Organ donationPeter Bishop

Clinical lead for organ donation

Number of deceased donors and transplants in the UK

1 April 1999 - 31 March 2009 - patients on the active transplant lists at each year

Number of deceased donors and transplants in the UK

• 1000+ patients die on transplant 1000+ patients die on transplant waiting list each yearwaiting list each year

• Access to waiting lists is cappedAccess to waiting lists is capped

• Live related liver transplantsLive related liver transplants

• 50% mortality rate for CF patients 50% mortality rate for CF patients awaiting transplants awaiting transplants

1 April 1999 - 31 March 2009 - patients on the active transplant lists at 31 March

Donors pmp

Organ Donors in SpainNumbers & Annual Rate (p.m.p)

50% increase in 5 years

550 68

7 778 83

2 865 96

0 1037

1032 11

55 1250 13

34

1345

1335 14

11

Organ Donation Taskforce

Terms of reference

To identify barriers to donation and transplantation and recommend solutions within existing operational and legalframeworks in England

Target – 50% increase in donation over 5 years

Elisabeth Buggins CBE

A UK Model for DonationNHSBT

Department of Health

Acute Hospital Trusts

Mo

re d

on

ors

National ODOEffective co-ordination and retrieval Education, training and auditPublic engagement

FundingResolution of ethical and legal issuesPerformance Management TrainingPublic recognition

Clinical leadsEmbedded co-ordinatorsDonation committees

Key recomendations1. A UK-wide Organ Donation Organisation should be established

2. The establishment of the Organ Donation Organisation should be the responsibility of NHS Blood and Transplant.

3. Urgent attention is required to resolve outstanding legal, ethical and professional issues in order to ensure that all clinicians are supported and are able to work within a clear and unambiguous framework of good practice. Additionally, an independent UK-wide Donation Ethics Group should be established.

4. All parts of the NHS must embrace organ donation as a usual, not an unusual event. Local policies, constructed around national guidelines, should be put in place. Discussions about donation should be part of all end-of-life care when appropriate. Each Trust should have an identified clinical donation champion and a Trust donation committee to help achieve this.

5. Minimum notification criteria for potential organ donors should be introduced on a UK-wide basis. These criteria should be reviewed after 12 months in the light of evidence of their effect, and the comparative impact of more detailed criteria should also be assessed.

6. Donation activity in all Trusts should be monitored. Rates of potential donor identification, referral, approach to the family and consent to donation should be reported. The Trust donation committee should report to the Trust Board through the clinical governance process and the medical director, and the reports should be part of the assessment of Trusts through the relevant healthcare regulator. Benchmark data from other Trusts should be made available for comparison.

7. BSD testing should be carried out in all patients where BSD is a likely diagnosis, even if organ donation is an unlikely outcome.

1. Financial disincentives to Trusts facilitating donation should be removed through the development and introduction of appropriate reimbursement

2. The current network of DTCs should be expanded and strengthened through central employment by a UK-wide Organ Donation Organisation. Additional co-ordinators, embedded within critical care areas, should be employed to ensure a comprehensive, highly skilled, specialised and robust service. There should be a close and defined collaboration between DTCs, clinical staff and Trust donation champions. Electronic on-line donor registration and organ offering systems should be developed.

3. A UK-wide network of dedicated organ retrieval teams should be established to ensure timely, high-quality organ removal from all heartbeating and nonheartbeating donors. The Organ Donation Organisation should be responsible for commissioning the retrieval teams and for audit and performance management

4. All clinical staff likely to be involved in the treatment of potential organ donors should receive mandatory training in the principles of donation. There should also be regular update training

5. Appropriate ways should be identified of personally and publicly recognising individual organ donors, where desired. These approaches may include national memorials, local initiatives and personal follow-up to donor families

6. There is an urgent requirement to identify and implement the most effective methods through which organ donation and the ‘gift of life’ can be promoted to the general public, and specifically to the BME population. Research should be commissioned through Department of Health research and development funding.

7. The Department of Health and the Ministry of Justice should develop formal guidelines for coroners concerning organ donation

Donation committee

• Non clinical Chair Mr Gerald Coteman• Clinical lead for organ donation• Intensive care clinical and nursing• Emergency• Physician• Paediatricians• Bereavement • Chapliancy• PALS

Princess AlexandraPrincess Alexandra ITU DeathsITU Deaths

0

2

4

6

8

10

12

Jan Mar

May Ju

lySept No

v

200720082009

ITU Donor Potential and Organ DonorsITU Donor Potential and Organ Donors

0

0.5

1

1.5

2

2.5

3

200720082009

2007 2 1 1

2008 3 3 0

2009 3 2 1

Potential NHBD HBD

Financial disincentives

• NHSBT fixed rate tariff £2086 per donor

• NHSBT finance 1 PA to support the work of the CLOD

• £2000pa to support the donation committee

• Critical care capacity

Future activity

• Embedded donor coordinator

• Local awareness

• Donor register

• Non heart beating programme

• End of life policy

• Tissue donation