organ donation & transplantation in ireland – changing times aileen counihan transplant...
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Organ Donation & Transplantation Organ Donation & Transplantation in Ireland – Changing timesin Ireland – Changing times
Aileen CounihanAileen Counihan
Transplant Co-ordinatorTransplant Co-ordinator
Beaumont HospitalBeaumont Hospital
Organ Procurement Centre TeamOrgan Procurement Centre Team
National Service for Organ Procurement National Service for Organ Procurement
– Current Location – Beaumont HospitalCurrent Location – Beaumont Hospital
Donor Coordinating TeamDonor Coordinating Team
– 24hr on call service for ICUs nationally24hr on call service for ICUs nationally
Recipient Co-ordinationRecipient Co-ordination
– 24hr call for renal transplant service24hr call for renal transplant service
The Donor Co-ordinator RoleThe Donor Co-ordinator Role
24hr call to deal with all enquiries pertaining to Organ Donation24hr call to deal with all enquiries pertaining to Organ Donation
Responsible for the technical and logistical arrangements.Responsible for the technical and logistical arrangements.
Involved in the donation process from referral, retrieval & to the Involved in the donation process from referral, retrieval & to the
transplantation of the organs.transplantation of the organs.
– Care of the Donor, the Family of the Donor, the Donor Hospital Care of the Donor, the Family of the Donor, the Donor Hospital
staff, the Transplant Team, & Transplant recipients.staff, the Transplant Team, & Transplant recipients.
Recipient Co-ordinator RoleRecipient Co-ordinator Role
Referral for Renal & Pancreas Transplant Referral for Renal & Pancreas Transplant
Management of Transplant waiting listManagement of Transplant waiting list
Coordination of Deceased Donor TransplantsCoordination of Deceased Donor Transplants
Live Donor Transplant ProgrammeLive Donor Transplant Programme
Kidney TransplantationKidney Transplantation
Kidney transplantation is considered the best treatment option for Kidney transplantation is considered the best treatment option for
patients in end stage renal failurepatients in end stage renal failure
Not all patients are suitable for transplantNot all patients are suitable for transplant
– Only 33% of patients with kidney failure are on transplant waiting Only 33% of patients with kidney failure are on transplant waiting
listlist
When transplant is not the best optionWhen transplant is not the best option
Clinical reasons :Clinical reasons :
– History of recent cancerHistory of recent cancer
– Major surgeryMajor surgery
– Severe cardiac problems or advanced blood vessel diseaseSevere cardiac problems or advanced blood vessel disease
Patient choice:Patient choice:
– decide that transplantation is not for them.decide that transplantation is not for them.
– can opt to stay on dialysis.can opt to stay on dialysis.
Renal TransplantationRenal Transplantation
Live Donor TransplantLive Donor Transplant
– from a family member/spouse/friend from a family member/spouse/friend – Paired ExchangePaired Exchange
Deceased Donor Transplant Deceased Donor Transplant
– Brain Death DonorBrain Death Donor
– Non Heart Beating DonorNon Heart Beating Donor. .
Recipient Evaluation for Transplant Recipient Evaluation for Transplant
Standard workup :Standard workup :– Full Blood ProfileFull Blood Profile– Tissue type x 2Tissue type x 2– Virology < 3mthsVirology < 3mths– Chest Xray & Abdo U/soundChest Xray & Abdo U/sound– Cardiac Tests, Stress ECG, Cardiac EchoCardiac Tests, Stress ECG, Cardiac Echo– Coronary Angio ( if indicated)Coronary Angio ( if indicated)– Dental ClearanceDental Clearance– Smear Test for female patients Smear Test for female patients – PSA for men > 50yrsPSA for men > 50yrs
Other tests determined by age/cause of failureOther tests determined by age/cause of failure– Copy of all results to Transplant Office with a detailed referral letterCopy of all results to Transplant Office with a detailed referral letter
Evaluation for TransplantEvaluation for Transplant
Some patients may require further assessment Some patients may require further assessment
Test results may require further investigation.Test results may require further investigation.
Patient is sent an appointment with an information Patient is sent an appointment with an information
booklet about transplantbooklet about transplant
All patients are seen at the transplant assessment clinic All patients are seen at the transplant assessment clinic
in Beaumontin Beaumont
Meet with Transplant Surgeon & Co-ordinatorMeet with Transplant Surgeon & Co-ordinator
Pre-Transplant ClinicPre-Transplant ClinicAssess suitability for transplantAssess suitability for transplant
Surgery explainedSurgery explained
Opportunity to ask questions , encourage patients to bring someone Opportunity to ask questions , encourage patients to bring someone
with them to clinic with them to clinic
Option of Live Donation givenOption of Live Donation given
Importance of contactability, urgency, keeping healthy & well reiteratedImportance of contactability, urgency, keeping healthy & well reiterated
Follow up phone callFollow up phone call
Letter to patient to inform approved for Transplant & regular blood Letter to patient to inform approved for Transplant & regular blood
samples for antibody screening while on the poolsamples for antibody screening while on the pool
Letter from H&I when activatedLetter from H&I when activated
Further ScreeningFurther Screening
– Other tests may be requiredOther tests may be required
– Anaesthetic assessmentAnaesthetic assessment
– Patients to lose weight or to monitor weightPatients to lose weight or to monitor weight
– Reassurance while on the listReassurance while on the list
– Patients over 2 yearsPatients over 2 years
– Patients suspended for a prolonged period of timePatients suspended for a prolonged period of time
– Older patientsOlder patients
Waiting TimeWaiting Time
Currently 29 months.Currently 29 months.
Factors influencing time on listFactors influencing time on list
– Patients with a high antibody level Patients with a high antibody level
– Patient BMIPatient BMI
– Increasing number of patients on listIncreasing number of patients on list
– Donor supplyDonor supply
Acknowledging the DonationAcknowledging the Donation
Donor and donor family will be foremost on recipients’ Donor and donor family will be foremost on recipients’ mindmind
Anonymity MaintainedAnonymity Maintained– Encourage recipients to write to donor family and can Encourage recipients to write to donor family and can
be done via the Transplant Co-ordinatorsbe done via the Transplant Co-ordinators
Information leaflet Information leaflet Attend the Annual Service of Remembrance and Attend the Annual Service of Remembrance and Thanksgiving Thanksgiving
Circle Of Life Garden in SalthillCircle Of Life Garden in Salthill
Organ Donor Web SiteOrgan Donor Web Site
Donor Families shared experiences
Transplant Recipient success stories
Gratitude of Recipients & Comfort received by Donor Families
Commemorative Garden
StatisticsStatisticsDeceased Donors/Transplants in IrelandDeceased Donors/Transplants in Ireland
(Organ Procurement Centre)(Organ Procurement Centre)
0
100
200
300
400
500
600
700
Transplants
Donors
Waiting List
Potential Live DonorPotential Live Donor
Patients will be asked if they wished to consider a Live Donor Patients will be asked if they wished to consider a Live Donor
TransplantTransplant
Potential donors to contact the transplant co-ordinators directlyPotential donors to contact the transplant co-ordinators directly
Initial suitability would be discussed with them – Initial suitability would be discussed with them – Blood Group Blood Group
CompatibleCompatible
Arrangements made for H&I screeningArrangements made for H&I screening
Information on Live donation givenInformation on Live donation given
Only one donor can go forward to workupOnly one donor can go forward to workup
Live Kidney DonationLive Kidney Donation
Donor must be fully informed and aware of risks and benefits of Donor must be fully informed and aware of risks and benefits of procedureprocedure
No risk to the potential donorNo risk to the potential donor
The decision to donate must be voluntary, no coercion or The decision to donate must be voluntary, no coercion or inducementinducement
The transplant must have a good chance of providing a good The transplant must have a good chance of providing a good outcome for the recipient.outcome for the recipient.
Ethical IssueEthical Issue– Exposes an otherwise healthy person to the risks of major Exposes an otherwise healthy person to the risks of major
surgery entirely for the physical benefit of another individualsurgery entirely for the physical benefit of another individual
Information for Live Donor RecipientInformation for Live Donor Recipient
Donor work up period 3 months approxDonor work up period 3 months approx
– Medical suitability, extensive screeningMedical suitability, extensive screening
– Immunological screeningImmunological screening
– Independent clinical & psychological reviewIndependent clinical & psychological review
Donor work up confidentialDonor work up confidential
Isolating period for recipientIsolating period for recipient
Recipient remains under the care of nephrology teamRecipient remains under the care of nephrology team
Suspended from list, when donor deemed suitableSuspended from list, when donor deemed suitable
Setting date for surgerySetting date for surgery
LRD and Deceased Renal LRD and Deceased Renal Transplant activity in IrelandTransplant activity in Ireland
0
50
100
150
200
25072 75 78 81 84 87 90 93 96 99
2002
2005
2008
2011
Year
Kid
ney
Tra
nspl
ants
LRDDeceased
Changing Role of Transplant OfficeChanging Role of Transplant Office
No responsibility for Organ ProcurementNo responsibility for Organ Procurement– Perceived conflict of interestPerceived conflict of interest– Independent ServiceIndependent Service
Recipient Coordination Recipient Coordination – 24 hour on call for renal/pancreas transplant24 hour on call for renal/pancreas transplant– Liaise with Renal Unit StaffLiaise with Renal Unit Staff– Patient educationPatient education
Co-ordinate Live Donation ProgrammeCo-ordinate Live Donation Programme