Donor Management Practitioner (MSc/PGDip)

BACKGROUND2 years PG dip/MSc: DMP at University of B’ham

4 DMPs each with previous extensive cardiac experience at senior staff level

BSE TTE/TOE echocardiography

Clinical skills: Invasive line insertion/Bronchoscopy/Independent protocol driven management of donor

Consultant led teaching

SCOUT TRIAL

Active nationally since April 2013 - active at QEHB since June 2013

Current Scout team consists of Retrieval surgeon and DMP

DMP works independently from retrieval team

Rest of team joins the DMP once the organs have been accepted

AIMS OF TRIAL

Increase the number of donor hearts/lungs retrieved and transplanted

Rectify the national supply and demand issue

Improving the quality of all retrieved organs

Successful pilot will lead to rolling out scout scheme to all DBD donors in UK

INITIAL ACTIONSDevelop an audit/database to run parallel to national audit

Held educational awareness and introductory meetings with local and national ITU departments

Continuing clinical skill competencies

Contact with CTAG and DOH/NHSBT

Provide a 24/7 Donor management service here at QEHB

OUR AIMSProve that our intervention improves the function of the small pool of cardio thoracic donors

Derive a successful transplant from the said optimised organs

Forge a relationship with local and national ITUs and integrate into the Heart and Lung service QEHB

Compile a database of our outcomes and research which can be monitored by clinical leads

HOW WE DO IT

Informed at point of consent for ‘Optimisation before retrieval’

Travel to donor hospital ahead of the retrieval team

Broadly divided into two main roles

Assessment and Optimisation

ASSESSMENT

Utilising several modalities to carry out a full assessment of both heart and lungs

Trans-oesophageal echocardiography

Right heart catheterisation (PAFC)

Bronchoscopy

PiCCO (EVLW)

Blood gas analysis/biomarkers and microbiology (sputum/lavage samples)

OPTIMISATION

On basis of previous findings, employ a comprehensive donor management protocol

Algorithmic

Based on extensive research carried out by Professor RSB and Venkat

Written by RSB and most importantly demonstrated by over course of our training - first hand experience

Donor UKT NumberRetrieval UnitDate and time of DMP arrival

Time (T)

Heart Rate

MAP

Mean PAP

PCWP

CVP

CO

CI

SVR

EVLW

Fi 02/ Peep

pO2

pCO2

ph

BE

HCO3

Drug Concentration Rate of infusion ml/hr

Noradrenaline

Vasopressin

Insulin

T3

Adrenaline

Dopamine

Dobutamine

Metraminol

Fluid Name Volume administered

Colloid

Crystalloid

Blood

Respiratory Manouvers

Chest physio

Suction

Alveoli recruitment procedures

Heart beating donor managementDonor detailsDonor age: Sex: Blood group: Height: Weight:Cause of death: 1st BSD tests: 2nd BSD tests:Medical History:Medication on admission:

Bronchoscopy findings

(MA

P –

RaP

mm

Hg)

Cardiac output (l/Min)

Time (T)

Symbol A B C D E F G H I J K L

ECHO Findings

Time

LVEF RV

AV

MV

TV

REPORTING FINDINGS

In recent NHSBT UK strategy ‘Taking transplant to 2020’, it was stated in one of many outcomes that ‘Transplant surgeons are to be supplied with more information and guidance to help decide which organs can be safely and effectively transplanted into which recipients’

Our diagnostic findings can be used as specific markers for function and suitability for retrieval

ACCEPTANCE OF OPTIMISED ORGANS

The optimised organs are offered nationally and it is of main priority to maintain the function until time of retrieval

This is achieved by careful titration of inotropes/fluids/hormone replacement therapy and continual haemodynamic monitoring

Detailed handover to SNOD and local anaesthetist involved in care of patient during retrieval process

SUMMARY

The success of a transplanted organ is multi-factorial but optimisation before retrieval plays a huge part

To quote again from NHSBT 2020 strategy ‘The care a person receives at end of life can have a significant impact on the functioning of their organs and without the right support, otherwise transplantable organs may become unusable’

ANY QUESTIONS