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Organ Donation in Scotland

Stephen Cole SICSAG September 2009. Organ Donation in Scotland. “making donation usual, not unusual”. Deceased donors, transplants and active transplant list : UK. Unmet need . Increasing numbers waiting for transplant. Aim for a 50% Increase in Donor numbers in 5 years.

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Organ Donation in Scotland

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  1. Stephen Cole SICSAG September 2009 Organ Donation in Scotland “making donation usual, not unusual”

  2. Deceased donors, transplants and active transplant list : UK

  3. Unmet need • Increasing numbers waiting for transplant

  4. Aim for a 50% Increase in Donor numbers in 5 years

  5. What this means is one extra donor per year from each donating unit in Scotland

  6. Organs for TransplantsEthical, legal and professional issues

  7. Role of NHSDonation as part of EOL care

  8. Role of NHSClinical leads/ Donation Champions

  9. Role of NHSMinimum referral criteria ?? • The DTC should be notified as soon as the decision to perform brainstem death tests has been made. • The DTC should be notified as soon as the decision to withdraw active treatment has been made. early referral is vital

  10. Donation CommitteeLocal governance “making donation usual, not unusual”

  11. Potential Donor AuditPossibly BSD, not tested 2007-8 Reasons for not testing (approx 350 / year)

  12. Potential Donor Audit • Carried out in every ICU in UK on monthly basis. • Uses WW data • Clinical Engagement with this process is vital • NHS BT performance management organisation

  13. Leakage • Patients with catastrophic brain injury who never get to ICU, • Failure to test, • Poor consent rates • failure to optimise donor physiology, • and donation after cardiac death.

  14. Role of NHSBrainstem death testing

  15. Heartbeating donors in UK

  16. Donor Numbers: Scotland

  17. Donor Numbers: Scotland

  18. 91% is the consent rate when patient is known to be on ODR

  19. Consent rates by Region < 30% 30 – 39% 40 – 49% 50 – 59% 60 – 69% 70 – 79% > 80%

  20. Non Heart Beating Donation Donation after Cardiac Death

  21. Controlled Non Heart Beating Donation • Slow planned development across Scotland • National protocol • Adults with Incapacity v’s Human Tissue Act • Organ Donor Register • OUTSTANDING ETHICAL & LEGAL CONCERNS

  22. Implementation: central issues • Resolution of ethical and legal issues (R3) • Performance management (R6) • Training (R11) • Recognition of donors (R12) • Guidelines for Procurator Fiscal Service (R14)

  23. Non-heartbeating donors in UK

  24. Heartbeating donors in the UK

  25. Ethico-legal UncertaintiesDying but not yet dead • donation after cardiac death • transfer from A&E • donor stabilisation • early referral to DTC • early consultation of ODR

  26. Recommendation 3 • Ethical issues • Planning for independent Ethics group completed • Home established • High profile chair • First meeting in May 2009 • Legal issues • QC opinion received • Being translated into policy statement

  27. Clinical LeadWhat it is………. • Development of clinical collaborative • action plan • Guideline development • diagnosis of death • donor identification & referral • donor management • family approach • Local training programs

  28. Clinical LeadWhat it is………. • Potential Donor Audit • Improved data collection • Extension to A&E • Local ownership • Review of the big issues • A&E • NHBD • consent

  29. Summary Aims • 1. Raise public and professional awareness • 2. Increase numbers on ODR • 3. Uniform practice within units and between units • 4. Resolve outstanding ethical & legal concerns • 5. Engagement with DTC to ensure PDA data is accurate.

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