donor identification and referral
DESCRIPTION
Donor Identification and Referral . Jeremy Brown Huw Twamley 4 th June 2013 . LONDON. 1. Regional Data. Jeremy Brown. LONDON. 2. 100. 98. 97. 95. 95. 93. 91. 89. 89. 88. 87. 86. 80. 84. 60. Referral rate (%). 40. 20. 0. - PowerPoint PPT PresentationTRANSCRIPT
Organ Donation Past, Present and Future
Donor Identification and Referral Jeremy BrownHuw Twamley4th June 2013
1
LONDON
Organ Donation Past, Present and Future
Regional Data
2
Jeremy Brown
LONDON
Organ Donation Past, Present and Future
-------- National rate
95 9788
9398
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
Yorks
hire
DBD referral rate
1 April 2012 to 31 March 2013, data as at 4 April 2013
2nd
Organ Donation Past, Present and Future 3
LONDON
Organ Donation Past, Present and Future
Ref
erra
l rat
e (%
)
0
20
40
60
80
100
Number of neurological death suspected patients
0 10 20 30 40 50 60
110
111213
14
1516 171819 22021 2223 24
2526
27
28
29
330 45
6
7
8
9
Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL
London DBD referral rate
1 April 2012 to 31 March 2013, data as at 4 April 2013
Organ Donation Past, Present and Future 4
Organ Donation Past, Present and Future
-------- 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 5
Tied 3rd
DCD referral rateLONDON
Organ Donation Past, Present and Future
London DCD referral rate
Organ Donation Past, Present and Future 6
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
1011
12
13
14
15
16
17
18
19220 21
22
23
24
25 26
27
28
29
3
30
45
6
7
8
9
Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL
Organ Donation Past, Present and Future
Identification and Referral
7
Dr Huw TwamleyNorth West Regional CLOD
Timely Identification and Referral of Potential Organ Donors
Organ Donation Past, Present and Future
www.odt.nhs.uk
LONDON
Organ Donation Past, Present and Future
Session Objectives
9Organ Donation Past, Present and Future
• 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
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%
Organ Donation Past, Present and Future
Overall timings
Organ Donation Past, Present and Future
Organ Donation Past, Present and Future
Potential donor
• 83 year old• OOH PEA cardiac arrest• Downtime 15-20 minutes• Known hypertensive ( three anti-
hypertensives)• Benign Prostate Hyperplasia
Organ Donation, Past, Present and Future
Organ Donation Past, Present and Future
Best Interests
• Recipient• Potential Donor Family• Potential Donor
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
Ref
erra
l rat
e (%
)
0
20
40
60
80
100
Number of neurological death suspected patients
0 10 20 30 40 50 60
110
111213
14
1516 171819 22021 2223 24
2526
27
28
29
330 45
6
7
8
9
Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL
London DBD referral rate
1 April 2012 to 31 March 2013, data as at 4 April 2013
Organ Donation Past, Present and Future 15
London DCD referral rate
Organ Donation Past, Present and Future 16
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
1011
12
13
14
15
16
17
18
19220 21
22
23
24
25 26
27
28
29
3
30
45
6
7
8
9
Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL
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
31Organ 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 32
Apr
il - S
epte
mbe
r 201
0
Oct
ober
201
0 - M
arch
201
1
Apr
il - S
epte
mbe
r 201
1
Oct
ober
201
1 - M
arch
201
2
Apr
il - S
epte
mbe
r 201
2
Oct
ober
201
2 - M
arch
201
3
0
500
1000
1500
2000
2500
3000
3500
4000
Number of audited referrals and actual donors reported through the Referral Record, data as at 9 May 2013
Num
ber o
f pat
ient
s
What are the barriers to implementing the NICE guidelines in your unit: any solutions?
Organ Donation Past, Present and Future 33
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.