taskforce implementation – progress and results chris rudge frcs national clinical director for...
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Taskforce Implementation – Progress and Results
Chris Rudge FRCSNational Clinical Director for
TransplantationRenal CDs Meeting 12 March 2010
Organ Donation Taskforce
• Made 14 recommendations• Clarified roles
– Acute hospital Trusts– Departments of Health/NHS
• Review of co-ordination & retrieval• Training• Legal and ethical issues• Public promotion
Target – 50% increase in donation over 5 years
A UK Model for DonationNHSBT
Department of Health
Acute Hospital Trusts
Mo
re d
on
ors
National ODOEffective co-ordination and retrieval Education, training and auditPublic engagement
FundingResolution of ethical and legal issuesPerformance Management TrainingPublic recognition
Clinical leadsEmbedded co-ordinatorsDonation committees
A UK Model for DonationNHSBT
Department of Health
Acute Hospital Trusts
Mo
re d
on
ors
FundingResolution of ethical and legal issuesPerformance Management TrainingPublic recognition
Clinical leadsEmbedded co-ordinatorsDonation committees
National Organ Donation Organisation
Effective co-ordination and retrieval
Education, training and audit
Public engagement
National Organ Donation Organisation
Recommendations
• A UK-wide Organ Donation Organisationshould be established
• The Establishment of the Organ Donation Organisation should be the responsibility of NHS Blood and Transplant
Complete
Review of Donor Transplant Coordination
Recommendation
The current network of Donor Transplant Co-ordinators should be expanded and strengthened through central employment by a UK-wide Organ Donation Organisation
Well underway: >75 additional DTCs recruited, 11/12 new teams established
Review of Organ Retrieval
Recommendation
A UK-wide network of dedicated organ retrieval teams should be established to ensure timely, high-quality organ removal from all heartbeating and non-heart beating donors
New commissioning contracts in place, major changes planned for 2010/11
Removing Financial Disincentives
Recommendation
Financial disincentives to Trusts facilitating donation should be removed through the development and introduction of appropriate reimbursement
Complete – reimbursement for all donors from April 2008 (now £2,055). Accurate tariff under
development
Promotion with the PublicA role for us all
Recommendation
There is an urgent requirement to identify and implement the most effective methods through which organ donation and the “gift of life” can be promoted to the general public, and specifically to the BME population
Major public campaign launched on 2nd November 2009. Research coordination group now active
A UK Model for DonationNHSBT
Acute Hospital Trusts
Mo
re d
on
ors
National ODOEffective co-ordination and retrieval Education, training and auditPublic engagement
FundingResolution of ethical and legal issuesPerformance Management TrainingPublic recognition
Clinical leadsEmbedded co-ordinatorsDonation committees
Funding
Resolution of ethical and legal issues
Performance Management
Training
Public recognition
Department of Health
Ethico-legal Uncertainties
Dying but not yet dead
• Non heart beating donation
• Transfer from Emergency Medicine
• Donor stabilisation
• Early referral to DTC
• Early consultation of ODR
Ethical, Legal and Professional Issues
Recommendation
Urgent attention is required to resolve outstanding legal, ethical and professional issues to ensure that clinicians are able to work within a clear and unambiguous framework of good practice. Additionally, an independent UK-wide Donation Ethics Group should be established
Ethical issues: Sir Peter Simpson appointed Chair, members appointed, 1st meeting held on 6th Jan 2010
Legal matters: Guidance published in November 2009
• November 2009 in England and Wales.
• Scottish guidance awaited.
Coronial Issues
RecommendationThe Department of Health and the Ministry of Justice
should develop formal guidelines for coroners concerning organ donation
Guidance expected shortly
Training, Education and Professional Development
Recommendation
All clinical staff likely to be involved in the treatment of potential organ donors should receive mandatory training in the principles of donation. There also be regular update training
NHSBT: Professional Development Programme for CLODS, non clinical chairs etc
DH: National Training Group established
Recognition of Donors
RecommendationAppropriate ways should be identified
of personally and publicly recognising
individual organ donors where desired.
These approaches may include
national memorials, local initiatives
and personal follow-up to donor families
Loveseat MemorialGlasgow
Workshop was held on September 11th 2009Priorities now being pursued
A UK Model for DonationNHSBT
Department of Health
Acute Hospital Trusts
Mo
re d
on
ors
National ODOEffective co-ordination and retrieval Education, training and auditPublic engagement
FundingResolution of ethical and legal issuesPerformance Management TrainingPublic recognition
Clinical leadsEmbedded co-ordinatorsDonation committees
Clinical leadsEmbedded co-ordinatorsDonation committees
Acute Hospital Trusts
Donation ChampionsRecommendationEach Trust should have an identified clinical donation
champion and a Trust donation committee to help achieve this.
Well underway. 171/194 Clinical Leads for Organ Donation
appointed. 101/180 Donation Committees and Chairs
Embedded Donor Transplant Co-ordinator
RecommendationAdditional co-ordinators, embedded within
critical care areas, should be employed… There should be a close and defined collaboration between donor co-ordinators, clinical staff and clinical leads
Well underway: 51% of hospitals have an embedded DTC.
Collaboratives of embedded donor co-ordinators and CLODs being established
Performance ManagementLocal governance
RecommendationDonation rates should be monitored. Rates of
potential donor identification, referral, family approach and consent should be reported. The Trust Donation Committee should report to the Trust Board and the reports should be part of the assessment of Trusts through the relevant healthcare regulator
Underway. Donation Activity supplied to all Trusts from August 2009
Support for the Collaborative
Central training and development
Sound ethical and legal framework
Collaborative of critical care and donor transplant co-ordination
Trust Donation Committee
Adequate resource
Trust executive support
777 778 770 709 814 753 779 793 884 931
2334 2339 2333 22222454
2195 2316 23402545 2598
5487 5518 5665 5837 6024
6543
71027313
7963 8065
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Deceased donors
Deceased donor transplants
Active transplant list
Deceased donors, transplants and active transplant list in the UK
739 737 717
643
726
630 633607 620 615
0
100
200
300
400
500
600
700
800
900
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Deceased heartbeating donors (DBD)
38 4153
66
88
123
146
186
264
316
0
50
100
150
200
250
300
350
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Deceased non-heartbeating donors (DCD)
376 381 384
462 477
553
683
824
960995
0
100
200
300
400
500
600
700
800
900
1000
1100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Living donors
1314 1329 1265 1185 12951111 1144 1101 1107 1106
47 56 85112
147
201 252 313455 510
348 358 372 451463
543671
804
924972
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2200
2400
2600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Donors after brain death Donors after cardiac death Living donors
Kidney transplants
1709 1743 1722 1748 1905 1855 2067 22182486 2588
4822 4846 4963 5072 52065660
61906685
7256 7241
0
1000
2000
3000
4000
5000
6000
7000
8000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Total kidney transplants Active transplant list
Kidney transplants and active transplant list
Europe: Deceased Donors
34.2
Europe: Deceased Donors
34.2
14.7
2046
1928
17161628
15751489
1370 13381243 1268
1161 1130
0
500
1000
1500
2000
2500
2003/04 2004/05 2005/06 2006/07 2007/8 2008/9
BSD possible diagnosis Patient confirmed BSD
Falling incidence of brainstem death
Incidence of BSD in 2007
Spain UK
No of patients diagnosis of BSD
2343 1130
Population (m) 45.2 60.2
BSD pmp 52.2 18.6
Summary
• Good progress in implementation of the infrastructure changes
• Increasing DCD, static DBD
• Future focus will be on:– Improving DBD– Improving DCD– Donation from Emergency Medicine
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