Framework of Country Donation Systems: UK · Framework of Country Donation Systems: UK ... •...
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Framework of Country Donation Systems: UKAnthony ClarksonAssistant Director – Organ Donation and Nursing
UK Overview
• NHS Blood and Transplant is the OPO for the United Kingdom.
• Population 65 million.
• The UK is one country comprising 4 Nations across 2 Islands and with 3 different laws relating to Organ Donation;
• England & Northern Ireland
• Scotland
• Wales
Background
• Three people in the UK will die every day due to the lack of an organ.
• 7000+ people in the UK need an organ transplant.
• 22 million people are on the UK organ donor register but fewer than 5000 people a year die in circumstances where they can become organ donors.
• Surveys show 90% of the population support organ donation.
Organ Donation, Past Present and
Deceased donation 2006• 1994: Organ Donor Register
– Opt-in legislation
• 2001: Non heartbeating organ donation programmes
– Controlled
– Uncontrolled
• 2003
– Potential Donor Audit
– Donor liaison nurses as in house coordinators for hospital development.
A series of ineffective interventions
745 777 778 770 709 814 753 779
2386 2334 2339 2333 22222454
2195 2316
5396 5487 5518 5665 5837 6024
6543
7102
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Deceased donor transplants
Active transplant list
The Taskforce Report
• Accepted in full by all four health departments.
• Comprehensive UK-wide framework for donation and retrieval
• 14 recommendations
– Donor identification and referral– Coordination– Retrieval The report of the UK Organ Donation
Taskforce, 2008
Target – 50% increase in donation over 5 years
Recommendations
Recommendation 2The establishment of the ODO should be the responsibility of NHSBT.
Recommendation 3Resolve outstanding legal, ethical and professional issues / UK DEC.
Recommendation 4All parts of the NHS to embrace organ donation as a usual, not unusual event.
Recommendation 5Minimum notification criteria for potential organ donors should be introduced.
Recommendation 1: UK wide Organ Donation Organisation should be established.
Recommendation 6Donation activity in all Trusts should be monitored.
Recommendation 7BSD testing should be carried out for all patients where BSD is likely.
Recommendations
Recommendation 8Financial disincentive to Trusts facilitating donation should be removed.
Recommendation 9Network of DTC’s to be expanded & strengthened through central employment.
Recommendation 10A UK-wide network of dedicated organ retrieval teams should be established.
Recommendation 11All clinical staff involved in organ donation should receive mandatory training.
Recommendation 12Personally and publicly recognise individual organ donors, where desired.
Recommendation 13Implement effective methods to promote organ donation to the general public.
Recommendation 14Develop formal guidelines for coroners concerning organ donation.
Post Taskforce Implementation Donation
•12 Regional Teams.•@ 250 Donor Co-ordinators (Specialist Nurses – Organ Donation)
• Embedded into 300 hospitals.
• Undertaking donor facilitation.
•Clinical Leads for Organ Donation•Hospital Donation Committees•DBD and DCD donors
Post TaskforceImplementation Retrieval
•7 Abdominal Teams.•6 Cardio-thoracic.•Commissioned by NHSBT as fully functioning teams.•Part of a transplant centre.•Available 24/7.•DBD and DCD donors.
Abdominal retrieval team
Cardiothoracic organ retrieval team
Abdominal retrieval team
Cardiothoracic organ retrieval team
Allocation of deceased donororgans
National allocation to individual, ranked patients Local / regional allocation
Kidneys – DBD donorsLivers – super-urgent patients onlyPancreasBowelHearts – urgent patients only
Livers – elective patients + DCD donors
Hearts – elective patientsLungs – all patients
National, patient-specific schemes being developed
Deceased Donation 2012
0 5 10 15 20 25 30 35
donors pmp
Greece
Sweden
Switzerland
Denmark
Poland
The Netherlands
Latvia
Germany
Hungary
Slovakia
Finland
UK
Norway
Italy
France
USA
Portugal
Croatia
Spain
19.4
UK 2012: much improved…………. but could do better still
The Six Big Wins• Consent / authorisation
• Brain-stem death testing
• Donation after circulatory death
• Donation from Emergency Medicine
• Donor identification and referral
• Donor optimisation
consent / authorisation
diagnosis of brain stem
deathNHBD
Donation in emergency medicine
Minimum notification
criteria
Donor Management
consent / authorisation
diagnosis of brain stem
deathNHBDconsent /
authorisation consent /
authorisation
diagnosis of brain stem
death
diagnosis of brain stem
deathNHBDNHBD
Donation in emergency medicine
Minimum notification
criteria
Donor Management
Donation in emergency medicine
Donation in emergency medicine
Minimum notification
criteria
Minimum notification
criteria
Donor Management
Donor Management
Taking Organ Transplantation to 2020
To match world class performance in organ donation and transplantation
UK wide joint strategy to promote continuous improvement in Organ Donation rates to the year 2020
Aim
Taking Organ Transplantationto 2020: Outcomes
1. Action by society and individuals will mean that the UK’s organ donation record is amongst the best in the world and people donate when and if they can.
2. Action by NHS hospitals and staff will mean that the NHS routinely provides excellent care in support of organ donationand every effort is made to ensure that each donor can give as many organs as possible.
3. Action by NHS hospitals and staff will mean that more organs are usable and surgeons are better supported to transplant organs safely into the most appropriate recipient.
4. Action by NHSBT and Commissioners means that better support systems and processes will be in place to enable more donations and transplant operations to happen.
Taking Organ Transplantationto 2020: Outcome Measures
1. Consent Rate – 80% by 2020
2. Deceased Organ Donors per million population – 26pmp by 2020
3. Increase Organ Utilisation – 5% by 2020
4. Patients Transplanted per million population – 74 pmp by 2020
TOT2020 Headline Actions
• Explore inclusion of teaching about organ donation and transplantation in the school curriculum
• Families will not normally be able to overrule express consent
• Only specially trained staff should approach families• Publish comparative hospital data & contract with Level 1
Trusts for a specified donor service• Implement new technologies for preserving and reviving
organs if proven• Review opportunities for a 24/7 service to support
cardiothoracic donors
TOT2020 Headline Actions Continued..• Training and accreditation programme for retrieval
surgeons• Peer review programme for transplant centres
underpinned by standards• New workforce strategy to provide a dedicated family
service separate from donor management and co-ordination
• ‘Lean’ the clinical pathway underpinning with IT• Review processes for donor characterisation, especially
microbiology and tissue typing
Transplants7,8
3,322Organs transplanted7,8
3,736
UK population1
~64,000,000UK deaths2
~576,000Deaths in hospitals3
~ 287,000Potential donors4,5
7,450Eligible donors4,6
5,636Donation requests4
3,295Consented donors7
1,923Actual
donors7
1,282
1 Mid 2013 estimates: www.ons.gov.uk2 2013 data: England & Wales www.ons.gov.uk; Scotland www.gro-scotland.gov.uk; Northern Ireland www.nisra.gov.uk3 2013 data: England & Wales www.ons.gov.uk; Scotland www.isdscotland.org; Northern Ireland www.nisra.gov.uk4 2014/2015 data: NHSBT, Potential Donor Audit 5 Potential donor - patients for whom death was confirmed following neurological tests or patients who had treatment withdrawn and death was anticipated within four hours6 Eligible donor - Potential donor with no absolute medical contraindications to solid organ donation7 2014/2015 deceased donor data: NHSBT, UK Transplant Registry 8 Using organs from actual donors in the UK
UK Potential deceased organ donor population, 1 April 2014 – 31 March 2015
Measure 1 – Consent rates
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Measure 1 - Consent rates by Region
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Consen
t rate (%)
Consent rate (%) by ODS team, Apr 2014 ‐ Jan 2015 (as at 9 Feb)
Overall
DBD
DCD
Overall target
DBD target
DCD target
South West = 82%
Some teams already at world class levels
Consent/authorisation rates byOrgan Donation Services Team1 April 2014 – 31 March 2015
DBDConsent/authorisation rates
40 - <45%45 - <50%50 - <55%55 - <60%60 - <65%65 - <70%70 - <75%>=75%
DCD
70%55%
66%63%
67%67%
69%
73%72%
73%
80%
70%
56%52%
48%53%
55%54%
43%
45%64%
44%
56%
51%
0.0
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NORTHEAST
NORTHWEST
YORKSHIREAND THEHUMBER
EAST ANDWEST
MIDLANDS
EAST OFENGLAND
LONDON SOUTHEASTCOAST
SOUTHCENTRAL
SOUTHWEST
SCOTLAND WALES NORTHERNIRELAND
UK
Dono
rs pmp
Former SHA
Donors pmp by former SHA of donating hospital, Feb 2014 ‐ Jan 2015
Donors pmp2019/20 target2014/15 target
Measure 2 – Donors pmp
Measure 2 – Performance against target
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Eligible donorsConsented eligible donorsActual donorsOrgans transplanted
Source: UK Potential Donor Audit as at 9 February 2015. Patients aged over 75 years and cardiothoracic ICUs are excluded. Additional source: UK Transplant Registry for organs transplanted from all deceased solid organ donors
Organ Utilisation can be a challenge
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DBDDCDTotal
Rolling 12 month donor totalsto end of April 2016