National donor and transplant network

Central transplant coordinators

The Central Transplant Coordinators (CTC) work in the Slovenija-transplant office. They are the central link in the national donor and transplant network. They coordinate and connect all procedures from the detection of potential donors in the donor center to the procurement and transplantation of organs. They talk to the relatives of the deceased about organ donation. At national and international level, they take care of the documentation of deceased donors, organs and tissues. They communicate and receive notifications about organs from Eurotransplant that are suitable and medically appropriate for Slovenian patients. They coordinate the logistics and the work of the surgical teams. They collect reports about potential adverse events and adverse reactions.

The CTC’s are available 24 hours a day, every day of the year. The team consists of dynamic medical colleagues. Specialized professional training is required for this task.

Consultants

Consultants are senior central transplant coordinators with extensive experience who advise their colleagues on more challenging coordination cases. An international European transplant coordination exam is required for the role of consultant. Currently, Slovenija-transplant team of consultants consists of five experts on standby.

Physician responsible for donation medicine

In accordance with the European Directive, Slovenija-transplant provides physician responsible for donation medicine at national level. The title is obtained by a consultant in the management position of the Institute and his deputy. The responsible physician in charge makes medical decisions in complex medical donation cases. Two responsible physicians are always on call for emergencies.

A donor centre is a public health institution or individual departments of this institution in which organ donation procedures are carried out. In the donor centres, possible and potential deceased donors are identified, brain death diagnostics are carried out, conversations with relatives are conducted, information about possible donors is forwarded to Slovenija-transplant, the proper functioning of the organs is maintained until removal and cooperation with the national team of surgeons for the removal of multiple organs takes place. The protocols for organ maintenance and removal are specified in the law and in professional guidelines.

There are 11 donor centres in Slovenia: UMC Ljubljana, UMC Maribor, GH Celje, GH Murska Sobota, GH Slovenj Gradec, GH Jesenice, GH Novo mesto, GH Izola, GH Ptuj, GH Nova Gorica, GH Brežice.

Hospital transplant coordinators

The Hospital Transplant Coordinator (HTC) works in the donor centre. He is the link between the donor centre and Slovenija-transplant. At the hospital level, he manages and promotes organ donation, encourages the identification of potential donors, conducts conversations with relatives, manages the procedures for active donors and co-operates with the central transplant coordinator in the procurement of organs and tissues. At a local level, he is responsible for the implementation of quality and safety audits in the donation programme. The tasks are defined in detail in the law and the regulations governing the work of the HTC. HTCs are medical specialists who have acquired specialized knowledge in the field of donation medicine.

List of HTCs (confirmed by the decision of the Ministry of Health, as of August 2024):

• UMC Ljubljana: cf. Rade Stanić, MD
• UMC Maribor: Iva Cestar, MD
• GH Brežice: Igor Đarmati, MD
• GH Celje: Barbara Hudournik, MD
• GH Izola: Maja Ivartnik Merkač, MD
• GH Jesenice: Andraž Nastran, MD
• GH Murska Sobota: Alja Beznec, MD
• GH Nova Gorica: Edyta Čerkini, MD
• GH Novo mesto: Matej Godnič, MD
• GH Ptuj: Mateja Prevolšek, MD
• GH Slovenj Gradec: Rok Popič, MD

The Tissue Typing Centre operates under the auspices of the Institute of Transfusion Medicine of the Republic of Slovenia. For the purposes of organ and tissue transplantation, tissue compatibility between recipients and donors is checked by determining leukocyte antigens and the immunological parameters of patients on the waiting list are monitored.

All solid organ transplantations are performed at Centre for transplantation at UMC Ljubljana. Corneal transplants are performed in the Department of Ophthalmology at UMC Ljubljana and in the Department of Ophthalmology at UMC Maribor.

Clinical transplant coordinators

The Clinical Transplant Coordinators are experienced medical specialists who work at the Centre for Transplantation at UMC Ljubljana. They are the specialists of internal medicine who manage respective organ transplantation recipient centres. In each clinic, they lead consilliums for the inclusion of patients on the transplant waiting list. They also assure, the patients are prepared for the procedure and cared for after the organ transplantation.

Organ removal and transplantation team

Organ removal is a surgical procedure that is carried out according to a precisely defined time and sequence. The removal of organs must be carried out quickly and precisely. It is therefore carried out by specially trained surgeons in collaboration with trained teams of instrument technicians and perfusionists. All removal procedures are coordinated with the transplant centres, where the patient is prepared for the transplant procedure at the same time.

All removal procedures are well documented and the traceability of procured organs and tissue is guaranteed. If the donor has several medically suitable organs for transplantation, this is referred to as multi-organ procurement. Each donor hospital has a specific protocol for organ procurement in which the tasks of the medical staff involved in multi-organ procurement are defined.

If necessary (if it is a heart, lung or liver), the organ procurement team travels to a donor centre abroad (in the Eutrotransplant region or, more rarely, outside the region), where they remove the organ, transport it to UMC Ljubljana and transplant it to a suitable patient. Additional teams from Eurotransplant countries can also come to Slovenia for organ removal.

The transplant team often consists of the same teams that perform the retrieval, as well as a team of anaesthetists and nurses who look after the recipient before and during the transplant. In more demanding cases, there are also surgeons who specialise in the transplantation of individual organs. These are mainly experienced surgeons who have extensive experience in the field of transplantation medicine. Surgeons from different specialities often work together. The transplant teams are on call 24/7.

After the transplantation, the organ recipients are treated in the intensive care unit, where they are cared for by specialised intensive care physicians. After intensive care, they are transferred to the individual departments of UMC Ljubljana, where they are cared for by clinical transplant coordinators.

Brain Death Determination Team

The medical criteria, method and procedure for determining brain death are laid down in national regulations and laws. Each procedure is carefully documented. The commission for determining brain death consists of two experts, specialists in the field of intensive care, anaesthesiology, neurology or neurosurgery, etc., who have experience in treating patients with severe brain injuries. The clinical tests are carried out by each member of the commission independently and at legally defined intervals. In addition, a specialist carries out an instrumental examination to confirm brain death.

If the donor hospital does not have access to the appropriate instrumental tests to confirm brain death, an electroencephalogram (EEG) can be carried out by a mobile team on call. The mobile team for the determination of brain death consists of experienced neurophysiologists from the Neurological Clinic of the UMC Ljubljana.