The impact of systemic innovations for transforming transplant systems. Lessons learned from the German lung transplantation system. A qualitative study

ABSTRACT

The aim of this paper is to demonstrate the potential of the systemic innovations approach for transforming transplantation systems. It explores potential leverage points for intervening in the LTx-system as well as possible paths of transformation. We present possible transition pathways giving the example of the German Lung transplantation system that teeters on the brink of collapse due to system failures and organ scarcity and illustrate systemic innovations as core mechanisms for systems change in health systems. Desk research and semi-structured experts interviews provided qualitative data for a deductive-inductive coding and a rigorous qualitative content analysis of the data. Depending on the systemic innovations chosen to achieve systems change, transplant systems follow different transformational paths: from a collapse to a leapfrogging towards a non-human transplantation system. Thus, global health areas like transplantation benefit from analysis on systemic innovations as these support researchers, public policy and regulators by developing transformative strategies in healthcare systems.

KEYWORDS:

• Systemic innovations
• transplantations systems
• transformations
• lung allocation score
• lung transplantation system
• healthcare systems

Acknowledgments

We would like to thank our reviewers for their very helpful comments. We believe that following these comments helped to improve the paper a lot. We sincerely want to express our gratitude to the experts, who were willing to give us detailed information and supported our study with their knowledge. Our special thanks goes hereby to (in the order of their interview date): Prof. Dr. Strueber, Prof. Dr. Reichenspurner, Dr. Samson-Himmelstjerna, Dr. Sommer, Mr. Schulz, Prof. Dr. Haverich, Dr. Richter, Dr. Oldigs, Mrs. Oelschner, Prof. Dr. Deuse, Dr. Heuer. We also sincerely thank Leonie Eising and Professor Markus Reihlen for their helpful remarks on this manuscript. We here with confirm that this manuscript has not been previously published, is not currently under consideration by any other journal, and will not be submitted to any other journal while submitted here for review.

Disclosure statement

No potential conflict of interest was reported by the authors.

Declaration statements

• Availability of Data and Material

The datasets used and analysed during the current study are available from the corresponding author on reasonable request

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. Solid lung transplantation comprises mainly single-lung and double-lung transplant. There are also heart-lung transplants and living related lung transplantations, called lobar-lung transplantation. A closer consideration of those surgical innovations, however, would go beyond the scope of our article, and are thus not part of the analysis.

2. like COPD (Chronic Obstructive Pulmonary Disease), lung fibrosis and cystic fibrosis etc.

3. Austria, Belgium, Croatia, Germany, Luxembourg, the Netherlands, Slovenia and, most recently Hungary.

4. e.g. when it is not possible to reach the donor centre in time, for example owing to bad weather conditions or when the donor is unstable.

5. in Germany this is the OCS™ device, see also the INSPIRE study (Warnecke et al., 2013).

6. In 2016, the USA reached a new transplantation record with the highest deceased donation rate of more than 30%, using the same legislative opt-in norms but having another informal institution and more (organisational, communicational and technological) innovative processes in the system than Germany with an organ donation rate of ca. 10% among its population. On the other hand there is a big gap to Austria (ca. 25%), a country with a very similar cultural background and norms to those of Germany, but using the opt-out norm and effective system structures (GODT 2016).

Additional information

Funding

We declare, that this research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.