National Organ Donation Committee, 28.01014

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National Organ Donation Committee, 28.01014

• Objectives
• Welcome new members / attendees
• Feedback on the proposed revisions to the
  pregnancy policy
• Review the educational activities of the
  Committee
• Contribute to the understanding of the current
  increases in deceased donation
• Advise ODT of the likely impact of any reduction
  in investment on donation-related activities
• Report on work in regional collaboratives
• Consider the future working arrangements of NODC

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Matters arising

• a) Extended DCD project (Roberto Cacciola)
• b) St Johns Award (Dale Gardiner)
• c) Clinical microsite (John Richardson / James
  Neuberger)
• c) Pregnancy and Organ Donation (Huw Twamley /
  Liz Waite)
• d) Regional on-call nurses (Sri Nagaiyan)
• e) Club 32 (Dale Gardiner)

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Pregnancy and organ donation MPD
Summary of Significant Changes
2.1 Where a pregnancy is suspected a ß-HCG blood test must be performed to confirm pregnancy. 2.3 Age criteria within this policy 13 55 years of age 2.4 In relation to deceased patients, to undertake a pregnancy test without the consent/authorisation of the patients family/husband/partner is permissable, if the test is needed as part of the donation process. If pregnancy testing is not possible, donation should only proceed with the agreement of the family and also the retrieval surgeon. 3.1 Female patients should not be tested for pregnancy until the family have given consent/authorisation for organ and/or tissue donation or if the wishes of the patient to donate were clearly stated ( such as joining the organ donor register) 3.4 If the blood test is positive, pregnancy should be confirmed by the relevant specialist clinician or alternative cause for the positive test sought e.g. Choriocarcinoma ( which would be a contra-indication to organ or tissue donation).
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Current UK donor and transplant activity
Current year(01.04.13 12.01.14) Previous year(01.04.12 12.01.13) Change Previous full financial year(2012/2013)
ORGAN DONORS ORGAN DONORS ORGAN DONORS ORGAN DONORS ORGAN DONORS
Donors after brain death 611 532 14.8 705
Donors after circulatory death 438 387 13.2 507
Total deceased donors 1049 919 14.1 1212
Deceased donors (DD) transplants Deceased donors (DD) transplants Deceased donors (DD) transplants Deceased donors (DD) transplants Deceased donors (DD) transplants
Kidney 1543 1320 16.9 1750
Pancreas 20 29 -3.1 37
Kidney/pancreas 151 123 22.8 166
Pancreas islets 27 27 0 30
Heart 155 106 46.2 142
Lung(s) 167 145 15.2 188
Liver 678 591 14.7 775
Total DD transplants 2711 2363 17.3 3113
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Number of donors, April 1st to January
12th2003/4 2013/4
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Proportion of DBD and DCD donors, up to12.01.14
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Key DBD rates
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Number of patients at each stage of pathway
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Age proportions of actual donors
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Age distributions along the DBD organ donation
pathway (1)
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Age distributions along the DBD organ donation
pathway (2)
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Key DBD rates for 18 to 34 year olds
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(No Transcript)
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Education and Training

• NODC Terms of Reference
• To lead the design and delivery of training and
  development opportunities for clinical staff
  involved in the care of potential deceased organ
  donors, including (but not limited to)
• refresher courses for CLODs and Donation
  Committee Chairs
• the National Donation Congress,
• relevant areas of the NHSBT organ donation
  microsite and organ donation toolkit
• the Map of Medicine organ donation pathways

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Education and Training

• a) Evaluation of doctors/nurses attitudes,
  knowledge training towards organ and tissue
  donation (Tim Collins)
• b) National Donation and Transplantation Congress
  (Paul Murphy / Olive McGowan)
• c) Training course for ICM trainees (Dale
  Gardiner)
• d) Role of NODC in education and training (all)

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Updates

• a) ACCORD (Paul Murphy / Sally Johnson)
• b) DePPart (Dale Gardiner)
• c) NICE Guidance (Gus Vincent)
• d) Scout Pilot (Gerlinde Mandersloot)
• e) UK DEC (Dale Gardiner / Paul Murphy)
• i. Heparin in DCD
• ii. Draft Guidance in DBD
• iii. Workshop on future workstreams (7th
  March, London)
• f) TOT2020 (Sally Johnson / James Neuberger)
• i. Workforce review (Anthony Clarkson for
  Ella Poppitt)
• g) Substitution Study (Alex Manara / James
  Neuberger)
• h) Statistics Group (Jo Allen)

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ACCORD

• EU funded programme
• UK leading workstream 5
• Promoting cooperation between ICUs and donor
  transplant coordination
• Impact of end of life care on organ donation
• 17 participating member states
• 66 participating hospitals
• WS5 design
• Audit of 20 consecutive patients dying of brain
  injury in 6 month study period (1670 completed
  patient Qs)
• Change methodology training and action plans
• Re-evaluation

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ACCORD country questionnaire

• DCD programme
• Legal definition of death
• Guidance for
• diagnosis of brain death
• care of potential donors
• ethical guidance
• withdrawal of life sustaining treatments
• donor identification and referral
• family approach
• Training
• National and / or regional OPOs
• Regulatory authority

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Care paradigms of study patients
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Heparin and DCD
Time from SBPlt 50 to asystole (min) median
5 minimum 1 maximum 26
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Heparin and DCD
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Regional Collaboratives

• a) Vision for regional collaboratives (Dale
  Gardiner)
• b) Reports from regional collaboratives, outcomes
  from this years work, priorities for 2014/15 and
  update on the promotion of the family approach
  material (Regional Managers / Regional CLODs)
• c) Overview (all)

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National Donation Committee Terms of Reference

• Service development
• To act as a source of advice and assistance to
  NHSBT in the development and implementation of
  strategies to increase organ, corneal and tissue
  donation
• To provide a forum for identifying and spreading
  best practice across the UK
• To assist NHSBT to improve and optimise all
  aspects of donation to enable more transplants to
  take place,
• Representative and performance
• To represent, lead and support the UK wide
  network of Donation Committees and Regional
  Collaboratives ensuring that regional issues are
  raised and shared at a national level
• Education and training
• To lead the design and delivery of training and
  development opportunities for clinical staff
  involved in the care of potential deceased organ
  donors
• Consultative
• To promote effective dialogue and collaboration
  between relevant professional groups and the
  Colleges and Societies that may represent them,
• Research
• To sponsor and support research, development and
  audit relevant to deceased donation, including
  (but not limited to) the analysis and future
  development of the Potential Donor Audit
• To commission a small number of working subgroups
  that will deliver the key objectives of the
  committee

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National Donation Committee membership

• National Clinical Lead for Organ Donation
• Deputy National Clinical Lead for Organ Donation
• National Clinical Lead for Donor Optimisation
• National Clinical Lead for Governance
• Associate Medical Director for Organ Donation and
  Transplantation
• Regional Clinical Leads
• Scotland
• Midlands
• Yorkshire and Humber
• South East Coast
• East of England
• North West
• London
• Northern
• South Central
• South East
• South West

• Director, Organ Donation and Transplantation
• Assistant Director for Operations, Organ Donation
• Head of Service Development
• Head of Service Delivery
• Lead Nurse for Health Informatics
• Regional Managers for Organ Donation
• London and Northern Ireland
• South East and Eastern England
• South West and South Wales
• Northern and Scotland
• Midlands and South Central
• North West and Northern
• Statistics and Clinical Studies, NHSBT
• Professional representatives
• Royal College of Anaesthetists
• Faculty of Intensive Care Medicine

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National Donation Committee - contributions

• Donor identification and referral policy
• Family approach Best Practice Guide and DVD
• National Donation Congress 2012 and National
  Donation and Transplantation Congress 2013
• Review of Map of Medicine pathways
• National pilot of simulation training for ICM
  trainees
• St John Award
• Scout pilot
• Club 32
• Taking Organ Transplantation to 2020
• Development of the clinical microsite
• Regional Organ Donation Roadshows 2013
• DBD / DCD substitution study

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National Donation Committee proposals

• Option 1 streamlined status quo
• Accept the reality of the landscape for deceased
  donation in the UK, but reconsider the need for
  both the Regional Manager and Regional Clinical
  Lead to attend all meetings.
• Option 2 disentangle the various
  responsibilities of the National Donation
  Committee and support each separately
• Limit the National Organ Donation Committee to
  the original advisory and consultative roles of
  the Donation Advisory Group, reducing frequency
  of meetings accordingly. Fulfill other
  responsibilities of the National Donation
  Committee through separately supported groups and
  pathways
• Option 3 hybrid option
• Reduce frequency and objectives of full meetings
  of the National Donation Committee. Formally
  establish subgroups with the following
  responsibilities
• Consultative
• Education and training
• Research, statistics and audit
• Service development
• Performance