Taskforce Implementation – Progress and Results

Chris Rudge FRCSNational Clinical Director for

TransplantationRenal CDs Meeting 12 March 2010

Organ Donation Taskforce

• Made 14 recommendations• Clarified roles

– Acute hospital Trusts– Departments of Health/NHS

• Review of co-ordination & retrieval• Training• Legal and ethical issues• Public promotion

Target – 50% increase in donation over 5 years

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

A UK Model for DonationNHSBT

Department of Health

Acute Hospital Trusts

Mo

re d

on

ors

FundingResolution of ethical and legal issuesPerformance Management TrainingPublic recognition

Clinical leadsEmbedded co-ordinatorsDonation committees

National Organ Donation Organisation

Effective co-ordination and retrieval

Education, training and audit

Public engagement

National Organ Donation Organisation

Recommendations

• A UK-wide Organ Donation Organisationshould be established

• The Establishment of the Organ Donation Organisation should be the responsibility of NHS Blood and Transplant

Complete

Review of Donor Transplant Coordination

Recommendation

The current network of Donor Transplant Co-ordinators should be expanded and strengthened through central employment by a UK-wide Organ Donation Organisation

Well underway: >75 additional DTCs recruited, 11/12 new teams established

Review of Organ Retrieval

Recommendation

A UK-wide network of dedicated organ retrieval teams should be established to ensure timely, high-quality organ removal from all heartbeating and non-heart beating donors

New commissioning contracts in place, major changes planned for 2010/11

Removing Financial Disincentives

Recommendation

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

Complete – reimbursement for all donors from April 2008 (now £2,055). Accurate tariff under

development

Promotion with the PublicA role for us all

Recommendation

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

Major public campaign launched on 2nd November 2009. Research coordination group now active

A UK Model for DonationNHSBT

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

Funding

Resolution of ethical and legal issues

Performance Management

Training

Public recognition

Department of Health

Ethico-legal Uncertainties

Dying but not yet dead

• Non heart beating donation

• Transfer from Emergency Medicine

• Donor stabilisation

• Early referral to DTC

• Early consultation of ODR

Ethical, Legal and Professional Issues

Recommendation

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

Ethical issues: Sir Peter Simpson appointed Chair, members appointed, 1st meeting held on 6th Jan 2010

Legal matters: Guidance published in November 2009

• November 2009 in England and Wales.

• Scottish guidance awaited.

Coronial Issues

RecommendationThe Department of Health and the Ministry of Justice

should develop formal guidelines for coroners concerning organ donation

Guidance expected shortly

Training, Education and Professional Development

Recommendation

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

NHSBT: Professional Development Programme for CLODS, non clinical chairs etc

DH: National Training Group established

Recognition of Donors

RecommendationAppropriate 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

Loveseat MemorialGlasgow

Workshop was held on September 11th 2009Priorities now being pursued

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

Clinical leadsEmbedded co-ordinatorsDonation committees

Acute Hospital Trusts

Donation ChampionsRecommendationEach Trust should have an identified clinical donation

champion and a Trust donation committee to help achieve this.

Well underway. 171/194 Clinical Leads for Organ Donation

appointed. 101/180 Donation Committees and Chairs

Embedded Donor Transplant Co-ordinator

RecommendationAdditional co-ordinators, embedded within

critical care areas, should be employed… There should be a close and defined collaboration between donor co-ordinators, clinical staff and clinical leads

Well underway: 51% of hospitals have an embedded DTC.

Collaboratives of embedded donor co-ordinators and CLODs being established

Performance ManagementLocal governance

RecommendationDonation rates should be monitored. Rates of

potential donor identification, referral, family approach and consent should be reported. The Trust Donation Committee should report to the Trust Board and the reports should be part of the assessment of Trusts through the relevant healthcare regulator

Underway. Donation Activity supplied to all Trusts from August 2009

Support for the Collaborative

Central training and development

Sound ethical and legal framework

Collaborative of critical care and donor transplant co-ordination

Trust Donation Committee

Adequate resource

Trust executive support

777 778 770 709 814 753 779 793 884 931

2334 2339 2333 22222454

2195 2316 23402545 2598

5487 5518 5665 5837 6024

6543

71027313

7963 8065

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Deceased donors

Deceased donor transplants

Active transplant list

Deceased donors, transplants and active transplant list in the UK

739 737 717

643

726

630 633607 620 615

0

100

200

300

400

500

600

700

800

900

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Deceased heartbeating donors (DBD)

38 4153

66

88

123

146

186

264

316

0

50

100

150

200

250

300

350

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Deceased non-heartbeating donors (DCD)

376 381 384

462 477

553

683

824

960995

0

100

200

300

400

500

600

700

800

900

1000

1100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Living donors

1314 1329 1265 1185 12951111 1144 1101 1107 1106

47 56 85112

147

201 252 313455 510

348 358 372 451463

543671

804

924972

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2200

2400

2600

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Donors after brain death Donors after cardiac death Living donors

Kidney transplants

1709 1743 1722 1748 1905 1855 2067 22182486 2588

4822 4846 4963 5072 52065660

61906685

7256 7241

0

1000

2000

3000

4000

5000

6000

7000

8000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Total kidney transplants Active transplant list

Kidney transplants and active transplant list

Europe: Deceased Donors

34.2

Europe: Deceased Donors

34.2

14.7

2046

1928

17161628

15751489

1370 13381243 1268

1161 1130

0

500

1000

1500

2000

2500

2003/04 2004/05 2005/06 2006/07 2007/8 2008/9

BSD possible diagnosis Patient confirmed BSD

Falling incidence of brainstem death

Incidence of BSD in 2007

Spain UK

No of patients diagnosis of BSD

2343 1130

Population (m) 45.2 60.2

BSD pmp 52.2 18.6

Summary

• Good progress in implementation of the infrastructure changes

• Increasing DCD, static DBD

• Future focus will be on:– Improving DBD– Improving DCD– Donation from Emergency Medicine