Development of Poland's Central Bone Marrow Donor Registry Affects Donor Searches for Patients With Hematological Diseases.

In the last 10 years, numbers of donors in the case of Polish potential unrelated hematopoietic stem cells (HSC) have increased dynamically, reaching 1,900,000 in 2020 (including donors presented in World Marrow Donor Association as PL6). On the world scale, the share of Polish donors in the global registry increased from 1% in 2010 to about 5% in 2020. The level and range of typing of potential donors has also been improving steadily toward the international "gold standard." At the end of 2020, 92% of Polish resources were at least HLA-A, B, C, DR, DQ high- or intermediate-resolution typed, mostly by way of genomic typing techniques, mostly by way of genomic typing techniques. The Central Bone Marrow Donor Registry (CBMDR) also stands out in terms of the young ages of potential donors. As of 2020, 27.2% of those registered were younger than 30 years of age, and 36.3% were aged between 30 and 40 years. Sixty percent of registered donors were female. The data in question were presented at the World Marrow Donor Association Search & Match Service, ensuring their visibility and accessibility to Polish and international search units and registries. In 2020, donors in Poland were the subject of almost 18,000 search requests from 40 countries, with 271 extended typing requests and more than 7600 confirmatory typing requests. The total number of donations from Polish donors also increased. In 2020, HSC of bone marrow, peripheral blood, or lymphocytes were collected from 1391 donors, as opposed to 94 donors in 2010. The growing number of donors available in the CBMDR means a better chance of a donor being found among Polish resources, without any need to resort to international registers. Although in 2010, just 24% of Polish recipients received HSC from Polish donors, by 2019 the figure was as high as 67%, and reached 63% in 2020. The CBMDR is an example of proper strategy on registry development being implemented in Poland.

Quality System of Kidney Donation for Transplantation From Living Donors in Poland.

OBJECTIVE: The program aims to build and develop a high-quality donation system at the hospital and national level. Thirty coordinator posts for the transplantation of kidneys from living donors (LDs) were created. The coordinators' tasks were identified as determining or excluding the possibility of LD donation for kidney transplantation for every potential kidney recipient referred to the waiting list, qualifying potential LDs, supervising health monitoring for LDs and kidney recipients, and education and promotion of transplantation from LDs. METHODS: The coordinators' reports and verification of data in the national transplant register from June 1, 2018 to November 30, 2019 were analyzed. ETHICS: The study was conducted according to principles of the Declaration of Helsinki, and the Declaration of Istanbul participation was on a voluntary basis. RESULTS: Information on possible LDs was obtained from 707 (43%) of the 1630 potential recipients entered on the waiting list. In 373 cases there was no potential LD; 16 recipients did not give consent for kidney transplantation from a LD; for 318 recipients, 340 potential LDs were identified; 90 potential LDs were rejected at the initial stage for medical reasons; 60 potential donors were rejected at further stages of the qualification process; 3 persons resigned from donation; and 23 recipients were transplanted from deceased donors. Kidneys from 73 LDs were qualified and transplanted. On November 30, 2019, 91 potential donors were awaiting further qualification. As part of the program, 27 potential pairs for paired kidney exchange were reported to Poltransplant (17 pairs with positive HLA crossmatch, 10 with incompatible blood groups). CONCLUSIONS: The creation of posts for coordinators for LD kidney transplantation in centers that qualify for LD kidney transplantation enabled systematic monitoring of donation potential, which led to an increase in the number of LD kidney transplants in 2019. Making full use of donation potential should significantly increase these numbers in the coming years.

Transplant Coordinators' Opinions Regarding the Decreasing Indicator of Organ Donation From Deceased Donors in Poland.

Despite the good overall condition of Polish transplantation medicine there is a shortage of organs for transplantation. Health care is also in a stage of development with problems including insufficient funding and lack of personnel. In 2015 the number of deceased organ donors in Poland was 526, which was distinctly lower than in 2014 when it reached 594. The aim of this paper was to collect, elaborate on, and summarize the opinions of transplant coordinators regarding the decrease of donation indicators in Poland. MATERIALS AND METHODS: The opinions of the transplant coordinators were collected during training meetings and questionnaires performed in 2016. The questionnaires targeted coordinators of active hospitals (above 5 retrievals a year) and less active donor hospitals. RESULTS AND DISCUSSION: Transplant coordinators indicated a number of factors that influence donor hospital activity, such as changing roles of intensive care units, changes in hospital flow of patients in critical condition, lack of nurses and anesthesiologists resulting in work overload, changes in forms of doctors' employment, low basic income of health professionals, difficulties in determination of brain death, decrease in engagement of transplant centers in cooperation with donors' hospitals, inadequate in-hospital training meetings, undermining of authority of doctors and medical personnel, change of attitude towards transplantation medicine (treated as profitable, regular specialty), insufficient funding of hospitals and personnel for deceased donor recruitment, and disobeying the rules of personnel remuneration for their engagement in donation and retrieval. CONCLUSIONS: Analyzing the opinions of the coordinators, we can state the following: 1. support of the hospital or hospital unit management is crucial for effective donation programs, 2. there is a need to build and implement a hospital quality systems covering each stage of donor recruitment as well as hospital trainings, 3. there should be a transplant coordination team rather than a single coordinator, 4. transplantation centers should maintain good cooperation with donor hospitals, and 5. intensive care unit personnel identification with their own hospital, which is less likely in the case of "locum" employment, is one of the major factors supporting donation programs.

Organ and Tissue Procurement From Non-residents Deceased in Poland: Guidelines for Transplant Coordinators.

Due to increasing global mobility, the number of non-residents who are potential deceased organ donors is likely to increase as well. Since 2014, 14 deceased foreigners have been referred as potential organ donors in Poland. There are, however, no precise international agreements between Poland and other countries regulating this issue. The aim of this paper is to provide guidelines on this subject for transplant coordinators. While there are no differences in the algorithms of potential donor identification, death diagnosis, donor management, organ procurement and preservation, allocation, transportation and transplantation, and the medical evaluation of a foreigner as a potential organ donor may differ. In certain cases, the risk of tropical or endemic infections should be evaluated. The authorization of the procurement may differ as well-foreigners who are not listed in the Polish Electronic System for Registration of Population cannot be registered in Polish Central Registry of Objection. They may have also not expressed refusal or consent for donation due to different legal solutions in their home countries. The donor's family and the proper diplomatic representative must be involved in donation process in order to obtain authorization for organ donation, to acquire essential medical information about the donor, and to ensure the transparency of the process. The procurement of organs, tissues and cells from foreigners deceased in Poland may be performed provided that a proper donor qualification process is conducted, the deceased had not objected to donation, there is no objection on the part of the donor's family or the prosecutor (if required), and the donation and procurement are properly described in medical documentation.

Hospital Profiling and Hospital Stratification System as a Step for Assessment the Potential of Organ Donation From Deceased Donors.

AIM: To be able to calculate the potential of organ donation from deceased donors in a single hospital, region, and country, it is necessary to develop a useful stratification system for all hospitals taking into account their characteristics in having or not having departments crucial for donor identification and recruitment, such as an intensive care unit (ICU or neurology and neurosurgery departments), number of beds, and patient profiles (pediatric vs adult). MATERIALS AND METHODS: There are 1032 hospitals in Poland, and 388 have facilities and tools to confirm death according to neurological criteria. These hospitals with the potential of deceased donation were characterized accordingly to the criteria presented above. RESULTS: The largest group of institutions were first-degree referral hospitals having ICUs only for adults (161 hospitals), followed by hospitals with ICU and stroke departments for adults (76), then hospitals for adults with ICU and neurological department with no stroke beds (25), and hospitals for adults with second-degree referral and with ICU, stroke departments, and neurosurgery. In the case of pediatric patients and possible pediatric organ donation, the largest group consisted of 5 hospitals with pediatric ICU, pediatric neurology, and pediatric neurosurgery units. The remaining hospitals were unique in the country range. An exemplary analysis of 1 of the 40 stratified groups (19 out of 388 hospitals) showed that differences in actual activity in the donation process between similar hospitals are significant (from 0 to 62 donations in a 3-year period). CONCLUSION: We believe the results of this study are fundamental for the calculation of potential donation in the country. Our thesis is that hospitals from the same group should have the same potential and should be active in donation process on the same level. Formal comparative analysis of historical data on donor referral from active and nonactive hospitals will allow us to estimate the lost numbers of possible donations and will help focus efforts to improve transplantation systems.

Results of Transplantation of Kidneys Procured From Donors After Brain Death Aged 60 Years and Older.

OBJECTIVE: To analyze results of transplantation of kidneys procured from donors after brain death aged 60 years and older (hereafter denoted by "≥60") compared to kidneys procured from donors after brain death aged 40-59 years (hereafter denoted by "40-59") in medium-term follow-up period, and to assess factors that affect recipient and kidney graft survival. MATERIAL AND METHODS: 92 transplant recipients of kidneys procured from donors after brain death ≥60 were enrolled into the study. The control group were 363 recipients of kidneys procured from donors after brain death 40-59. RESULTS: Mean values of serum creatinine were higher in recipients of kidneys procured from donors after brain death ≥60 compared to control after 3 years: 168.2 ± 57.5 (n = 59) vs 147.9 ± 65.7 (n = 294), P < .05; and after 5 years: 196.2 ± 95.3 (n = 38) vs 157.3 ± 80.0 µmol/L (n = 211), P < .01. Restricted mean recipient survival time was 56.4 (95% confidence interval: 55.0-57.8) and 52.0 (48.0-56.1) months, P < .05; and kidney graft survival time was 51.6 (49.6-53.5) and 43.9 (39.0-48.9) months, P < .01 in recipients who received kidneys from donors after brain death 40-59 and from donors after brain death ≥60 respectively. In Cox regression, donor death due to cardiovascular disease proved to be the factor increasing risk of kidney graft loss (hazard ratio 1.553, P < .001). CONCLUSIONS: The survival and function of kidneys procured from donors after brain death ≥60 at medium-term follow-up remain worse compared to kidneys procured from donors after brain death 40-59, and the donor dependent risk factor of kidney graft loss is cardiovascular disease, which caused donor death.

Kidney Transplant Recipients With Rheumatic Diseases: Epidemiological Data From the Polish Transplant Registries 1998-2015.

Chronic kidney disease (CKD) is a common complication of rheumatic disorders. We analyzed the incidence of different rheumatic conditions as a primary diagnosis of end-stage renal disease (ESRD) in kidney transplant recipients in Poland. Data were received from the national waiting list for organ transplantation (Poltransplant) registries. Primary diagnosis leading to ESRD were analyzed in 15,984 patients who received kidney transplants between 1998 and 2015. There was no information about primary diagnosis in 4981 cases (31%) and in 1482 cases (9%) the diagnosis was described as unknown. Rheumatic diseases were specified in 566 (5.14%) kidney transplant recipients: lupus erythematosus, (systemic lupus erythematous nephritis) in 211 (1.92%), vasculitis in 176 (1.60%), amyloidosis AA in 82 (0.75%), hemolytic uremic syndrome in 59 (0.54%), secondary glomerulonephritis in 24 (0.22%), scleroderma in 9 (0.08%), rheumatoid arthritis in 4 (0.04%) and Sjögren syndrome in 1 (0.01%). Graft survival at 1 and 5 years were significantly better in the nonrheumatic versus rheumatic group (90 vs 87% and 76 vs 72% respectively, P = .04). Recipient survival at 5 years was significantly better in the nonrheumatic versus the rheumatic group (88 vs 84%, P = .02). Our study showed that systemic lupus erythematosus and systemic vasculitides are the major rheumatic causes of ESRD in the Polish population. Long-term graft and recipient survival were significantly better in the nonrheumatic versus the rheumatic group in the Poltransplant cohort.

Results of Renal Transplant From Deceased Anti-hepatitis C Virus Donors, Poland 1998-2012.

Kidney transplant (KTx) is the best method of renal insufficiency treatment. In dialyzed patients, mortality rises with the time on dialysis. There is a continuing shortage of organs for transplantation, hence a propensity to expand the donor pool with expanded-criteria donors, anti-hepatitis C virus-positive included. In the above case a transmission of hepatitis C virus (HCV) genotype to recipient is present. It has been proven that contamination with more than 1 HCV genotype did not worsen KTx outcomes. There are 2.6% anti-HCV(+) donors in Poland. Use is only possible in cases of anti-HCV(+) and anti-HCV RNA(+) recipients. METHODS: Retrospective analysis covered 8675 deceased donors (1998-2012 Polish data from Poltransplant). The early (after 12 months) and late (after 60 months) graft and patient survival was assessed in KTx recipients, with documented recipient and donor data spanning at least 1 year after KTx. In comprehensive analysis, 7016 KTx recipients with known anti-HCV status were included according to anti-HCV profile of recipient and donor. The results are in absolute and percentage values and P < .05 assessed with χ2 test. RESULTS: Twelve-month survival: recipient (R) (95%), graft (G) (89%), total; R (95% vs 89%, P < .001), G (88 vs 79, P < .001) in HCV(-) to HCV(+/-) vs HCV(+) to HCV(+); R (95 vs 94, P = .2), G (88 vs 83, P < .001), HCV(-) to HCV(-) vs HCV(-) to HCV(+); R (93 vs 95, P = .004), G (82 vs 89, P < .001) in HCV(+/-) to HCV(+) vs HCV(-) to HCV(-); R (95 vs 89, P < .001), G (88 vs 79, P < .001) in HCV(-) to HCV(-) vs HCV(+) vs HCV (+). Sixty-month survival: R (86%), G (75%), total; R (84 vs 88, P = .01), G (63 vs 71, P = .001) in HCV(+/-) to HCV(+) vs HCV(-) to HCV(-); R (88 vs 80, P = .003) in HCV(-) to HCV(-) vs HCV(+) to HCV(+). CONCLUSIONS: The worst anti-HCV serological profile was HCV(+) to HCV(+), although transplanting HCV(+) to HCV(+) did not worsen outcomes in that group. Worse KTx outcomes of HCV(+) over HCV(-) donors can be attributed to HCV(+) status of the recipient.

Relationships Between Social Attitudes Toward Deceased Organ Donation and the Donation Rates in Poland, a Country With an Opting-out System.

BACKGROUND: Monitoring of attitudes toward deceased donation gives the general view of the acceptance of this treatment but does not allow for precise prediction of single person's behavior. Consistency of actions and attitudes has many determinants, personal and situational. The idea of this study was to assess and compare relationships between behaviors and attitudes toward postmortem organ donation in single districts and between larger regions of the country (west and east). METHODS: Indicators calculated for the years 1996-2014 included the number of potential deceased donors (per million population [pmp]/y), the number of objections registered in the refusal registry (pmp), and the number and percentage of family refusals to donation. To assess relationships between variables, statistical and descriptive analyses were used. RESULTS: There were 10,731 potential donor referrals: 10 times more in the most active than in the least active province. Potential donor referrals from the western region were almost twice as high (18.3 pmp/y) as from the east (10.1). In 1,045 cases (9.7%), organs were not used owing to objections of the relatives; this index differed in each province up to 7-fold, but was almost the same in western and eastern regions. Total number of objections listed in the Refusal Registry was 28,725 (748 pmp). This index was different in each district up to 4-fold, but was not distinctly different in west and east regions. No distinct correlation (Pearson test) was found among the 3 assessed variables. CONCLUSIONS: Donation in Poland has much geographic differences. There is no common pattern of behavior and attitude toward donation and no correlation between these variables.

Implementation and Sustainability of European Training Program on Organ Donation in Poland: Results and the Impact on Donation Indicators.

BACKGROUND: Hospital training called ETPOD-Essentials in Organ Donation-was introduced in Poland in 31 hospitals with under-utilized potential of donation. The aim of this study was to assess the effect in hospitals included and not included in program, before and after trainings. METHODS: The number of potential and effective donors, organs used, and number (%) of family refusals were compared at 10 and in 20 months after the training and in equal periods before. RESULTS: In trained hospitals, the number of potential donors increased (17% in 10 months, 10% in 20 months); in remaining hospitals, donors increased in 5% in both periods. In hospitals included in ETPOD, the number of effective donors increased (2% and 4.5%); in the whole country, donors also increased (5.6% and 2.7%). In ETPOD hospitals, the number of utilized organs increased (14.5% and 8.5%); in the rest, the increase was 3% and 7%. In trained hospitals, family refusals increased from 6.9% to 16.2% and from 8.9% to 10.7%; in the whole country, family refusals decreased from 11.7% to 11% in the short term and increased from 9.6% to 12.1% in the long term. CONCLUSIONS: In hospitals involved in the ETPOD program, the increase in organ donation is greater than in the rest of hospitals. Distinct benefit was observed in consent to organ donation.

Central Register of Objections for Deceased Donation in Poland 1996 to 2014: The Country With an Opting-Out System.

BACKGROUND: Organ, tissue, and cell procurement from deceased donors for transplantation requires consent and authorization, documented donor's positive acceptance, or lack of objection to donation expressed while alive (consent). It also requires the fulfillment of other legal conditions required by law, such as person's legal abilities to act in this field or to obtain approval for donation (authorization). Consent to and authorization of donation from deceased donors requires regulations at the national level. Poland developed an opting-out policy with the Transplantation Act in 1996. The Central Register of Objections (CRO) was introduced on November 1, 1996. The purpose of this article is a formal analysis of all submitted objections and objection withdrawals managed by the CRO since the introduction of the registry in 1996 until the end of 2014. MATERIALS AND METHODS: All data collected by the CRO during 18 years of service was subject to analysis. The objections and withdrawals of objections are summarized in the tables, along with the age, sex, and place of residence of the registered residents. RESULTS: By December 31, 2014, a total of 29,288 records were registered, including 29,013 registered objections and 275 registered withdrawals of objections; this means that 0.075% of the country's population expressed objection to posthumous tissue and organ donation for transplantation. Legal representatives submitted 4208 declarations (15.6% of all declarations). The largest inflow of objections took place in 1997, the first full year of CRO activity. CONCLUSION: CRO is an indispensable option in a country with opt-out system as a part of organ donation authorization protocol. Number of registered objections is extremely low, in practice, this leads to a situation where the will of the deceased most often is obtained from his family.

Liver Donation and Transplantation in Poland: Numbers, Indicators, and Trends.

We aim to provide a panorama of liver donation and transplantation in Poland, where each year around 300 liver transplantations from deceased donors and 20 liver fragment transplantations from living donors are performed. This means about 9 transplantations per population of 1 million. Each year, the number of deceased donors reaches more than 500. In more than 50% of cases, livers are used. The law allows liver procurement from living donors. Until the end of 2013, liver fragments were recovered from 236 living donors and transplanted mainly to pediatric recipients (n = 232). A living-donor registry was created to monitor and assess the health condition of donors. The range of the national waiting list and allocation is nationwide. It is managed with the use of the Web tool www.rejestry.net. There are 2 modes of recipient referral: "urgent" and "elective." Allocation is either patient oriented and center oriented. Disease groups, which comprise the most frequent indications for transplantation in adults, include the cirrhosis group (48%), in which the highest number of procedures was performed for patients with hepatitis C virus (24%); alcohol-induced cirrhosis (14%); alcohol-induced hepatitis (8%), and hepatitis B virus cirrhosis (7%). Among pediatric recipients, the most frequent indications were congenital cholestatic diseases, which made up 38% of all transplantation indications. The results of liver transplantations are collected in the national transplant register. The 1-year graft and recipient survival with deceased donor transplantation are 81% and 84% and with living donor transplantation 86% and 89%. The 5-year graft and recipient survival in deceased donor transplantation are 69% and 73%, and in living donor transplantation are 80% and 83%.

Liver Transplant Registry in Poland: Web-Netted Quality Tool in Liver Transplantation From Deceased and Living Donors.

BACKGROUND: Poltransplant managed a national transplant registry with the use of the Web tool www.rejestry.net. It collects information about all organ transplantations in the country along with outcomes. This article presents a formal analysis of data collected in the registry for the years 1998 to 2014. MATERIALS AND METHODS: Results presented are actual, not extrapolated, numbers; these were calculated only for the events for which the observation was complete, meaning that a given term of follow-up had passed and the information on recipient's and graft survivals were available. RESULTS: All liver transplant procedures were registered from the years 1998 to 2014, with follow-up data completeness of 89% to 99%. Detailed statistical descriptions of liver transplant results were significantly better for transplants from living donors, in comparison to deceased donors, for pediatric recipients. Results for pediatric and adult recipients did not vary if the organ was from a deceased donor. Elective and primary transplantations have significantly better results in comparison to urgent and re-transplanted cases. Results depend on indications for transplantation. Significantly better results were obtained in the case of cholestatic diseases and cirrhosis other than hepatitis C virus. Significantly worse results were obtained in acute liver failure, independently of etiology. Results in the case of hepatitis C virus cirrhosis, metabolic diseases, and neoplasms do not vary significantly. CONCLUSIONS: The strength of these findings are based on the registry's reliability and completeness. The registry fulfills its aims related to collecting records and monitoring graft function, and recipient survival. The data are an important source of information, to be used by transplantation institutions and referred to in the literature.

The Model of Postgraduate Studies for Transplant Coordinators in Poland: 500 Graduates in the Years 2007-2015.

BACKGROUND: Since 2007, the Medical University of Warsaw has been organizing the Transplant Coordinators Postgraduate Studies, which are funded by the National Programme for the Development of Transplantation Medicine. The aim of the studies is to recruit medical professionals for every hospital with the potential of deceased donations. The goal of the present study was to formally evaluate the previous 16 editions of Transplant Coordinators Postgraduate Studies by assessing graduate profiles and analyzing the efficiency and sustainability of their education. METHODS: Graduate profiles were determined by gathering sociodemographic information contained in student records. Training efficiency and sustainability were defined by assessing the actual performance of the coordinators' functions in the hospital after taking the course. RESULTS: As of May 2015, the number of Transplant Coordinators Postgraduate Studies graduates totals 501. Approximately one half of the graduates (n = 248) had nursing degrees; training was also finished by 199 physicians, and 54 individuals had other medical education. The number of graduates per million population across the whole country totals 13. A total of 226 of the graduates (45%) were employed in the years 2007-2015 in hospitals as transplant coordinators; physicians (93 graduates), nurses (107 graduates) and other medical proffessionals (26 graduates). CONCLUSIONS: The academic formula of the Transplant Coordinators Postgraduate Studies funded by public sources makes it possible to educate practicing staff (physicians and nurses alike) for a nationwide system of donor hospital transplant coordinators posted in >200 hospitals and maintained by a national transplant organization.

Effective Application of a Quality System in the Donation Process at Hospital Level.

This article describes the application of a quality system at the hospital level at the Multidisciplinary Hospital in Warsaw-Miedzylesie in Poland. A quality system of hospital procedures (in accordance with the ISO system 9001:2008) regarding the donation process, from the identification of a possible donor to the retrieval of organs, was applied there in 2014. Seven independent documents about hospital procedures, were designed to cover the entire process of donation. The number of donors identified increased after the application of the quality system. The reason for this increase is, above all, the cooperation of the well-trained team of specialists who have been engaged in the process of donation for many years, but formal procedures certainly organize the process and make it easier.

System of Monitoring Potential Deceased Organ Donations in Over 200 Hospitals in Poland Using a Web Tool: Implementation and Structure.

BACKGROUND: In 2010 the formation of the Polish Hospitals Network of Organ Donation Coordinators, originated by Poltransplant, began. One of the goals of this project is to report all deaths in hospital ICUs in which a coordinator is posted. The aim of this strategy is to monitor donation potential, following the recruitment process of potential donors and indicating stages of that process that may be improved to increase effective recruitment. Until the end of 2014 all data were forwarded to Poltransplant as Excel files, but since January 1, 2015, reporting and data collection have been are performed using web tool www.koordynator.net. AIMS: The aim of the paper is to present the essentials in functioning principles, structure, and usage of the www.koordynator.net system, its technical construction, and to display good practices (know-how) tested by 1 country, for countries such as Poland, that contend with organ insufficiency. METHODS: The application www.koordynator.net allows for remote addition of individual records with information about deceased patients in hospital ICUs, the forwarding of data about potential and actual organ donors, the generation of complete reports about deceased patients in each hospital monthly, and the introduction of historical data. SUMMARY: Introduction of a potential donation monitoring system in 209 hospitals with transplant coordinators increases the number of identified potential and effective actual donors due to self-assessment analysis. Eventually, the www.koordynator.net reporting system allowed for external evaluation by coordinators from other hospitals, regional coordinators, and Poltransplant. The system is a modern tool that improves and increases the quality system in the organ donation field (quality assurance program).

Organ Donation From Elderly Deceased Donors and Transplantation to Elderly Recipients in Poland: Numbers and Outcomes.

The age of a donor and recipient is one medical criterion in the kidney allocation system. The number of elderly donors and recipients is steadily growing. The aim of the study was to retrospectively evaluate the 5-year results of kidney transplantation from donors over 65 years of age to recipients over 60 years of age. In the years 1998 to 2010, 8526 potential deceased donation after brain death organ donors and 8206 people (81%), who had been treated with transplantation of kidneys were referred to the Poltransplant. The actual number of deceased donors >65 years was 358 and <65 years was 7207. The actual 5-year survival of a kidney transplant from donors >65 years was 59.2% (55.3% of recipients >60 years and 60.7% of recipients <60 years of age; P < .0001) and from donors <65 years was 75.1% (67.5% of recipients >60 years and 75.7% of recipients <60 years; P < .0001). The actual 5-year survival of kidney recipients from all donors >65 years was 75.6% (79.5% younger recipients vs 65.9% elderly recipients; P < .0001). The 5-year survival of kidney recipients from all donors <65 years was 88.1% (P < .0001); 89% younger recipients and 74.3% elderly recipients (P < .0001). The above analysis of the material from the Polish registry displayed significantly worse results of kidney transplantation from donors >65 years, regardless of the age group of recipients.

Assessment of Donation Potential After Circulatory Death as the First Step in Implementing and Running a Hospital Program of Organ Procurement.

BACKGROUND: In Poland the potential for organ donation from donation after circulatory death (DCD) donors is not known. This assessment will allow the hospital to create a quality organ harvesting system from this group of donors. AIMS: The aim of this study was to assess the DCD potential based on retrospective analysis of hospital deaths at Hospital Infant Jesus in Warsaw. METHODS: Documentation of 718 deceased patients from 2010 to 2014 was analyzed. This population could be classified as potential DCD donors in IIb category. The deceased's characteristics were analyzed while undergoing the qualification process for DCD. The analysis was to confirm the presence or absence of factors disqualifying kidneys from donation and transplantation. Data from particular departments and from the entire hospital were analyzed. RESULTS: The total number of deaths was 718. Excluding factors from the DCD donation process were found in 664 cases (92%), mainly age >60 and concomitant diseases. The rest of the patients (n = 54.8%) did not have factors that would exclude DCD donation. Group characteristics are given in detail. SUMMARY: The attempt to measure donation potential was done at the Hospital of the Infant Jesus in Warsaw, a large, multispecialty hospital with intensive organ donation and transplantation programs. Results show a potential for DCD donation (54 potential donations over the last 4years), which allows us to create a quality system and algorithms for organ donation after circulation death.

National Transplants Registry in Poland: Early and Long-term Results of Organ Transplantations in the Years 1998 to 2014.

BACKGROUND: In 2006, the National Transplants Registry, administered by the national transplant organization, was introduced in Poland for monitoring the results of organ transplantations. Statistical analysis is published yearly in Poltransplant Bulletin and publicly available on the website and reported to European institutions. The Transplants Registry cooperates with another registers functioning on-line, based on the web-net tool www.rejestry.net. We present the formal analysis of data collected for the years 1998 to 2014. METHODS: Analysis covered the total number of organ transplantations in every transplant center; outcomes after 3 months and 1, 3, and 5 years; and if data were available after 10, 15, and 20 years from transplantation. Results presented are real, not extrapolated. RESULTS: Some examples are as follows. The total number of deceased kidney transplantations was 15,009; 1-year recipient survival was 95%, graft survival was 88% (data completeness of 81%), 5-year recipient survival was 87%, and graft survival was 74% (data completeness of 82%). The total number of deceased liver transplantations was 3143; 1-year recipient survival was 84%, graft survival was 81% (data completeness of 99%), 5-year recipient survival was 73%, and graft survival was 89% (data completeness of 99%). CONCLUSIONS: The National Transplant Registry is an important tool for quality and safety systems in the transplantation field on the national level. Nowadays, the Registry efficiently and effectively fulfills its tasks related to collecting records of all performed transplantations. Monitoring function for graft and recipient survival is also satisfied. Collected numbers are an important and unique source of information to be used by transplant institutions and referred to in the literature.

Evolution of Organ Transplantation in Poland 1966 to 2014: Dates and Numbers.

BACKGROUND: Several events inspired us to collect data on organ transplantation in Poland (2016: the 50th anniversary of the first transplantation and the 20th anniversary of Polish Transplant Coordinating Center Poltransplant). The paper aims at presenting comprehensive data on all organ transplants, beginning with the first in 1966 (deceased kidney) until the end of 2014. METHODS: Source documents were reports published in Poltransplant Bulletin, a website registry managed by Poltransplant, reports by the Transplantation Council and by the Transplantation Institute of Warsaw. A source data enabled us to establish a preliminary report, presented for verification during the 12th Congress of the Polish Transplantation Society. RESULTS: By the end of 2014, the total number of organ transplants was 26,691. Kidney transplantation is the most common (total number = 19,812). The number of living kidney transplants is low, about 50 per year. The number of liver part transplants from living donors is relatively high, 20 to 30 annually. The program of deceased liver transplantation results in more than 300 transplants yearly. The first heart transplantation was in 1985, but the number of these procedures has been decreasing. No significant increase in the number of lung transplantations was noted. CONCLUSIONS: The number of organ transplantations from deceased donors places Poland in the middle among European countries. The number of living donor kidney transplants is lower than in other countries; therefore a living donor liver transplantation program belongs to leading programs. Progress of lung transplantation has been slow. The development is highlighted by vascularized composite tissue transplantations of the hands and face. The strength of the report lies in its reliability and completeness. Numbers are the unique source of information to be used and referred to in the literature.