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Claire Hamilton

Potential Donor Audit. Claire Hamilton. Audits of deaths undertaken late 1980s/ early 1990s England and Wales by Gore et al Wales by Salih et al In 1995 MORI/UKTCA/BACCN reported reasons for relatives’ refusal of consent to donation A national approach was required. Previous studies.

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Claire Hamilton

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  1. Potential Donor Audit Claire Hamilton

  2. Audits of deaths undertaken late 1980s/ early 1990s England and Wales by Gore et al Wales by Salih et al In 1995 MORI/UKTCA/BACCN reported reasons for relatives’ refusal of consent to donation A national approach was required Previous studies

  3. Heartbeating donors in UK

  4. Falling numbers of deceased heartbeating donors in the UK and the need to reverse the trend The recognised need for an up-to-date assessment of the current potential for solid organ donation across the UK Requirement by the UK Health Departments Implementation agreed by the UK Intensive Care Societies Background

  5. Determine the potential for solid organ donation Identify all patients for whom death was diagnosed following brain stem tests If not a solid organ donor, why not? Raise the profile of solid organ donation Heighten awareness of donation issues Aims of the PDA

  6. Implementation Pilot study: • 1 Jun to 31 Dec 2002 National study: • All ICUs in the UK from 1 Apr 2003 • Data collected on every patient death in an ICU National study extended: • To audit potential for NHB donation from 1 Jan 2004 National study revised: • Cardiothoracic ICUs and patients aged over 75 years excluded from 1 April 2006

  7. Current data process • Donor coordinators collect data from ICUs • Complete a PDA form on an Access Database at office • Print the form out and send in to ODT Data Services team • Data are then input onto national database and validated • Teams have access to their data from their own database • ODT Statistics & Clinical Audit team has access to all data

  8. Current reporting process • There is a time lag between deaths being audited and reporting time periods. • Coordinators are allowed 2 months after the end of a quarter to return all their PDA forms. • Statistics and Clinical Audit allow a further 6 weeks for the data to be entered by Data Services before creating reports • E.g. report on data up to 30 September in mid January

  9. N Audited patient deaths 30,276 Ever on mechanical ventilation 27,915 Brain stem death possible diagnosis 3,184 Brain stem tests performed 2,475(78%) Potential HB donors 2,407 (Death diagnosed following tests and no absolute medical contraindications) Solid organ donors 1,186 (49%) Results: 1 Apr 2006 – 31 Mar 2008Heartbeating (HB) donation

  10. Potential HB donors 2,407 No recorded discussion of HB 282 (12%)of 2,407 solid organ donation with family Consent for solid organ donation Given 1,299 (61%) of 2,125 Not given 826 (39%) of 2,125 Actual solid organ donors 1,186 (91%) of 1,299 with consent Results (2)

  11. Key areas for monitoring - HB • BSD testing rate – 78% (% of those where BSD likely that were tested) • Referral rate – 84% (% of potential donors referred to coordinators) • Consent (authorisation) rate – 61% (% of families approached that consent to/ authorise donation) • Conversion rate – 49% (% of potential donors that become actual donors)

  12. Reasons for lack of consent to donation • Patient stated in past he/she did not wish to be a donor • Family not sure patient would have agreed to donation • Family divided over decision • Family felt patient had suffered enough • Family did not want surgery to the body • Family felt it was against their religious or cultural beliefs

  13. Consent rates by DTxC team < 30% 30 – 39% 40 – 49% 50 – 59% 60 – 69% 70 – 79% > 80%

  14. Patient age group 0-17 18-24 25-34 35-49 50-59 60+ 60% 59% 58% 61% 63% 62% p=0.8 Patient sex Male Female 61% 61% Patient ethnicity White Non-white 68% 26% p<0.001 Consent rates by patient demographics

  15. Non-heartbeating donors in UK

  16. N Audited patient deaths 30,276 Ever on mechanical ventilation 27,915 Not confirmed brain stem dead 25,498 NHB donation possible 3,187 Potential NHB donor 2,051 (NHB donation possible and treatment was withdrawn) Solid organ donors 263 (13%) Results: 1 Apr 2006 – 31 Mar 2008Non-heartbeating (NHB) donation

  17. Potential NHB donors 2,051 No recorded discussion of NHB 1,288 (63%)of 2,051 solid organ donation with family Consent for solid organ donation Given 450 (59%) of 763 Not given 313 (41%) of 763 Actual solid organ donors 263 (58%) of 450 with consent Results (2)

  18. Key areas for monitoring - NHB • Referral rate – 38% (% of potential NHB donors referred to coordinators) • Consent (authorisation) rate – 59% (% of families approached that consent to/ authorise donation) • Conversion rate –13% (% of potential donors that become actual donors)

  19. The Future of the PDA • Subgroup of the Donation Advisory Group reviewed form • Form has been revised to • clarify questions and terminology • collect information on a patient’s wishes to donate, in more cases • collect less free text and more coded reasons • Will enable better analysis of reasons why potential donors do not become actual donors at each stage

  20. The Future of the PDA • Data entry process will be streamlined by having coordinators enter data onto a centrally held database • Stringent validation rules will maintain the accuracy of data • Coordinators will be able to enter data offline in an ICU, making data collection simpler • Reporting time lag will be shortened as data will be available sooner

  21. Reports to Donation Champions • Produced 6 monthly due to low volume of data • Report template to be finalised • PDA data • Key percentages (BSD testing, referral, consent and conversion) • Current and previous year for comparison • National UK data for comparison • National Transplant Database • Number of actual HB and NHB donors • Number of patients transplanted • Organs retrieved per donor • Number of organs transplanted • Current and previous year for comparison

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