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

0

1000

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3000

4000

5000

6000

7000

8000

1999 2000 2001 2002 2003 2004 2005 2006

Year

Num

ber

Deceased donors

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

50% increase by 2012/13

Further increase in number ofdeceased donors

Deceased donors &transplants

Target figures to 2020

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

Data Headlines

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

0%

20%

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100%

2010/11   Q

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Consen

t rate

Quarter

Consent rate (%) by ODR status

On ODR

Not on ODR

Overall consent rate

Measure 1 - Consent rates by Region

0%

10%

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90%

Eastern London Midlands NorthWest

Northern N Ireland Scotland SouthCentral

SouthEast

SouthWales

SouthWest

Yorkshire UK

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

5.0

10.0

15.0

20.0

25.0

30.0

35.0

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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/11

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/15

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of e

ligib

le,

cons

ente

d an

d ac

tual

don

ors,

an

d or

gans

tran

spla

nted

Quarter

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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f dec

ease

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nors

DBDDCDTotal

Rolling 12 month donor totalsto end of April 2016

www.odt.nhs.uk

Questions ?