The need for organs for donation is far greater than organ availability. In the last decade this has led to restructuring and investment in the organ donation programme with political and public support. The majority of transplanted organs are retrieved from patients dying on an intensive care unit, and the wish to consider organ donation as a normal part of end-of-life care has led to considerable pressure on clinicians to adhere to the large amount of practical and ethical guidance being published to achieve this. Organ Donation Management System There has not been universal acceptance of the guidance by critical care clinicians, and this paper explores some of the concerns related to the practicalities of the evolving changes in management of potential organ donation patients within intensive care.
In the healthcare context, organ transplantation has raised to great importance in the last years. Improvements in medical techniques and pharmacological anti-reject therapies have made transplantation a powerful and valid way to treat diseases. Thanks to this, and to the relevance that mass media put on it, the number of donors is constantly increasing all over Europe. The decision to assign an organ from a particular donor to a particular recipient is a very complex process which can be decomposed into the following activities:
- Gather, store and manage a mandatory set of personal and medical information about each recipient and each donor (ex: blood group, weight, height, tissues characteristics,)
- In presence of a donor, find a group of potential recipients which are compatible with the donor with respect to the mandatory sets of information stored
- Among the group of potential recipients, find the one that best fits with the donor. This decision is taken not just on the base of medical parameters (such as the current health state of the patient), but also on the base of logistical considerations (such as the possibility to transport the organ from the donor’s to the recipient’s hospital and the availability of medical teams to perform the operation)
Currently, the way in which the procurement phase tasks are performed is still largely no automated and non-coordinated. The main pitfalls in the transplant process are:
- Medical experts have to consider one by one all the possible receivers and evaluate the matching with weak supports to process large amount of data.
- Information is usually not stored a in compact, re-usable way, therefore the coordination between medical experts and surgeons has to pass through telephone and facsimile.
- Finding the best route involves looking up several timetables of means of transport (such as trains or planes) and making spatial and temporal reasoning to provide the most efficient solution
. • Scheduling the medical teams involves looking up the timetables of operating theatres and medical personnel to find solutions which are available at the required times.
Moreover, the event of not finding a suitable medical team for the operation or a convenient route for the transportation would no longer represent a dramatic problem. In fact, with the matchmaking tool producing a list of potential recipients, the experts would have now to deal with a restricted number of possible receivers and undertaking another matching process would be easier. Moreover, the system could be designed in such a way to exchange information with the other tools and take into account their results, producing a result which is already suitable under the three points of view. Even in the case of multiple organs to be assigned, the process would turn out to be more efficient, since different software tools (one for each organ/medical team/route) could work in parallel substituting human beings and producing results with less cost in term of human resources involved.
Constantly changing environment. Constraints on the system can be added or removed (for example by surgeons), new recipients can register to the waiting list, and new organs can become suddenly available. Possibly conflicting tasks to perform. The best recipient for an organ accordingly to the physical characteristics could be a certain patient, but the presence of a 0- emergency case could force the result to be different. Many different possible courses of actions available. The goal to reach is the selection of a recipient, but the actions through which is possible to get to the goal are multiple and the appropriate one must be chosen every time. For example, with a rare blood group donor, the first criteria of selection (in order to speed up the decision process) could be the blood group, in other cases another criteria could be more efficient.
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