taking organ transplantation to 2020...transplantation rates. the welsh government’s plan...
TRANSCRIPT
Contents
Cardiff and Vale University Health Board
TAKING ORGAN TRANSPLANTATION TO 2020
Review of 2015/16 and
Action Plan for 2016/17
CONTENTS
1.0 Executive summary
Section 1: Annual Report
2.0 Introduction and background
3.0 Our approach to ensuring excellent organ donation and transplantation services and care
4.0 Outcome 1
5.0 Outcome 2
6.0 Outcome 3
7.0 Outcome 4
Section 2: Action Plan and Priorities for 2016 / 17
8.0 Development of Cardiff and Vale Health University Board action plan for 2016/2017
9.0 Priorities for the coming year
10.0 Performance measures and management
11.0 Action plan for 2016/17
12.0 Actions required to deliver locally
1.0 Executive summary
The purpose of this document is to set out the annual organ donation plan for Cardiff and Vale University Health Board (UHB) for 2016-17. Our vision is to ensure that organ donation is part of usual end of life care and that every eligible patient has the possibility explored. This will be underpinned by robust supporting policies and a strict clinical governance framework surrounding this. The Welsh Government wants Wales to be amongst the best performing countries in the world of organ donation and transplantation. In 2013, NHS Blood and Transplant (NHSBT) published ‘Taking Organ Transplantation to 2020’, a strategy to improve organ transplantation rates. The Welsh Government’s plan ‘Taking Organ Transplantation to 2020 - Wales Action Plan’ sets out the actions and outcomes up to 2020 to enable us to achieve this. On the 1st December 2015 Wales became the first UK country to introduce the soft opt-out system for organ and tissue donation following the implementation of the Human Transplantation Wales Act. The aim of the Act is to increase the number of organs and tissues available for transplant. This will benefit the Welsh population by reducing the number of people dying whilst waiting for a suitable organ to become available and improving the lives of others. Cardiff and Vale UHB was well prepared for the launch date with much media interest from regional and national sources which were coordinated by the UHB Communications Team. Further actions taken to ensure a smooth implementation has been the specific training that remains ongoing for clinical staff involved in organ donation through new and existing teaching sessions. In Wales only 35% of the population have signed onto the Organ Donor Register and since the availability for opt-out; to date 157,133 have chosen this option. There has also been the uptake of 32 appointed representatives. At the end of 2015 there were 211 Welsh residents on the transplant waiting list and the UK figure stands at just over 6500. This is an improvement to the 7600 people listed at the end of 2012. In 2015/2016 Wales had 64 deceased donors which is a rise from the previous 3 year average of 55. Even though in 2015/2016 Wales only accounted for 5% of the UK deceased donors, Cardiff and Vale UHB was responsible for 34% of those cases which highlights the importance of delivering and supporting the UK Organ Donation Taskforce recommendations. Cardiff and Vale UHB has achieved progress within 2015-2016:
Increased Specialist Nurse for Organ Donation attendance.
Effective screening of marginal donors.
Increased referral rates from ED and ITU.
Effective implementation of deemed consent approaches.
Good collaborative working.
Increased consent rate.
Cardiff and Vale UHB’s organ donation priorities are:
Increase engagement with Paediatric Intensive Care and consider the development of a Clinical Lead for Organ Donation for Paediatrics.
Instigation of extending the potential donor audit to neonatal services.
Continued legislation awareness – supporting and teaching clinical staff.
Improve organ donation consent rates across the University Health Board.
Strive towards 100% referral rate in all departments, to eliminate risk of missed potential.
Further develop relationships with key stakeholders e.g. Critical Care, Theatres, Emergency Unit, Transplant Unit, Mortuary.
Section 1: Annual Report
2.0 Introduction and background
In 2013 NHS Blood and Transplant (NHSBT) published ‘Taking Organ Transplantation to 2020’, a strategy to improve organ transplantation rates.
The Wales Action Plan, published in January 2014, sets out what needs to happen in Wales to deliver this strategy. We need simultaneously over the next few years to drive continuous improvement on all aspects of organ donation and transplantation and this plan seeks to do just that. It sets out actions right across the pathway, from ensuring that everybody has the opportunity to make their decision known, whatever that may be, to ensuring that those who receive transplants have the appropriate after-care and follow-up. The Wales Action Plan commits Health Boards to deliver certain outcomes by 2020.
The Welsh Transplant Advisory Group has identified all Wales Organ Donation and Transplantation Priorities for 2016-17 which are also considered part of the delivery plan. This focus on a small number of priorities will give a clear sense of direction over the next 12 months. Health Boards are expected to work together to ensure that these priorities are delivered.
1 December 2015, saw the enactment of the Human Transplantation Wales Act 2013. All other UK health departments are waiting to see what impact the change to a soft opt out consent system in Wales will have.
The new system has made it easier for people in Wales who want to donate to become organ donors, whilst enabling those who do not to be able to formally register their decision on the NHS organ donor register.
The aim of the Act is to increase the number of organs and tissues available for transplant. This will benefit the people of Wales by reducing the number of people dying whilst waiting for a suitable organ to become available and improving the lives of others. Cardiff and Vale University Health Board, in line with other Health Boards in Wales, has a significant role to play in ensuring all patients who could potentially be organ donors are managed within the new legislative framework.
3.0 Our approach to ensuring excellent organ donation and transplantation services and care
In 2015-2016, we published our Organ Donation Action Plan. The Plan is designed to enable us to deliver on our responsibility to save and improve lives through organ donation and transplantation. It sets out:
Delivery aspirations we expect
Specific priorities for 2015-2016
Responsibility to develop and delivery actions
NHS assurance measures Our vision for organ donation is that by 2020, donation and transplantation rates in Wales shall be comparable with the best performing countries in the world. Our priorities for organ donation and transplantation for the last 12 months were:
Increase engagement with Paediatric Intensive Care
Implementation of the legislation; supporting and teaching clinical staff
Improve consent rates across the University Health Board
Strive towards 100% referral rate in all departments; to eliminate any risk of missed potential
Continue to maintain and build further relationships with key stakeholders; Critical Care, Theatres, Emergency Unit, Transplant Unit, Mortuary.
We are measuring our progress against the following measures:
Increasing the number of potential donors
Improving donor conversion rates
Making the most of donor organs
Increasing retrieval and transplantation of organs
Resuscitation of retrieved organs
Improving survival of transplant patients
Systems to support organ donation and transplantation
This annual report provides a baseline to where Cardiff and Vale UHB is; sets out the
progress we have made against each of our priorities and sets out a baseline for future
years against which progress can be monitored.
4.0 Outcome 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.
Progress against this measure is measured by the following measures:
Measure 1: Consent rate for organ donation when patient ODR1 status unknown (%)
0
10
20
30
40
50
60
70
80
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff
And Vale
DCD
Cardiff
And Vale
DBD
UK Target
DCD
UK Target
DBD
0
10
20
30
40
50
60
70
80
90
100
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff And
Vale
Wales
England
Scotland
Northern
Ireland
1 Organ donation register
Measure 2: Consent rate for organ donation when patient ODR status known (%)
0
20
40
60
80
100
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff
And Vale
DCDCardiff
And Vale
DBDUK
Target
DCDUK
Target
DBD
0
10
20
30
40
50
60
70
80
90
100
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff And
Vale
Wales
England
Scotland
Northern
Ireland
Overall the consent rate has increased in Cardiff and Vale UHB, however an important factor to note is the rise within the ODR unknown category. Such findings may be a result of the legislation implementation as it has either prompted discussion within families or consent has been obtained utilising the deemed approach method. There is still a disparity in the unknown status between DCD and DBD as the DCD process holds much more uncertainty of proceeding which may impact upon family decision making. A further aspect to note is the evident ODR overrides when consent has not been given within the known status. This is a nationwide issue and the UK has one of the highest family refusal rates. NHSBT believe that a further 9% of donors could become available if such a block was disallowed.
Measure 3: Deemed consent rate for organ donation when patient had not expressed a decision and deemed consent could be applied
1 December 2015 - 31 March 2016
Board Approaches Consents
Adjusted consent rate (%)
Abertawe Bro Morgannwg University Health Board 1 1 100
Aneurin Bevan Health Board 1 0 0
Betsi Cadwaladr University Health Board 2 1 50
Cardiff And Vale Health Board 6 4 66.7
Cwm Taf Health Board 2 2 100
Hywel Dda Health Board 1 1 100
Wales 13 9 69.2
*Please interpret these rates with caution due to calculations being based on small numbers
Source: NHSBT
Following the deemed approach it is clear that Cardiff and Vale UHB have had two episodes where consent was not obtained and due to the soft method the family have a choice to express their opinions surrounding the possibility of donation. However, prior to the approach it is of high importance that the framework for deemed consent is followed to ensure full eligibility in terms of Welsh residency, mental capacity, age and no expressed or recorded decision.
Measure 4: Rate where family override the known decision/ deemed consent of the patient
1 December 2015 - 31 March 2016
Board Approaches
Family support not given
Rate of overrides (%)
Abertawe Bro Morgannwg University Health Board 3 0 0
Aneurin Bevan Health Board 1 1 100
Betsi Cadwaladr University Health Board 3 2 66.7
Cardiff And Vale Health Board 8 2 25
Cwm Taf Health Board 2 0 0
Hywel Dda Health Board 1 0 0
WALES 18 5 27.8
*Please interpret these rates with caution due to calculations being based on small numbers
Source: NHSBT
Measure 5: Approach Rates (%)
0
20
40
60
80
100
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff
And Vale
DCDCardiff
And Vale
DBDUK Target
DCD
UK Target
DBD
0
10
20
30
40
50
60
70
80
90
100
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff
And Vale England
Wales
Northern
Ireland
Scotland
UK Target
Following the implementation of a more robust DCD screening tool in December 2015 it has
provided a detailed approach when assessing marginal donors. This has allowed for a
clearer identification of potential donors which can be effective both financially and
emotionally for families in assisting in the prevention of poor management at end of life care.
A key success to note is that the Cardiff and Vale UHB DBD approach has exceeded the UK
target.
5.0 Outcome 2: Action by NHS hospitals and staff will mean that the NHS routinely
provides excellent care in support of organ donation and every effort is made
to ensure that each donor can give as many organs as possible.
Progress against this measure is measured by the following measures:
Measure 6 : Number of deceased organ donors (per million population)
0
5
10
15
20
25
30
35
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff &
Vale
Wales
0
5
10
15
20
25
30
35
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff &
Vale
Wales
England
Scotland
Northern
Ireland
Despite the significant drop in deceased organ donors per million population, this is not reflected within the proceeding donors from the Cardiff and Vale UHB. In 2013/2014 there were 15 donors and 2015/2016 has noted an increase to 22. Therefore the 32% rise does not match the reduction as illustrated above.
Measure 7: Number of living organ donors (per million population)
0
5
10
15
20
25
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff &
Vale
Wales
0
5
10
15
20
25
30
35
40
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff &
Vale
Wales
England
Scotland
Northern
Ireland
Measure 8: Percentage referral rate (%)
0
20
40
60
80
100
120
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff
And Vale
DCDCardiff
And Vale
DBDUK Target
DCD
UK Target
DBD
0
10
20
30
40
50
60
70
80
90
100
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff And
Vale
Wales
England
Scotland
Northern
Ireland
UK Target
Over the last 3-4 years there has been an increased effort to engage with all units that have
potential organ donors and this has proved successful as the Cardiff and Vale UHB referral
rate has succeeded the UK target. Key elements that may account for an improved rate is
the early identification that allows for better planning, increased SNOD presence with
changed working hours, teaching, simulation and handover attendance. A further positive
has been the robust screening tool as decision making can be more effective and efficient on
assessment. Thus providing clear management to clinicians in a timely manner which can
promote positivity surrounding referrals of those marginal patients
6.0 Outcome 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.
Progress against this measure is measured by the following measures:
Measure 9a: Deceased organ utilisation from donors after brain death (DBD) donors transplanted (per million population)
Cardiff and Vale
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Renal 30.18 6.41 25.42 29.45 16.71 18.67
Liver/bowel 8.33 2.08 8.33 10.52 8.35 6.22
Cardio 4.17 4.17 8.33 0.00 2.09 8.30
Organs 41.67 12.50 41.67 39.97 27.15 35.27
Cornea 4.17 4.17 8.33 10.52 0.00 6.22
0
5
10
15
20
25
30
35
40
45
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Renal
Liver/bowe
l
Cardio
Organs
Cornea
Renal
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 30.18 6.41 25.42 29.45 16.71 18.67
Wales 29.29 23.93 25.13 22.77 24.98 23.61
England 19.12 19.64 21.05 23.48 22.07 22.79
Scotland 20.02 20.49 20.19 24.65 23.65 19.64
Northern Ireland 42.48 34.46 28.73 34.55 38.26 32.60
Liver/bowel
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 8.33 2.08 8.33 10.52 8.35 6.22
Wales 13.64 10.39 10.71 11.06 11.68 8.41
England 7.63 8.32 8.97 10.64 9.78 9.00
Scotland 8.26 9.38 8.44 10.73 9.95 8.60
Northern Ireland 20.22 15.85 10.93 15.35 12.02 13.04
Cardio
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 4.17 4.17 8.33 0.00 2.09 8.30
Wales 4.22 8.77 7.47 5.86 3.57 7.76
England 5.64 6.63 6.76 7.76 7.05 7.11
Scotland 6.38 5.25 6.75 9.97 7.13 6.73
Northern Ireland 21.31 12.57 12.57 22.48 8.20 11.95
Organs
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 41.67 12.50 41.67 39.97 27.15 35.27
Wales 47.08 42.53 43.83 40.66 40.88 42.69
England 31.97 34.31 36.65 42.21 38.78 40.10
Scotland 34.15 34.90 35.65 44.79 39.04 35.53
Northern Ireland 83.61 63.39 51.37 73.48 56.29 60.31
Cornea
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 4.17 4.17 8.33 10.52 0.00 6.22
Wales 5.84 6.82 6.17 6.83 3.24 3.56
England 3.94 4.57 4.81 4.51 4.46 3.96
Scotland 4.32 3.38 4.69 6.59 3.75 3.55
Northern Ireland 10.38 8.20 3.28 8.23 6.01 1.63
Source: NHSBT
Measure 9b: Deceased organ utilisation from donors after circulatory death (DCD) donors transplanted (per million population)
Cardiff and Vale
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Renal 20.83 41.67 8.33 25.25 25.06 4.15
Liver/bowel 2.08 4.17 2.08 6.31 8.35 0.00
Cardio 0.00 4.17 0.00 8.42 0.00 0.00
Organs 22.92 50.00 10.42 39.97 33.41 4.15
Cornea 12.94 10.69 4.24 8.42 6.26 0.00
0
10
20
30
40
50
60
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Renal
Liver/bowel
Cardio
Organs
Cornea
Renal
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 20.83 41.67 8.33 25.25 25.06 4.15
Wales 15.91 22.40 11.69 12.69 18.17 18.43
England 9.93 11.27 13.22 14.30 13.33 15.04
Scotland 6.00 9.01 11.26 15.62 12.20 14.77
Northern Ireland 2.73 3.28 9.29 17.00 14.21 17.39
Liver/bowel
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 2.08 4.17 2.08 6.31 8.35 0.00
Wales 2.27 2.92 2.27 2.60 4.87 3.88
England 1.58 1.95 2.13 2.43 2.64 3.15
Scotland 1.13 1.88 1.88 2.07 2.44 3.74
Northern Ireland 0.55 1.09 1.09 1.65 1.64 1.09
Cardio
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 0.00 4.17 0.00 8.42 0.00 0.00
Wales 1.30 1.30 1.30 1.30 1.30 1.29
England 0.71 0.52 0.85 1.07 1.24 1.34
Scotland 0.00 0.75 1.13 0.75 0.75 0.75
Northern Ireland 1.09 1.09 1.64 0.55 0.00 3.26
Organs
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 22.92 50.00 10.42 39.97 33.41 4.15
Wales 19.48 26.62 15.26 16.59 24.33 23.61
England 12.22 13.74 16.21 17.80 17.21 19.59
Scotland 7.13 11.63 14.26 18.44 15.39 19.82
Northern Ireland 4.37 5.46 12.02 19.19 15.85 21.73
Cornea
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 12.94 10.69 4.24 8.42 6.26 0.00
Wales 6.58 6.89 4.57 3.58 5.19 5.82
England 3.03 2.83 3.60 3.78 3.27 3.22
Scotland 1.73 3.45 3.24 4.33 3.38 3.18
Northern Ireland 0.00 2.22 1.11 5.48 1.09 3.26
Source: NHSBT
Measure 10: Patients transplanted by organ - including both living and deceased donors (per million population)
Cardiff and Vale
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Renal 51.7 59.8 63.5 42.1 45.9 47.7
Liver/bowel 10.8 8.6 6.4 12.6 6.3 12.4
Cardio 4.3 8.6 2.1 8.4 6.3 10.4
Organs 66.8 76.9 72.0 63.1 58.5 70.5
Cornea 51.7 36.3 40.2 31.6 23.0 22.8
0
10
20
30
40
50
60
70
80
90
100
110
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Renal
Liver/bowe
l
Cardio
Organs
Cornea
The number of transplants has remained fairly stagnant over the last 6 years however there has been a notable decline in cornea. Therefore it is of high importance to promote the significance of tissue donation and ensure that clinical areas have contact details of the National Referral Centre that now coordinates tissue services and retrieval.
Renal
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 51.7 59.8 63.5 42.1 45.9 47.7
Wales 53.0 62.0 55.8 52.7 41.2 46.2
England 43.7 44.2 47.8 50.8 49.0 49.8
Scotland 36.4 42.7 45.0 52.5 46.7 54.0
Northern Ireland 43.0 47.8 47.5 58.1 55.7 64.7
United Kingdom 43.8 45.6 48.1 51.4 48.8 50.6
Liver/bowel
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 10.8 8.6 6.4 12.6 6.3 12.4
Wales 8.2 9.5 9.1 9.4 10.1 14.6
England 10.5 11.4 12.3 14.0 13.1 13.2
Scotland 17.1 19.3 17.5 19.6 19.7 19.8
Northern Ireland 12.9 16.1 12.2 10.4 14.2 18.5
United Kingdom 11.1 12.2 12.6 14.2 13.6 14.0
Cardio
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 4.3 8.6 2.1 8.4 6.3 10.4
Wales 5.3 7.5 3.9 5.9 5.2 8.4
England 4.7 5.0 5.1 6.4 5.8 6.0
Scotland 4.4 4.0 6.1 7.7 4.5 3.6
Northern Ireland 5.0 3.9 8.3 4.4 3.8 5.4
United Kingdom 4.7 5.0 5.2 6.5 5.7 5.9
Organs
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 66.8 76.9 72.0 63.1 58.5 70.5
Wales 66.5 79.0 68.9 68.0 56.4 69.2
England 58.9 60.6 65.1 71.2 67.9 69.0
Scotland 58.0 66.1 68.6 79.8 70.9 77.4
Northern Ireland 60.9 67.8 68.0 72.9 73.8 88.6
United Kingdom 59.5 62.9 65.9 72.1 68.0 70.5
Cornea
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 51.7 36.3 40.2 31.6 23.0 22.8
Wales 51.3 32.1 45.4 42.0 42.2 44.3
England 58.8 61.2 60.4 59.9 57.6 60.6
Scotland 45.1 37.7 46.5 48.7 47.1 47.7
Northern Ireland 53.1 47.8 37.6 39.5 34.4 34.8
United Kingdom 58.3 58.4 58.2 57.8 55.6 58.5
Measure 11: Number of deaths on the organ transplant list (per million population)
0
2
4
6
8
10
12
14
16
18
20
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardi ff& Vale
Wales
Financial year 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Cardiff & Vale 17.25 10.69 0.00 2.10 8.35 4.15
Wales 16.12 13.11 9.47 6.83 3.89 7.76
England 9.37 9.42 8.72 9.22 7.00 7.40
Scotland 8.66 11.87 8.38 7.34 6.76 5.80
Northern Ireland 9.50 8.34 8.84 6.58 8.74 4.89
There has been a decline in the number of deaths on the transplant list in the last year which is positive. It potentially indicates that those waiting are receiving transplants or that their clinical management is of a less severity and the urgency of a transplant allows a time extension for better quality/matching organs.
7.0 Outcome 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.
We have worked hard over the past 12 months to ensure that we have good support systems and processes in place to support an increasing level of donation and transplant activity.
Progress against this measure is measured by the following measures:
Measure 12: Transplant survival: by organ and by transplant centre.
One and five year adult kidney-only patient survival using kidneys from deceased donors 1 April 2007 - 31 March 2015
One and five year patient survival for first SPK transplant recipients 1 April 2007- 31 March 2015
One and five year graft survival for first SPK transplant recipients 1 April 2007 – 31 March 2015
Measure 13: Transplant waiting time by organ and by transplant centre.
Median waiting time to kidney only transplant in the UK, for patients registered 1 April
2010 - 31 March 2013
Median waiting time to Pancreas only transplant in the UK, for patients registered 1 April 2010 - 31 March 2013
Over the past 12 months we have:
Maintained the outcomes for our kidney and pancreas transplant recipients at or
above the national UK figures.
Patients listed for a kidney transplant in Cardiff wait a significantly shorter time to
transplant than the UK average.
Patients listed for a pancreas transplant in Cardiff wait a significantly shorter time to
transplant than those from any other transplant unit in the UK.
Noted that the implementation of a revised DCD screening tool can provide greater
accuracy when assessing marginal donors.
Appointed 5 scrub nurses to our NORS team so now fully established at retrievals.
Begun the process of Peer review for Transplantation.
Section Two - Action Plan and Priorities for 2016 / 17
Health Boards are required, together with their partners, to produce and publish a detailed local service delivery plan to identify, monitor and evaluate action needed within timescales. The Health Board executive ‘lead’ responsible role for organ donation report progress formally to their Boards against milestones in these delivery plans and publish these reports on their websites annually.
Having reviewed our progress against our action plan produced in 2015, we have updated our action plan to ensure that it will allow us to respond to the challenges identified by our review and to ensure that we are in a position to meet the requirements of the NHS Blood and Transplant (NHSBT) strategy: ‘Taking Organ Transplantation to 2020’, the Wales Action Plan (2014) and the all Wales Organ Donation and Transplantation Priorities 2016-17.
8.0 Development of Cardiff and Vale University Health Board action plan for
2016/2017
Cardiff and Vale UHB is one of the largest NHS organisations in the UK.
The population of Cardiff and Vale is growing rapidly in size, projected to increase by 10% between 2015-25, significantly higher than the average growth across Wales and the rest of the UK. An extra 50,000 people will live in Cardiff and Vale and require access to health and wellbeing services.
The Cardiff and Vale population is relatively young compared with the rest of Wales, with the proportion of infants (0-4 yrs) and the traditional working age population (17-64) higher than the Wales average; however, the number of over 85s is increasing at a much faster rate than the rest of the population (32.4% increase between 2015-25).
The population is ethnically very diverse, particularly compared with much of the rest of Wales, with a wide range of cultural backgrounds and languages spoken. Arabic, Polish, Chinese and Bengali are the four most common languages spoken after English and Welsh. Cardiff is an initial accommodation and dispersal centre for asylum seekers.
The Cardiff and Vale health community has a diversity of inequalities that may impact on quality of organs for donation due to premorbid conditions but also the number of people on the transplant waiting list. Risk factors for disease
Unhealthy behaviours which increase the risk of disease are endemic among adults in Cardiff and Vale:
1. Nearly half (44-45%) drink above alcohol guidelines.
2. Nearly two thirds (66-67%) don’t eat sufficient fruit and vegetables.
3. Over half (55-57%) are overweight or obese, this increases to two thirds (64%) among 45-64 year olds.
4. Around three quarters (72-75%) don’t get enough physical activity.
5. Just over one in five (22%) smoke.
Many children in Cardiff and Vale are also developing unhealthy behaviours:
1. Two thirds (66%) of under 16s don’t get enough physical activity.
2. Nearly a third (31%) of under 16s are overweight or obese.
Around 1 in 10 adults are recorded as having high blood pressure in Cardiff and Vale.
Equity, inequalities and wider determinants of health
There are stark inequalities in health outcomes in Cardiff and Vale: 1. Life expectancy for men is nearly 12 years lower in the most-deprived areas
compared with those in the least-deprived areas.
2. The number of years of healthy life varies even more, with a gap of 22 years between the most- and least-deprived areas.
3. Premature death rates are nearly three times higher among the most-deprived areas compared with the least deprived.
There are also significant inequalities in the ‘wider determinants’ of health, such as
housing, household income and education: 1. For example, the percentage of people living without central heating varies by
area in Cardiff and Vale from one in a hundred (1%) to one in ten (13%).
There are inequalities in how and when people access healthcare. Ill health in Cardiff and Vale
The disease profile in Cardiff and Vale is changing: 1. The number of people with two or more long term conditions in Cardiff and
Vale has increased by around 5,000 in the last decade, and this trend is set to continue;
2. Around 1 in 7 (15%) people consider their day-to-day activities are limited by a long-term health problem or disability;
3. Many people with long term conditions are not diagnosed and do not appear on official registers; and
4. Due to changes in the age profile of the population and risk factors for disease, new diagnoses for conditions such as diabetes and dementia are increasing significantly.
Around 1 in 5 adults have visited their GP within a 2 week period; and nearly three
quarters visit a pharmacy over a year period.
Rates of delayed transfer of care for social care reasons are nearly twice as high in Cardiff and Vale than the Wales average.
Heart disease, lung cancer and cerebrovascular disease are the leading causes of death in men and women.
Preventable illness and deaths: 1. Many (but not all) of the most common long term conditions and causes of
death may be avoided by making changes in health-related behaviours.
Cardiff and Vale UHB fully supports organ donation and have an Organ Donation Committee (ODC) that has a variety of representatives. These include the Chair of the Board, Medical Director, and representatives from Critical Care, Emergency Department, Theatres,
Transplantation, Bereavement, Communications, Spiritual, Ethics, Pathology, Mortuary and Finance. There is a Clinical Lead for Organ Donation (CLOD) based in the Emergency Department and in Critical Care where the position is to be taken by the regional CLOD. There are also 2 NHSBT Specialist Nurses in Organ Donation (SNOD) and a further 2 newly appointed to commence in September. In addition to the workforce a further SNOD will attend for a week each month as an extension to an educator role. The SNOD’s work within the UHB’s critical care areas and are part of the multi disciplinary team to allow collaboration between the two organisations. The relationship between SNOD’s, CLOD’s, ODC and Health Board is pivotal to the success of organ and tissue donation within Cardiff and Vale. Cardiff and Vale UHB has the highest donation rates in the region covered by NHSBT South Wales Organ Donation Services Team. It also has the only transplant centre in Wales and has the following transplantation rates, 47.7 per million population (UK 50.6 PMP). In order to meet the requirement of referral demand the SNOD team have been trialling an extended work pattern to ensure availability for collaborative approaches and legislative awareness. However, this has been difficult to manage at times as our staffing has been depleted at times therefore we endeavour to fully implement when at a full quota. The Emergency Department has completed its remodel to provide a more efficient service. This has resulted in an increase in the number of resuscitation beds, which will allow identification and assessment of potential organ donors with less pressure on the UHB. Noah‘s Ark Children‘s Hospital for Wales is now fully operational with an increased capacity for critically ill children on Paediatric Intensive Care. Critical care and surgery have a well established 6 bedded Post Anaesthetic Care Unit (PACU). There is often a discrepancy between the supply and demand for critical care beds; on previous occasions a potential organ donor could not be facilitated due to capacity within the intensive care unit. The introduction of PACU will reduce this pressure by allowing more appropriate use of the critical care beds. The National Organ Retrieval Service (NORS) has a newly appointed Cardiff scrub team consisting of 3 fully trained staff and a further 2 that have recently commenced the training post. Such an extension to the service will enhance the activation of the retrieval team and benefit the donation process in terms of time management and minimal delays. Cardiff and Vale UHB are part of a two year research project by Bangor University. The study aim is to examine family attitudes, actions, decisions and experiences following the implementation of deemed consent and the Welsh Human Transplantation Act. Families have the option to participate following an approach in conjunction with SNOD perspectives to contextualise consenting and non-consenting donor family views, experiences and decision making. Following the implementation of the changed legislation the BBC have been filming various aspects of organ donation for a series called ‘ The Greatest Gift’ to be aired in December 2016 to mark a year of deemed consent. The documentary follows the SNOD and transplant team in varying aspects of their role alongside a number of patient stories.
9.0 Priorities for the coming year
The Taking Organ Transplantation to 2020 – Wales Action Plan sets out action to improve outcomes between now and 2020. The all Wales Organ Donation and Transplantation Priorities 2016-17 presents the national priorities that the Wales Transplantation Advisory Group will be focusing upon over the next 12 months. In addition to these national priorities, we have also identified priorities for 2016-17 which reflects our local challenges.
Increase engagement with Paediatric Intensive Care and a job description for a CLOD has been submitted to the Chair of the Health Board.
Instigation of extending the potential donor audit to neonatal services to assist with the identification.
Continued legislation awareness – supporting and teaching clinical staff.
Improve consent rates across the University Health Board.
Strive towards 100% referral rate in all departments, to eliminate any risk of missed potential.
Continue to maintain and build further relationships with key stakeholders e.g. Critical Care, Theatres, Emergency Unit, Transplant Unit, Mortuary.
10.0 Performance Measures and Management
The Welsh Transplant Advisory Group has agreed on a small number of outcome indicators and performance measures that will be used to measure success:
• Increasing the number of potential adult, paediatric and neonatal donors • Improving donor conversion rates • Making the most of donor organs • Increasing retrieval and transplantation of organs • Resuscitation of retrieved organs • Improving survival of transplant patients • Systems to support organ donation and transplantation
11.0 Action Plan for 2016/17
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
Outcome 1 – Society and Individuals
Develop national strategies to
promote a shift in behaviour
and increase consent and test
progress with regular public
surveys.
Implement NICE and good
practice guidelines on family
approach.
Improve communication skills
of health professionals to talk
to patients and their families.
Support families to respect the
decision of their loved ones.
Amend NHSBBT educational
pack for use in Welsh schools.
Continued education and support
of clinical staff regarding NICE
guidelines and legislation change.
Ongoing simulation training,
internal practice sessions and
advanced communication courses
made available to health
professionals.
Continue progress in collaborative
requesting to ensure families can
make informed choices regarding
the wishes of their loved one.
Engage with community services to
promote organ donation and
legislative change.
Cardiff and Vale
CLOD’s
Cardiff and Vale
SNOD’s
Organ Donation
Committee
March 2017
All Governments should
provide regular reports to
Parliament/Assembly on
Publish an annual report on
progress improving organ
Continue to collect and analyse
Cardiff and Vale UHB potential
Cardiff and Vale
CLOD’s
March 2017
Annual report
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
progress in their nation and
Health Ministers should have a
duty to promote organ donation
and transplantation, effectively
leading to a significant
improvement in public attitudes
and consent for organ donation.
donation and transplantation.
Report performance against
specific organ donation and
transplant indicators to the All
Wales Donation and
Transplantation Advisory
Group at least annually.
donor audit.
Publish Cardiff and Vale UHB
annual report inclusive of delivery
plan against specific organ
donation and transplant indicators.
Cardiff and Vale
SNOD’s
Organ Donation
Committee
July 2017
Ensure that the introduction of
a system of deemed consent to
organ and tissue donation in
Wales as described by the
Human Transplantation (Wales)
Bill is as successful as possible
and learn from this experience.
Ensure all patients who could
donate organs/tissue for
transplant are operationally
managed within the new
system
Continue legislation training within
education sessions for all clinical
staff involved in organ donation.
Provide support to all queries within
the hospital regarding legislative
change.
Finalise updated policy on organ
donation in line with the new
legislation.
Provision of learning materials in
the form of leaflets and information
booklets issued by the Welsh
Government.
Cardiff and Vale
CLOD’s
Cardiff and Vale
SNOD’s
Organ Donation
Committee
March 2017
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
Develop a community volunteer
scheme to support Trust/Health
Board donation committees to
promote the benefits of
donation in local communities,
particularly amongst groups
with little tradition of organ
donation.
Explore opportunities to
develop community volunteer
schemes.
Work with the Third Sector to
ensure effective signposting to
sources of information and
support.
Offer advice and support to these
groups as required.
Extend invitation of Organ
Donation Committee membership
to relevant parties.
Work alongside patient experience
team within the hospital to identify
possible third sector involvement.
Cardiff and Vale
CLOD’s
Cardiff and Vale
SNOD’s
Organ Donation
Committee
Cardiff and Vale
Executive Board
March 2017
Outcome 2 – NHS (Donation)
Families of potential donors will
only be approached by
someone who is both
specifically trained and
competent in the role, training
packages and accreditation will
be provided to those who wish
to develop this competence.
NHS in Wales to work with
professional bodies and NHS
Blood and Transplant to ensure
training and accreditation
packages are adopted and
families of potential donors will
only be approached by
someone who is both
specifically trained and
competent in the role.
Provide information so
generalist teams know how to
Ongoing simulation training,
internal practice sessions and
advanced communication courses
made available to health
professionals.
Continue progress in
collaborative requesting to ensure
families can make informed
choices regarding the wishes of
their loved one.
Ensure every appropriate clinical
Cardiff and Vale
CLOD’s
Cardiff and Vale
SNOD’s
Organ Donation
Committee
March
2017
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
access support to facilitate
organ donation, if appropriate.
environment knows how to access
the SNOD or tissue services 24
hour service.
Increased SNOD presence by
extending the working hours at
UHW to promote involvement with
early referrals and family
approaches.
Publish hospital data to include:
brain-stem death testing rates,
donor referral rates, family
approach rates, Specialist
Nurse involvement and other
key areas.
Ensure published data is
analysed at a local level and any
potential service improvements
are considered and implemented
where necessary
Continue to analyse Cardiff and
Vale UHB potential donor audit.
Identify any barriers to donation
and seek to implement change to
make improvements.
Publish Cardiff and Vale Annual
Report inclusive of delivery plan
against specific organ donation and
transplant indicators.
Cardiff and Vale
CLOD’s
Cardiff and Vale
SNOD’s
Organ Donation
Committee
Cardiff and Vale
Executive Board
March 2017
Outcome 3 – NHS (Transplantation)
Improve donor management for
potential cardiothoracic donors,
providing a 24/7 service to
Monitor outcome of pilot
programme and consider
Support clinical staff within critical
care with management of the
Cardiff and Vale
SNOD’s
March 2017
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
assist if pilot schemes prove
effective. (SCOUT Pilot)
potential within Wales. potential donor.
Review what pre-mortem
interventions could legally and
ethically be undertaken to
maximise the potential for
organ donation (such as the
administration of heparin,
elective ventilation etc.).
Ensure any guidance developed
is implemented within the NHS
in Wales.
Read, comment and adhere to any
new guidelines provided.
Cardiff and Vale
CLOD’s
Cardiff and Vale
SNOD’s
March 2017
Evaluate new techniques and
technologies for the
preservation of retrieved organs
with a view to their use in the
UK.
Ensure any guidance developed
is implemented within the NHS
in Wales
Utilisation of machine perfusion.
We intend to be part of any
developments in organ retrieval,
perfusion and preservation.
Transplant
Centre
NHSBT
March 2017
Develop a system of peer
review that is underpinned by a
set of agreed standards for
retrieval/ transplant centres.
Fully participate in and act on
the outcome of national clinical
audits.
This needs to be led at a UK wide
level by NHSBT. Full participation is
expected.
Transplant
Centre
NHSBT
March 2017
Provide guidance on levels of
acceptable risk in relation to
offered organs, particularly from
extended criteria donors,
Ensure any guidance developed
is implemented within the NHS
in Wales.
This also needs to be completed at
a UK wide level but for our patients
in Cardiff we continue to carefully
audit our outcomes to help inform
Transplant
Centre
NHSBT
March 2017
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
relevant to the individual
recipient’s needs and wishes.
the risk: benefit discussion which
occurs on an individual basis for
every transplant patient. The
introduction of protocols for
considering organ offers from
donors where there is an increased
risk of donor derived disease and
new consent pathway also reflects
this.
Transplant related risk is described
in SaBTO guidelines. But any donor
related risk should be considered in
relation to recipient risk factors,
medical status and outcomes.
Mainly to risk staying on the waiting
list.
Publish centre-specific risk-
adjusted patient survival from
listing as well as from
transplantation.
Ensure published data is
analysed at a local level and any
potential service improvements
are considered and
implemented where necessary.
From April 2014 NHSBT have
included this data for Kidney
transplant centres on their website
which is available to the public.
NHSBT March 2017
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
Ensure clinicians are aware of
and follow, best practice to
increase patient and graft
survival.
Ensure clinicians are aware of
and follow best practice.
Ensure transplant recipients
receive the care and support
they need.
Cardiff and Vale UHB conducts
regular audit and review meetings
to monitor outcomes from our
programme and compare with other
centres. All clinicians undergo
annual appraisal during which they
demonstrate continuing
professional development in the
field of transplantation and the
directorate supports all appropriate
study leave to facilitate this.
Transplant
Centre
March 2017
Outcome 4 – Working with NHSBT and Commissioners
Develop a workforce strategy
for the organ donation service
which will tailor the service to
the needs of individual
hospitals and seek to provide a
workforce that is focused on
supporting the potentially
conflicting demands of
providing a service to the donor
family, donor management and
donor co-ordination. This may
be configured in one or more
Joint UK action
Joint UK action with NHSBT SNOD’s
NHSBT
March 2017
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
roles as the needs of the
service dictate.
Subject to variations in
Government policy, agree a
formal contract for organ
donation with hospitals
specifying how hospitals and
the NHSBT donation service
work together to achieve
excellence.
Joint UK action
Joint UK action with NHSBT SNOD’s
NHSBT
March 2017
Regional Collaboratives to lead
local improvement in organ
donation, retrieval and
transplant practices and in local
promotion of donation and
transplantation.
Review and refresh membership
and terms of reference of organ
donation committee
Develop and implement a
coordinated action plan to drive
improvements in organ donation
and retrieval across Wales.
Work with Health Boards to
develop a local communication
plan to promote public
awareness of the importance of
Attend regional collaborative events.
Invite key stakeholders from UHB to
attend.
Cardiff and Vale
CLOD’s
Cardiff and Vale
SNOD’s
Regional CLOD
March 2017
Taking Organ
Transplantation to 2020
UK Action
Taking Organ Transplantation to
2020 Wales Action
Wales Action
Taking Organ Transplantation to
2020 Wales Action
Cardiff and Vale University Health
Board Action
Lead Date
organ donation and
transplantation including Living
Donation.
Optimise the processes,
timescales, resources and
supporting IT at every stage of
the pathway from donor
identification to long-term
survival.
Work with NHSBT to optimise
the processes, timescales,
resources and supporting IT at
every stage of the pathway from
donor identification to long-term
survival.
Work with NHSBT to optimise the
processes, timescales, resources
and supporting IT at every stage of
the pathway from donor
identification to long-term survival.
NHSBT March 2017
Review the current processes
for donor characterisation
(especially for microbiology and
tissue typing).
Work with NHSBT to review the
current processes for donor
characterisation (especially for
microbiology and tissue typing).
Work with NHSBT to review the
current processes for donor
characterisation (especially for
microbiology and tissue typing).
NHSBT March 2017
Investigate the feasibility and
implications for the provision of
a 24/7 provision of expert
histopathology advice.
Work with NHSBT to investigate
the feasibility and implications
for the provision of a 24/7
provision of expert
histopathology advice for Welsh
residents.
Work with NHSBT to investigate the
feasibility and implications for a
24/7 provision of expert
histopathology advice for Welsh
residents.
NHSBT March 2017
12.0 Actions Required to Deliver Locally
Objectives for the next year to meet incremental service improvements
Actions required to deliver objective
Measurable outcome/ KPIs
Why, Context, Inter Relationships, and Contingencies. Risk
Role responsible for leading action. Review date
Evaluation
Identify key actions required to improve donation from emergency departments including:
100% referral of potential donors from Emergency Departments
Identify a donation lead in each Emergency Department
Ensure representation from Emergency Department on UHB Donation Committee
Set clear referral pathways for potential donors from emergency department
Continue to educate staff in ED to adhere to NICE guidance
Continued close work between ED CLOD and SNOD’s
Continue to adhere to UHB ED Organ Donation Pathway
Ensure all clinicians are aware of the hospital policy regarding organ donation
Simulation days
Referral rate
Why?
Substantial donor potential from ED
Risk
No office space for SNODs with ED
Limited opportunity for teaching due to clinical pressures
High staff turnover (both medical and nursing)
Relationships
2 SNOD’s with UHB senior ED experience
UHB has a dedicated ED CLOD
ED CLOD
Cardiff and Vale SNOD’s
March 2017
Identify key actions required to deliver an increase in the number of living donation
Improve the awareness of live donor transplant benefits amongst patients and non-transplant clinicians.
Stream-line the
Number of live donor transplants.
Number of live donor transplants per million
Live donor transplantation (especially pre-emptive) provides the optimum outcome for patients with end stage renal disease, although only approximately one third of
Clinical lead for Transplantation (Mr Michael Stephens) and Clinical Director for Nephrology and
March 2017
Objectives for the next year to meet incremental service improvements
Actions required to deliver objective
Measurable outcome/ KPIs
Why, Context, Inter Relationships, and Contingencies. Risk
Role responsible for leading action. Review date
Evaluation
assessment process for donors and recipients to increase the opportunity for pre-emptive transplantation.
population.
Number of live donor transplants as a proportion of the kidney transplant waiting list.
Number of pre-emptive live donor transplants.
Graft and patient survival at 1 and 5 years post transplant.
such patients will be fit enough to tolerate the surgery and the immunosuppression required to achieve this. In comparison to the alternative of dialysis it is extremely cost-effective.
The recipient and donor need a very careful (and time consuming) work-up and therefore early referral and education is essential. This requires awareness and enthusiasm from general nephrologists and a robust information provision programme.
Transplantation (Prof Aled Phillips).
Identify key actions required to ensure equity of access to both living and deceased organ transplants
Compare live donor outcomes describes above across health authorities.
Outcomes described above per UHB.
There are data suggesting access to transplantation is related to proximity to a transplant centre and also that outcomes following kidney transplantation is related to socio-economic deprivation. To better understand these relationships may allow us to improve outcomes for
Clinical lead for Transplantation (Mr Michael Stephens) and Clinical Director for Nephrology and Transplantation (Prof Aled Phillips).
March 2017
Objectives for the next year to meet incremental service improvements
Actions required to deliver objective
Measurable outcome/ KPIs
Why, Context, Inter Relationships, and Contingencies. Risk
Role responsible for leading action. Review date
Evaluation
all patients.
Develop a plan to support Local Health Boards to improve tissue retrieval services
Provide information and support the transfer of tissue services to the National Referral Centre
Continue to consent and facilitate tissue donation in multi organ donors
National transplantation data
EPSOD data
Contingency
Maintain relationships with National Referral Centre
Provide support and advice regarding tissue donation
NRC
Cardiff and Vale SNOD’s
March 2017
Implement best practice guidance for all eligible patients on the organ donation pathway
Adhere to care bundles and policies
Standardised approach when possible to optimise donor potential
Referral data
Donor outcome
Risk
Clinical pressures
Available service provision
Relationships
Clinical staff Contingency
Attain high standards of donor care
Teamwork
Cardiff and Vale SNOD’s
Critical Care
March 2017
Identify key actions to improve organ donation from paediatric and neonatal units
Set clear referral pathways for potential paediatric and
Continue to educate staff in PIC to adhere to NICE guidance.
Attend all appropriate teaching sessions/meetings to teach and discuss
Referral rate
Risk
Engagement Relationships
Consultant with special interest is on ODC
Contingency
More visible SNOD
Cardiff and Vale SNOD’s
March 2017
Objectives for the next year to meet incremental service improvements
Actions required to deliver objective
Measurable outcome/ KPIs
Why, Context, Inter Relationships, and Contingencies. Risk
Role responsible for leading action. Review date
Evaluation
neonatal donors organ donation
Ensure all clinicians are aware of hospital policy regarding organ donation
Simulation days (observers)
Awaiting the release of a paediatric CLOD post
Extend PDA to neonatal services
presence
Build trust and relationships
Develop a local communications strategy for organ donation and transplantation, including living donation
Maximise awareness of organ donation pathways amongst local health professionals
Contact with UHB communications team to highlight activity or events
ODC attendance
Transplant week
Teaching
Simulation training
Attendance to course days
PDA data
Contingency
Maintain relationships with all committee members
Publicise relevant courses to engage with health professionals
Maximise training opportunities with clinicians and nursing staff
Cardiff and Vale SNOD’s
Cardiff and Vale CLOD’s
Organ Donation Committee
March 2017
Additional End Note The committee would like to thank all those families who have generously given a gift of Organ and Tissue donation, as well as those working towards and supporting end of life choices for families to enable life saving transplants for others.