1 / 48

Organs for Transplants A Report from the ODTF

Organs for Transplants A Report from the ODTF. role of NHS review of co-ordination & retrieval training legal and ethical issues public promotion. 14 recommendations………. ……20 donors pmp by 2013. Implementation: central issues. Resolution of ethical and legal issues (R3)

merlin
Download Presentation

Organs for Transplants A Report from the ODTF

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Organs for TransplantsA Report from the ODTF • role of NHS • review of co-ordination & retrieval • training • legal and ethical issues • public promotion 14 recommendations………. ……20 donors pmp by 2013

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

  3. Implementation: operational issues BASL Organisational change ODT within NHSBT (Rs 1,2) Implementation workstreams 1: Organ retrieval (Rs 8,10) 2: Donor transplant co-ordination (R9) 3: Engagement of NHS (Rs 4,5,6,7) 4: Gift of life (R13)

  4. The Spanish ModelOverarching principles “The burden of responsibility to raise the question of donation …falls on medical professionals, few of whom ever receive any specific training for this difficult and delicate task.This is, by far, the target group on which the efforts to improve organ donation must be concentrated.” Rafael Matesanz M. Director de la Organizacion Nacional de Trasplantes

  5. The UK Model!Organ donation partnership ICUs / Trusts NHSBT Elisabeth Buggins CBE Chair, ODTF Clinical champions Embedded co-ordinators Donation Committees Effective coordination and retrieval Education, training and audit SHAs Departments of Health NHS Funding Resolution of outstanding ethical & legal issues Performance management Public engagement

  6. The UK Model!Process mapping NHSBT Effective coordination and retrieval Education, training and audit ICUs Trusts More donors Central administrations Clinical champions Embedded co-ordinators Donation committees Funding Resolution of outstanding ethical & legal issues Performance management Public engagement

  7. The UK Model!Process mapping NHSBT Leeds General Infirmary ICUs Trusts More donors Brainstem death testing Referral of marginal donors Consent Donation from A&E Donation after cardiac death Donor management Central administrations

  8. Brainstem death testingAssessment of marginal donors

  9. Potential Donor Audit

  10. Potential Donor AuditPossibly BSD, not tested 2007-8 • 350 missed potential donors • 172 actual donors • 619 additional transplanted patients • extra 2.8 donors pmp 01/01/2006 – 31/12/2007

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

  12. Potential Donor AuditBSD, not considered / approached • 137 missed potential donors per annum • 62 actual donors • 180 additional transplanted patients • extra 1.3 donors pmp 01/01/2006 – 31/12/2007

  13. (approx 70 cases / year) Potential Donor AuditBSD, donation not considered

  14. Potential Donor AuditBSD, family not approached

  15. Consent

  16. Potential Donor AuditBSD, consent refused • UK consent rate 61% • a consent rate of 85% • 256 additional donors • 921 additional transplanted patients • extra 4.1 donors pmp 01/01/2006 – 31/12/2007

  17. International Consent Rates, 2007

  18. The public don’t support donationBBC DoNation Poll, 2005

  19. 91% is the consent rate when patient is known to be on ODR on 36% of occasions, the ODR is not used to inform approach to family

  20. One million additional registrants ≡ 5 extra donors per year

  21. Donation from Accident and Emergency Departments

  22. North Thames ED donation summary activity 2001- current

  23. Donation after cardiac death

  24. Donation after Cardiac DeathAdoption in UK

  25. NHB donors by DTC team 1 April 2007 – 31 March 2008

  26. Donation after Cardiac DeathPDA, 2007-8 • conversion rate 12% • unavailability • consent • unpredictability • 580 missed potential NHB donors per annum • 177 missed actual donors • 407 additional transplanted patients • extra 3 donors pmp 01/01/2006 – 31/12/2007

  27. Medical management to optimise donor organ potential

  28. Organ Transplants 2007-8Deceased donors

  29. Standardised donor managementMaximisation

  30. Organs for TransplantsA Report from the ODTF • role of NHS • review of co-ordination & retrieval • training • legal and ethical issues • public promotion

  31. Role of NHSDonation as part of EOL care

  32. Role of NHSDonation Champions

  33. Review of DT Co-ordinationClinical collaborative Collaborative of embedded donor co-ordinators and clinical champions

  34. 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

  35. Role of NHSBrainstem death testing

  36. 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

  37. Organs for TransplantsEthical, legal and professional issues

  38. 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

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

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

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

  42. Donation CommitteePurpose • To ensure that donation is considered in all appropriate situations • To ensure that the option of donation is part of all end of life care • To maximise donation through better support for families “making donation usual, not unusual”

  43. Donation CommitteeObjectives • To oversee the development and maintenance of local policies relating to donation • To monitor donation activity and report through normal governance channels • To support the clinical collaborative • To ensure the delivery of educational programmes to meet recognised training needs “making donation usual, not unusual”

  44. Implementation of the ODTF ReportCentral role for the collaborative Central training and development Sound ethical and legal framework Collaborative of critical care and donor transplant co-ordination Trust Donation Committees Adequate resource Trust executive support

More Related