donor identification and referral
DESCRIPTION
Donor Identification and Referral . Dr Huw Twamley 21 st May 2013 . NORTH WEST. 1. Session Objectives. 2. Understand difficulties with donor identification and referral Recognise benefits of improving elements of the process Increased identification and referral Timely referral - PowerPoint PPT PresentationTRANSCRIPT
Organ Donation Past, Present and Future
Donor Identification and Referral
Dr Huw Twamley21st May 2013
1
NORTH WEST
Session Objectives
• Understand difficulties with donor identification and referral
• Recognise benefits of improving elements of the process
– Increased identification and referral
– Timely referral
– Responsiveness to referral
• Consider which of the proposed methods of identification and referral may work in your hospital
2Organ Donation Past, Present and Future
Organ Donation Past, Present and Future
Regional Data
3
NORTH WEST
-------- National rate
95 97
8893
98
86 8791
95
8489 89
Ref
erra
l rat
e (%
)
0
20
40
60
80
100
Team
Easter
n
London
Midlands
North
West
Northern
Northern
Irelan
dSco
tland
South
Centra
lSouth
East
South
Wales South
West
Yorkshire
DBD referral rate
1 April 2012 to 31 March 2013, data as at 4 April 2013
5th
Organ Donation Past, Present and Future 4
NORTH WEST
Ref
erra
l rat
e (%
)
0
20
40
60
80
100
Number of neurological death suspected patients
0 10 20 30
110 11 121314 15
16
17
18
19
2
2021 22
23
242526
27
28293 30 31
32
33
45
6
7
8 9
Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL
North West DBD referral rate
1 April 2012 to 31 March 2013, data as at 4 April 2013
Organ Donation Past, Present and Future 5
1 Barrow-In-Furness, Furness General Hospital2 Douglas, Nobles I-O-M Hospital3 Chester, Countess Of Chester Hospital4 Crewe, Leighton Hospital5 Macclesfield, Macclesfield District General Hospital6 Warrington, Warrington Hospital7 Liverpool, Royal Liverpool University Hospital8 Liverpool, Alder Hey Children's Hospital9 Prescot, Whiston Hospital
10 Southport, Southport District General Hospital11 Liverpool, University Hospital Aintree12 Liverpool, Walton Centre For Neurology And Neurosurgery13 Wirral, Arrowe Park Hospital14 Lancaster, Royal Lancaster Infirmary15 Blackpool, Blackpool Victoria Hospital16 Preston, Royal Preston Hospital17 Blackburn, Royal Blackburn Hospital18 Chorley, Chorley And South Ribble District General Hospital19 Bolton, Royal Bolton Hospital20 Bury, Fairfield General Hospital21 Manchester, North Manchester General Hospital22 Manchester, Manchester Royal Infirmary23 Manchester, Royal Manchester Children's Hospital24 Manchester, Wythenshawe Hospital25 Oldham, Royal Oldham Hospital(Rochdale Road)26 Salford, Salford Royal27 Stockport, Stepping Hill Hospital28 Ashton-Under-Lyne, Tameside General Hospital29 Manchester, Trafford General Hospital30 Wigan, Royal Albert Edward Infirmary31 Bodelwyddan, Glan Clwyd District General Hospital32 Wrexham, Maelor General Hospital33 Bangor, Ysbyty Gwynedd District General Hospital
-------- National rate
80
72
54
72
81
52
42
54 5659 60
65
Ref
erra
l rat
e (%
)
0
20
40
60
80
100
Team
Easter
n
London
Midlands
North
West
Northern
Northern
Irelan
dSco
tland
South
Centra
lSouth
East
South
Wales
South
West
Yorkshire
1 April 2012 to 31 March 2013, data as at 4 April 2013
Organ Donation Past, Present and Future 6
Tied 3rd
DCD referral rateNORTH WEST
Ref
erra
l rat
e (%
)
0
20
40
60
80
100
Number of imminent death anticipated patients
0 10 20 30 40 50 60 70 80
1
10
11
12
13
14
15
1617
18
19
2
20
21
22
23
24
25 26
27
28
29
3
30 3132
334
5
6
7
8
9
Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL
North West DCD referral rate
Organ Donation Past, Present and Future 7
1 Barrow-In-Furness, Furness General Hospital2 Douglas, Nobles I-O-M Hospital3 Chester, Countess Of Chester Hospital4 Crewe, Leighton Hospital5 Macclesfield, Macclesfield District General Hospital6 Warrington, Warrington Hospital7 Liverpool, Royal Liverpool University Hospital8 Liverpool, Alder Hey Children's Hospital9 Prescot, Whiston Hospital
10 Southport, Southport District General Hospital11 Liverpool, University Hospital Aintree12 Liverpool, Walton Centre For Neurology And Neurosurgery13 Wirral, Arrowe Park Hospital14 Lancaster, Royal Lancaster Infirmary15 Blackpool, Blackpool Victoria Hospital16 Preston, Royal Preston Hospital17 Blackburn, Royal Blackburn Hospital18 Chorley, Chorley And South Ribble District General Hospital19 Bolton, Royal Bolton Hospital20 Bury, Fairfield General Hospital21 Manchester, North Manchester General Hospital22 Manchester, Manchester Royal Infirmary23 Manchester, Royal Manchester Children's Hospital24 Manchester, Wythenshawe Hospital25 Oldham, Royal Oldham Hospital(Rochdale Road)26 Salford, Salford Royal27 Stockport, Stepping Hill Hospital28 Ashton-Under-Lyne, Tameside General Hospital29 Manchester, Trafford General Hospital30 Wigan, Royal Albert Edward Infirmary31 Bodelwyddan, Glan Clwyd District General Hospital32 Wrexham, Maelor General Hospital33 Bangor, Ysbyty Gwynedd District General Hospital
Timely Identification and
Referral of Potential Organ Donors
Huw TwamleyRegional CLOD
North West Region
Organ Donation Past, Present and Future
UK rates of referral
referral of deceased donors
0
20
40
60
80
100
2005-6 2006-7 2007-8 2008-9 2009-10 2010-11 2011-12
year
perc
enta
ge
DBD DCD
Organ Donation Past, Present and Future
91%
52%
Cause of death in MC III DCD donors
10.4
16.2
12.4
25.9
3.2
5.6
26.3
3.5
4.2
6.2
27.5
7.8
8.0
42.8
0 5 10 15 20 25 30 35 40 45
Other Miscellaneous
Other Medical Disease
Primary Respiratory Disease
Hypoxic Brain Injury
Trauma (including head injury)
Other CVA (thrombotic or unclassified)
Intracranial haemorrhage (non traumatic)
Dia
gnos
tic c
ateg
orie
s
Percentage
Actual DCDs %
Potential DCDs %
UK Potential Donor Audit (October 2009 – March 2012)7504 patients referred as potential DCD donors877 actual DCD donors
Potential Donor
• 83 year old• PEA Out of hospital cardiac arrest• “Downtime” 15-20 minutes• Hypoxic brain injury• Known Hypertensive• Urea 16.4 Creat 94• Prev Basal cell Carcinoma
Overall timings
Organ Donation Past, Present and Future
Aims of Strategy• 100% Identification of potential
Donors
• 100% Referral of Potential Donors
• 100% Timely Referral
• Implement NICE Guidance
The consideration of donation should be core ICU / ED and part of all end of life care plans.
Timely referral promotes this possibility
Organ Donation Past, Present and Future
NICE Guideline 135
Organ Donation Past, Present and Future
British Medical Association 2012
The research data -------- showed that the use of clinical triggers and a requirement to refer according to standard criteria led to an increase in both referrals and donors. It is hoped that implementation of the NICE guideline will result in early and consistent donor referral.
Organ Donation Past, Present and Future
General Medical Council 2010
I”f a patient is close to death and their views cannot be determined, you should be prepared to explore with those close to them whether they had expressed any views about organ or tissue donation, if donation is likely to be a possibility.”
“You should follow any national procedures for identifying potential organ donors and, in appropriate cases, for notifying the local transplant coordinator.”
Decisions to limit or withdraw treatments in potential DCD donors MUST be in compliance with national End of Life Care policy.
Organ Donation Past, Present and Future
UK Donation Ethics Committee
“There is no ethical dilemma if the treating clinician wishes to make contact with the SN-OD at an early stage, while the patient is seriously ill and death is likely, but before a formal decision has been made to withdraw life-sustaining treatment.”
[“Benefits] include establishing whether there are contra-indications for organ donation……
Other practical and organisational factors might be relevant – if the SN-OD is based at a distant location then early contact can help to minimise distressing delays for the family.”
Organ Donation Past, Present and Future
Objectives, benefits and outcomesAll potential donors are identified and referred
All donors are referred in a timely fashion
SN-ODs are deployed in a way that improves responsiveness
All patients are given the option of donation
Access to clinical advicePrompt donor optimisationResolution of potential legal obstaclesEarly assessment of marginal donorsEarly tissue typing / screeningPlanning the family approach
Reduction in delays for families and units
Increased donor numbersImproved consent / authorisation ratesIncrease in donor organsBetter experience for families and staff
Organ Donation Past, Present and Future
NHSBT Strategy
• Implementation not publication• Key area for collaboration
between hospitals and donor care teams
• Very clear emphasis on benefits– How not who
• Suite of options• Clarity over implementation
Organ Donation Past, Present and Future
Strategy proposals
• Every hospital should have a written policy for the identification and timely referral of all potential donors
• Every donating area within a given hospital adopts a consistent approach
• As far as possible ‘decouple’ early referral from individual clinician
Donation Committees and SN-OD teams should collaborate to develop and implement a policy that ensures that all potential donors are identified and referred in a timely fashion.
Organ Donation Past, Present and Future
1. Daily visit by SN-OD
Organ Donation Past, Present and Future
2. Early daily phone call
Organ Donation Past, Present and Future
3. Daily ICU team safety brief
Organ Donation Past, Present and Future
Organ Donation Past, Present and Future
North Bristol Trust ICU Safety Brief
4. Standard Operating Procedure
Organ Donation Past, Present and Future
Midlands Standard Operating Procedure
Organ Donation Past, Present and Future
5. Nurse led referrals
Organ Donation Past, Present and Future
Summary
28Organ Donation Past, Present and Future
• Donation should be a element of end of life care
• Make identification and referral routine business of the unit.
• This decouples early referral from the individual clinician caring for the patient
• Implement or develop a solutions /policy for your individual hospitals adopt to timely referral
• Ensure consistency within a given hospital
Organ Donation Past, Present and Future 29
What are the barriers to implementing the NICE guidelines in your unit? Any solutiions?
Organ Donation Past, Present and Future 30
Whichever is the earlier, either:
Use trigger factors in patients with a catastrophic brain injury The absence of one or more cranial nerve reflexes
AND a GCS of 4 or less that is not explained by sedation
And / or a decision is made to perform brainstem death tests.
The intention to withdraw life-sustaining treatment in patients with a life-threatening or life-limiting condition which will, or is expected to, result in circulatory death.