the implementation and monitoring of the deceased donation and transplantation programs success

• organizing procurement/tissue typing teams

• increasing diagnostic equipment availability in hospitals for determining brain death

• allotting funds for deceased donation/transplant program

• planning and providing additional training for professionals initiating organ donation promotion activities for public awareness

• well established brain death criteria

ACTIONS TAKEN TO INCREASE DONOR RATE IN CROATIA

1998 Croatian Donor Network (donor Card) established

2000 In-house coordinators nominated in university/acute hospital

2000 National Transplant Coordinator appointed in the ministry

2000 24 hour Coordination “duty desk “established at the Ministry

2002 Training programs for coordinators launched

2002 Funds allotted for tx program ( education, promotion)

2004 New legislation adopted - presumed consent

2005 HU liver exchange program– international cooperation with Italy

2006 Hospital reimbursement for donor hospitals provided

2007 Public awareness campaign launched ( National Donor Day, EDD)

2007 International cooperation- ET membership

2009 Donor quality program started

DONOR RATE in CROATIA

2000 - 2011

12

32

41 39

59

44

6158

79 77

127

144

7,1

9,1 8,7

13,1

9,8

13,612,9

17,6 17,2

33,5

28,7

2,70

20

40

60

80

100

120

140

160

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

0,0

5,0

10,0

15,0

20,0

25,0

30,0

35,0

PMP

DONORS DONOR RATE

SWOT Analysis

Organ donation and transplantation in Croatia 2001

STRENGHTS

Political support and tools

Vision & Decision making position

Good and close collaboration with professionals/expert

Enthusiasm

Presumed consent/catholic population

Centraised public health care system.

Autonomy and capability of improvisation

OPPORTUNITIES

Creativity

Professional challenge

Growing together with professionals

Education

Creating network

Saving lives

Improving ash uman beeing

THREATS

Interfering with private interest

Resistance to changes

Lack of awarding and punishing tools

Influence of politics

Potential corruption

WEAKNESSES

Inertia of the system and bureaucracy

Lack of organization and administrative support

Lack of understanding of the processes and needs

Health care system burdened and devastated by

homeland war

Inadequate financial coverage ( economic situation)

Chaotic sistuation

Ignorance &Lack of interst in the working enviroment

ORGANISATION

2 LEVEL NETWORK OF TRANSPLANT COORDINATORS

NATIONAL LEVEL

Ttransplant coordinators

Profile: senior year medical students, interns

HOSPITAL LEVEL In House Coordinators

Profile: ICU Doctors/intensivists (part-time extra job)

Organization (NTO)

National Coordination Office 24/7 - Ministry of Health (3+6)

providing service and logistics to all donor and tx hospitals

1 National Transplant coordinator (Medical Doctor)

1 Senior adviser ( Medical Doctor)

1 Psychologist

6 Medical students - flexible contracted

In - house coordinators network (33) ICU doctors, additionally trainned (extra work)

Key donation person at hospital level

Coordination team (doctors, nurses)

Hospital level

National level

Without integrity, motivation is dangerous;

Without motivation, capacity is impotent;

Without capacity, understanding is limited;

Without understanding, knowledge is meaningless;

Without knowledge, experience is blind.

Experience is easy to provide and quickly put to good use by people with all the

other qualities.

- Dee Hock

INTEGRITY

MOTIVATION

CAPACITY

UNDESTANDING

KNOWLEDGE

EXPERIENCE

SELECT AND PROMOTE BASED ON

TPM education

number of trainned health care professionals/transplant coordinators

1

2

3

6

7

12

19

20

24

27

32

37

42

0 5 10 15 20 25 30 35 40 45

1994

2001

2003

2005

2007

2009

2011

Ye

ar

Total number of educated health care professionals

European Donor Day 2010

Public campaign Student medical association at the central Zagreb square

National Donor Day Transplant recipients cooperation-press conference

Public campaigns- NGO’s / Patient’s Assotiations

CROATIA - MEMBER OF EUROTRANSPLANT May 25th 2007

Implementation of donor quality program / hospital control visit /

9,91

13,74

18,02

30,41

34,97

13,06

17,79

0 0 0

6

12

15

00,00

5,00

10,00

15,00

20,00

25,00

30,00

35,00

40,00

2005 2006 2007 2008 2009 2010 2011

Do

no

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per

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on

po

pu

lati

on

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2

4

6

8

10

12

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18

20

Nu

mb

er of su

rveillance

Donors pmp Number of surveillance

828 31 22

36 38 4732 22

37 33 3823

39 41 4524

6179 74

10785

107129

149156

224228

2

2

2151341 1 2

1

920

14

919

20

9

7

43

7

9

6131013

95

11

4

2719

71023

39

343

1

0

50

100

150

200

250

19

72

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73

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74

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20

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20

10

20

11

FROM DECEASED DONORS FROM LIVING DONORS

KIDNEY TRANSPLANTATIONS 2000 - 2011 (all combinations)

LIVER TRANSPLANTS (1990 - 2011) all combinations

18 24 28

4336

44 47

64 60

103

121

9 622

3

2

21

54

11

2

0

20

40

60

80

100

120

140

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

DECEASED DONATION LIVING DONATION

HEART TRANSPLANTS (1988 - 2011)

36

42

64 4 4 5

96

3

9 97 8

6

14 15

20 20

3638

0

5

10

15

20

25

30

35

40

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

HEART TRANSPLANTS

200

250

300

350

400

450

500

Eurotransplant International Foundation, February 2012

Data from the Croatian Ministry of Health, January 2012

NARROWING THE WAITING LIST in superior level of the organ donation rate > 28 ppm

nu

mb

er

of

pati

en

ts

2008 2009 2010 2011

waiting list: 36%

number of transplantations: 62%

WHY ? • Sustained joint effort in improving donor

program in hospitals

• Hospitals donor programs closely monitored and supported by NTO

• Donation program implemented as social responsibility

• Partnering with In-house coordinators, health workers, NGOs and the public

• Working together in the creating a new attitude and perception in donation

• Eurotransplant membership (trust and transparency in the allocation process)

BOOSTING THE DONATION RATE IN

CROATIA 2007-2011

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2006 2007 2008 2009 2010 2011

How does Croatia compare with

other countries

Transplanted organs in 2010 pmp

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60

70

80

90

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Po

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Small bowel

Pancreas

LungHeart

Liver

Kidney

Source: Newsletter Transplant of the Council of Europe 2011

Transplanted livers pmp in 2010 from both living and deceased donors

Source: Newsletter Transplant of the Council of Europe 2011

Transplanted kidneys pmp in 2010 both from living and deceased donors

Source: Newsletter Transplant of the Council of Europe 2011

Actual deceased organ donors in 2010 per milion population

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5

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15

20

25

30

35

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EDM

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NUMBER OF ORGAN DONORS (PMP)

Source: Newsletter Transplant of the Council of Europe 2011

The SEE (HN) Project on Organ Donation and Transplant Medicine, RHDC Croatia - Ministry of Health Republic of Croatia

South East Europe Initiative on Deceased Organ Donation

SEE Meeting, Skopje, Macedonia, May 26-27, 2011

• Zagreb meeting, Ferbruary 2011

Introduced the RHDC and its collaborative partner organisations (TTS,ISODP,ESOT,ETCO)

• Established a network of SEE country partners - National Focal Points

• Create personal relationships, network, and get to know each other and share the experiences

Croatia SEEHN Regional Health Develoment Center on

Organ Donation and Transplantation

SEE(HN) RHDC Croatia - - Ljubljana Meeting March 15-17th, 2012

Workshop on Brain Death Determination

Lydia Raley

RHDC Croatia Project Manager

Montenegro , experts mission, May 2012

About leadership Situational Leadership is not something you do to people but something you do with people

Kenneth Blanchard, Patricia Zigarmi, Drea Zigarmi

Good leader A leader must have integrity .. People have to believe that you are pursuing your dream because it's the right thing to do, not just because you are ego driven… F. John Reh

48 MINISTRY OF HEALTH

49 2.Tečaj za transplantacijske

koordinatore Brijuni 05.-08.11.09

Thank you for your attention!

MB