Organ Donation & Transplantation in Ireland – Changing times

1. Organ Donation & Transplantation in Ireland – Changing times Aileen Counihan Transplant Co-ordinator Beaumont Hospital

2. Organ Procurement Centre Team National Service for Organ Procurement Current Location – Beaumont Hospital Donor Coordinating Team 24hr on call service for ICUs nationally Recipient Co-ordination 24hr call for renal transplant service

3. The Donor Co-ordinator Role 24hr call to deal with all enquiries pertaining to Organ Donation Responsible for the technical and logistical arrangements. Involved in the donation process from referral, retrieval & to the transplantation of the organs. Care of the Donor, the Family of the Donor, the Donor Hospital staff, the Transplant Team, & Transplant recipients.

4. Recipient Co-ordinator Role • Referral for Renal & Pancreas Transplant • Management of Transplant waiting list • Coordination of Deceased Donor Transplants • Live Donor Transplant Programme

5. Kidney Transplantation • Kidney transplantation is considered the best treatment option for patients in end stage renal failure • Not all patients are suitable for transplant • Only 33% of patients with kidney failure are on transplant waiting list

6. When transplant is not the best option • Clinical reasons : • History of recent cancer • Major surgery • Severe cardiac problems or advanced blood vessel disease • Patient choice: • decide that transplantation is not for them. • can opt to stay on dialysis.

7. Renal Transplantation • Live Donor Transplant • from a family member/spouse/friend • Paired Exchange • Deceased Donor Transplant • Brain Death Donor • Non Heart Beating Donor.

8. Recipient Evaluation for Transplant • Standard workup : • Full Blood Profile • Tissue type x 2 • Virology < 3mths • Chest Xray & Abdo U/sound • Cardiac Tests, Stress ECG, Cardiac Echo • Coronary Angio ( if indicated) • Dental Clearance • Smear Test for female patients • PSA for men > 50yrs • Other tests determined by age/cause of failure • Copy of all results to Transplant Office with a detailed referral letter

9. Evaluation for Transplant • Some patients may require further assessment • Test results may require further investigation. • Patient is sent an appointment with an information booklet about transplant • All patients are seen at the transplant assessment clinic in Beaumont • Meet with Transplant Surgeon & Co-ordinator

10. Pre-Transplant Clinic • Assess suitability for transplant • Surgery explained • Opportunity to ask questions , encourage patients to bring someone with them to clinic • Option of Live Donation given • Importance of contactability, urgency, keeping healthy & well reiterated • Follow up phone call • Letter to patient to inform approved for Transplant & regular blood samples for antibody screening while on the pool • Letter from H&I when activated

11. Further Screening • Other tests may be required • Anaesthetic assessment • Patients to lose weight or to monitor weight • Reassurance while on the list • Patients over 2 years • Patients suspended for a prolonged period of time • Older patients

12. Waiting Time • Currently 29 months. • Factors influencing time on list • Patients with a high antibody level • Patient BMI • Increasing number of patients on list • Donor supply

13. Acknowledging the Donation Donor and donor family will be foremost on recipients’ mind Anonymity Maintained • Encourage recipients to write to donor family and can be done via the Transplant Co-ordinators • Information leaflet • Attend the Annual Service of Remembrance and Thanksgiving • Circle Of Life Garden in Salthill

15. Organ Donor Web Site Donor Families shared experiences Transplant Recipient success stories Gratitude of Recipients & Comfort received by Donor Families Commemorative Garden

17. Statistics Deceased Donors/Transplants in Ireland (Organ Procurement Centre)

18. Potential Live Donor • Patients will be asked if they wished to consider a Live Donor Transplant • Potential donors to contact the transplant co-ordinators directly • Initial suitability would be discussed with them – Blood Group Compatible • Arrangements made for H&I screening • Information on Live donation given • Only one donor can go forward to workup

19. Live Kidney Donation • Donor must be fully informed and aware of risks and benefits of procedure • No risk to the potential donor • The decision to donate must be voluntary, no coercion or inducement • The transplant must have a good chance of providing a good outcome for the recipient. • Ethical Issue • Exposes an otherwise healthy person to the risks of major surgery entirely for the physical benefit of another individual

20. Living Donation Programme

21. Information for Live Donor Recipient • Donor work up period 3 months approx • Medical suitability, extensive screening • Immunological screening • Independent clinical & psychological review • Donor work up confidential • Isolating period for recipient • Recipient remains under the care of nephrology team • Suspended from list, when donor deemed suitable • Setting date for surgery

22. LRD and Deceased Renal Transplant activity in Ireland

25. Changing Role of Transplant Office • No responsibility for Organ Procurement • Perceived conflict of interest • Independent Service • Recipient Coordination • 24 hour on call for renal/pancreas transplant • Liaise with Renal Unit Staff • Patient education • Co-ordinate Live Donation Programme

26. Responsibility of Transplant Office

27. Organ Procurement Office

28. Thank YouAll Further information www.beaumont.ie www.icmed.com www.strangeboat.org www.ika.ie www.coe.int