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  • Donor Management Practitioner (MSc/PGDip)

  • BACKGROUND2 years PG dip/MSc: DMP at University of Bham4 DMPs each with previous extensive cardiac experience at senior staff levelBSE TTE/TOE echocardiographyClinical skills: Invasive line insertion/Bronchoscopy/Independent protocol driven management of donorConsultant led teaching

  • SCOUT TRIALActive nationally since April 2013 - active at QEHB since June 2013Current Scout team consists of Retrieval surgeon and DMPDMP works independently from retrieval teamRest of team joins the DMP once the organs have been accepted

  • AIMS OF TRIALIncrease the number of donor hearts/lungs retrieved and transplanted Rectify the national supply and demand issueImproving the quality of all retrieved organsSuccessful pilot will lead to rolling out scout scheme to all DBD donors in UK

  • INITIAL ACTIONSDevelop an audit/database to run parallel to national auditHeld educational awareness and introductory meetings with local and national ITU departmentsContinuing clinical skill competencies Contact with CTAG and DOH/NHSBTProvide a 24/7 Donor management service here at QEHB

  • OUR AIMSProve that our intervention improves the function of the small pool of cardio thoracic donorsDerive a successful transplant from the said optimised organsForge a relationship with local and national ITUs and integrate into the Heart and Lung service QEHBCompile a database of our outcomes and research which can be monitored by clinical leads

  • HOW WE DO ITInformed at point of consent for Optimisation before retrievalTravel to donor hospital ahead of the retrieval team Broadly divided into two main rolesAssessment and Optimisation

  • ASSESSMENTUtilising several modalities to carry out a full assessment of both heart and lungsTrans-oesophageal echocardiography Right heart catheterisation (PAFC)BronchoscopyPiCCO (EVLW)Blood gas analysis/biomarkers and microbiology (sputum/lavage samples)

  • OPTIMISATIONOn basis of previous findings, employ a comprehensive donor management protocol Algorithmic Based on extensive research carried out by Professor RSB and VenkatWritten by RSB and most importantly demonstrated by over course of our training - first hand experience

  • Heart beating donor management(MAP RaP mmHg)Cardiac output (l/Min)

    Time (T) Heart RateMAP Mean PAPPCWPCVPCOCISVREVLWFi 02/ PeeppO2pCO2phBEHCO3DrugConcentrationRate of infusion ml/hrNoradrenalineVasopressinInsulinT3AdrenalineDopamineDobutamineMetraminolFluidNameVolume administeredColloidCrystalloidBloodRespiratory ManouversChest physioSuction Alveoli recruitment procedures

    Time (T) SymbolABCDEFGHIJKL

    ECHO FindingsTimeLVEF RVAVMVTV

    Explain to audience that this is our chart in which we can plot the function of the heart on the Frank Starling curve. Every zone has a dedicated course of treatment which can be employed immediately in order to return the heart function back into the optimal zone.

    The chart is also used to note down all drug doses and diagnostic assessments in order to be used as a clear and concise Hand over tool when discussing with Consultant/SNOD/Retrieval team to discuss to stability and ultimate viability of the organ function

    Lastly for us, it can be utilised as a key part of our auditing and research to demonstrate how our intervention can turn a marginal donor to an optimal donor just by careful titration of haemo and pulmonary dynamics

  • REPORTING FINDINGSIn 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 recipientsOur diagnostic findings can be used as specific markers for function and suitability for retrieval

  • ACCEPTANCE OF OPTIMISED ORGANSThe optimised organs are offered nationally and it is of main priority to maintain the function until time of retrievalThis 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

  • SUMMARYThe success of a transplanted organ is multi-factorial but optimisation before retrieval plays a huge partTo 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

    Explain to audience that this is our chart in which we can plot the function of the heart on the Frank Starling curve. Every zone has a dedicated course of treatment which can be employed immediately in order to return the heart function back into the optimal zone.

    The chart is also used to note down all drug doses and diagnostic assessments in order to be used as a clear and concise Hand over tool when discussing with Consultant/SNOD/Retrieval team to discuss to stability and ultimate viability of the organ function

    Lastly for us, it can be utilised as a key part of our auditing and research to demonstrate how our intervention can turn a marginal donor to an optimal donor just by careful titration of haemo and pulmonary dynamics