Building a Territorial System for Quality Management in the Implementation of a Regional Program for Organ Donation and Transplantation

Organ donation and transplantation is one of the most difficult branches of medicine, associated not only with clinical issues, but, first of all, with issues of organization at the local, regional and national levels. The success in the development of this direction in many countries of the world is associated with the construction of regional and national programs based on the principles of quality management. Until now, there are no such examples in the Russian Federation. The aim of this study was the development and testing of a territorial quality management system in the implementation of the organ donation and transplantation program in the Republic of Bashkortostan. The presented work analyzes the international and Russian experience in this area, presents quality indicators from international practice. Based on the analysis, groups of criteria have been formed that can be applied in the Russian Federation. The introduction of the process approach into the work of the regional center for organ and tissue transplantation made it possible to carry out an objective analysis of the current situation in a short time. It was revealed that up to 90% of potential donor losses occur at the level of first-level medical organizations. We have standardized the processes of identifying patients with irreversible brain damage, as well as introduced an algorithm for the actions of medical personnel. In the regional center for transplantation and donation, the key sub-processes have been identified, limit process have been identified that significantly affect to performance indicators. By means of controlled changes, with the use of process maps, an adjustment was made to the activities of the subdivision. Based on the standardization of the work of medical institutions, the entire transplantation program is presented as a single macro-process at the regional level. At a meeting at the Ministry of Health of the Republic of Bashkortostan, a three-level system for organizing donation and transplantation in the region was presented. The basic principles of patient routing, as well as the scheme of interaction of medical organizations with the regional transplant center are proposed. The quantitative result of the work was an increase in the number of potential donors in 2020 by 62% compared to 2018, despite significant restrictions on inpatient care due to the novel coronavirus infection pandemic), as well as an increase in the number of effective donors by 2 times over the past year. In conclusion, the analysis of world experience and the results of our own research demonstrate a qualitative and quantitative change in the territorial programs of organ donation and transplantation when introducing quality management systems for medical activities.