The Tuscany Model of a Regional Transplantation Service Authority: Organizzazione Toscana Trapianti

Abstract 

In 2003, the Tuscan Regional Government appointed a transplantation service authority to reorganize all regional donation and transplantation activities: the Organizzazione Toscana Trapianti (OTT). Herein we have presented a retrospective review of deceased donation and transplantation activities from 1993 until 2006 in Tuscany to illustrate the results of OTT activity and the methodology in reorganizing the regional network. After the advent of OTT, the mean rate of recovered deceased donors (DDs) rose from 16.9 ± 7.7 per million population (pmp) to 32.7 ± 4.3 pmp (Δ = +93.4%); multiorgan DDs increased by 48.6%, from a mean of 12.8 ± 5.2 pmp to 21.1 ± 2.9 pmp, despite a 55.2% increase in recovered DDs ≥60 years. Recovered DD solid organs rose by 78.4% after the advent of OTT (from a mean of 53 ± 20.1 pmp to 89.5 ± 13.6 pmp), and the number of DD organ transplants rose by 87.3% (ie, from a mean of 49.9 ± 23.9 to 91.9 ± 5.2 pmp). The experience of OTT showed that an efficient regional network requires a global approach to donation and transplantation, according to the principles of clinical governance. A region-based model, whereby health care professionals share clinical governance with regional authorities and regional networks integrated at a national level, may prove favorable not only to increase donor procurement rates but also to improve the quality of the whole transplantation care process.