Transcript National Organ Donation Committee, 28.01014

National Organ Donation Committee,
28.01014
• Objectives
– Welcome new members / attendees
– Feedback on the proposed revisions to the pregnancy
policy
– Review the educational activities of the Committee
– Contribute to the understanding of the current
increases in deceased donation
– Advise ODT of the likely impact of any reduction in
investment on donation-related activities
– Report on work in regional collaboratives
– Consider the future working arrangements of NODC
Matters arising
a) Extended DCD project (Roberto Cacciola)
b) St John’s Award (Dale Gardiner)
c) Clinical microsite (John Richardson / James
Neuberger)
c) Pregnancy and Organ Donation (Huw Twamley /
Liz Waite)
d) Regional on-call nurses (Sri Nagaiyan)
e) Club 32 (Dale Gardiner)
Pregnancy and organ donation MPD
Summary of Significant Changes
2.1 Where a pregnancy is suspected a ß-HCG blood test must be
performed to confirm pregnancy.
2.3 Age criteria within this policy 13 – 55 years of age
2.4 In relation to deceased patients, to undertake a pregnancy test without
the consent/authorisation of the patient’s family/husband/partner is
permissable, if the test is needed as part of the donation process.
If pregnancy testing is not possible, donation should only proceed with the
agreement of the family and also the retrieval surgeon.
3.1 Female patients should not be tested for pregnancy until the family
have given consent/authorisation for organ and/or tissue donation or if the
wishes of the patient to donate were clearly stated ( such as joining the
organ donor register)
3.4 If the blood test is positive, pregnancy should be confirmed by the
relevant specialist clinician or alternative cause for the positive test sought
e.g. Choriocarcinoma ( which would be a contra-indication to organ or
tissue donation).
Current UK donor and transplant activity
Current year
(01.04.13 –
12.01.14)
Previous year
(01.04.12 –
12.01.13)
% Change
Previous full
financial year
(2012/2013)
ORGAN DONORS
Donors after brain
death
611
532
14.8
705
Donors after circulatory
death
438
387
13.2
507
Total deceased donors
1049
919
14.1
1212
1543
1320
16.9
1750
20
29
-3.1
37
151
123
22.8
166
27
27
0
30
Heart
155
106
46.2
142
Lung(s)
167
145
15.2
188
Liver
678
591
14.7
775
2711
2363
17.3
3113
Deceased donors (DD) transplants
Kidney
Pancreas
Kidney/pancreas
Pancreas islets
Total DD transplants
Number of donors, April 1st to January 12th
2003/4 – 2013/4
Proportion of DBD and DCD donors, up to12.01.14
Key DBD rates
Number of patients at each stage of pathway
Age proportions of actual donors
Age distributions along the DBD organ donation
pathway (1)
Age distributions along the DBD organ donation
pathway (2)
Key DBD rates for 18 to 34 year olds
Education and Training
NODC Terms of Reference
To lead the design and delivery of training and
development opportunities for clinical staff involved in the
care of potential deceased organ donors, including (but not
limited to)
– refresher courses for CLODs and Donation Committee Chairs
– the National Donation Congress,
– relevant areas of the NHSBT organ donation microsite and
organ donation toolkit
– the Map of Medicine organ donation pathways
Education and Training
a) Evaluation of doctors/nurses attitudes,
knowledge & training towards organ and tissue
donation (Tim Collins)
b) National Donation and Transplantation
Congress (Paul Murphy / Olive McGowan)
c) Training course for ICM trainees (Dale Gardiner)
d) Role of NODC in education and training (all)
Updates
a) ACCORD (Paul Murphy / Sally Johnson)
b) DePPart (Dale Gardiner)
c) NICE Guidance (Gus Vincent)
d) Scout Pilot (Gerlinde Mandersloot)
e) UK DEC (Dale Gardiner / Paul Murphy)
i.
Heparin in DCD
ii. Draft Guidance in DBD
iii. Workshop on future workstreams (7th March, London)
f) TOT2020 (Sally Johnson / James Neuberger)
i. Workforce review (Anthony Clarkson for Ella Poppitt)
g) Substitution Study (Alex Manara / James Neuberger)
h) Statistics Group (Jo Allen)
ACCORD
• EU funded programme
• UK leading workstream 5
– Promoting cooperation between ICUs and donor transplant
coordination
– Impact of end of life care on organ donation
• 17 participating member states
• 66 participating hospitals
• WS5 design
– Audit of ≥ 20 consecutive patients dying of brain injury in 6
month study period (1670 completed patient Qs)
– Change methodology training and action plans
– Re-evaluation
ACCORD: country questionnaire
•DCD programme
Donor rate by number of positive national indicators for organ donation
•Legal definition of death
40
•Guidance for
No DCD programme
–diagnosis of brain death
–donor identification and
referral
–family approach
•Training
•National and / or
regional OPOs
•Regulatory authority
30
Donor rate pmp (2011)
–withdrawal of life
sustaining treatments
Spain
Croatia
–care of potential donors
–ethical guidance
DCD programme
35
Portugal
France
25
Italy
Rep. Ireland
20
Latvia
UK
Slovenia
Germany
Netherlands
Estonia
15
Lithuania
Hungary
10
Greece
5
0
5
6
7
8
Number of positive indicators
9
10
11
Care paradigms of study patients
CROATIA (66)
ESTONIA (94)
FRANCE (87)
GERMANY (40)
GREECE (28)
HUNGARY (56)
IRELAND (31)
ITALY (75)
LATVIA (12)
LITHUANIA (81)
PORTUGAL (43)
SLOVENIA (18)
SPAIN (413)
NETHERLANDS (95)
UK (531)
ALL MS (1670)
0%
20%
40%
60%
80%
100%
A: Full active treatment on CCU until the diagnosis of BD
B: Full active treatment until unexpected cardiac arrest from which the patient could not be resuscitated
C: Admitted to CCU to incorporate organ donation into end-of-life care
D: Full active treatment on CCU until the decision of withdrawal or limiting life sustaining therapy was made, with
an expected final cardiac arrest
E: Not admitted, or admitted to CCU but subsequently discharged
Heparin and DCD
proceeding DCD, n = 35
300
Time from SBP< 50 to
asystole (min):
250
systolic BP (mmHg)
median 5
200
minimum 1
maximum 26
150
100
50
0
1
7
13
19
25
31
37
43
49
55
61
67
73
time after withdrawal (min)
79
85
91
97
103 109 115
Heparin and DCD
non proceeding DCD, n = 28
300
systolic BP (mmHg)
250
200
150
100
50
0
1
9
17 25 33 41 49 57 65 73 81 89 97 105 113 121 129 137 145 153 161 169 177
time after treatment withdrawal (min)
Regional Collaboratives
a) Vision for regional collaboratives (Dale Gardiner)
b) Reports from regional collaboratives, outcomes from this
year’s work, priorities for 2014/15 and update on the
promotion of the family approach material (Regional
Managers / Regional CLODs)
c) Overview (all)
National Donation Committee – Terms of Reference
•
•
Service development
–
To act as a source of advice and assistance to NHSBT in the development and
implementation of strategies to increase organ, corneal and tissue donation
–
To provide a forum for identifying and spreading best practice across the UK
–
To assist NHSBT to improve and optimise all aspects of donation to enable more transplants
to take place,
Representative and performance
–
•
Education and training
–
•
To promote effective dialogue and collaboration between relevant professional groups and
the Colleges and Societies that may represent them,
Research
–
•
To lead the design and delivery of training and development opportunities for clinical staff
involved in the care of potential deceased organ donors
Consultative
–
•
To represent, lead and support the UK wide network of Donation Committees and Regional
Collaboratives ensuring that regional issues are raised and shared at a national level
To sponsor and support research, development and audit relevant to deceased donation,
including (but not limited to) the analysis and future development of the Potential Donor Audit
To commission a small number of working subgroups that will deliver the key
objectives of the committee
National Donation Committee – membership
National Clinical Lead for Organ Donation
Deputy National Clinical Lead for Organ
Donation
National Clinical Lead for Donor Optimisation
National Clinical Lead for Governance
Associate Medical Director for Organ Donation
and Transplantation
Regional Clinical Leads
–
–
–
–
–
–
–
–
–
–
–
–
Scotland
Midlands
Yorkshire and Humber
South East Coast
East of England
North West
London
Northern
South Central
South East
South West
South Wales
Donation Committee Chair
Director, Organ Donation and Transplantation
Assistant Director for Operations, Organ
Donation
Head of Service Development
Head of Service Delivery
Lead Nurse for Health Informatics
Regional Managers for Organ Donation
–
–
–
–
–
–
London and Northern Ireland
South East and Eastern England
South West and South Wales
Northern and Scotland
Midlands and South Central
North West and Northern
Statistics and Clinical Studies, NHSBT
Professional representatives
–
–
–
–
–
–
Royal College of Anaesthetists
Faculty of Intensive Care Medicine
Intensive Care Society
British Association of Critical Care Nursing
College of Emergency Medicine
Royal College of Child Health and Paediatrics /
Paediatric Intensive Care Society
– British Transplantation Society
– Society of British Neurological Surgeons
National Donation Committee - contributions
•
Donor identification and referral policy
•
Family approach Best Practice Guide and DVD
•
National Donation Congress 2012 and National Donation and
Transplantation Congress 2013
•
Review of Map of Medicine pathways
•
National pilot of simulation training for ICM trainees
•
St John Award
•
Scout pilot
•
Club 32
•
Taking Organ Transplantation to 2020
•
Development of the clinical microsite
•
Regional Organ Donation Roadshows 2013
•
DBD / DCD substitution study
National Donation Committee – proposals
• Option 1 – streamlined status quo
Accept the reality of the landscape for deceased donation in the UK, but reconsider
the need for both the Regional Manager and Regional Clinical Lead to attend all
meetings.
• Option 2 – disentangle the various responsibilities of the National Donation
Committee and support each separately
Limit the National Organ Donation Committee to the original advisory and
consultative roles of the Donation Advisory Group, reducing frequency of meetings
accordingly. Fulfill other responsibilities of the National Donation Committee
through separately supported groups and pathways
• Option 3 – hybrid option
Reduce frequency and objectives of full meetings of the National Donation
Committee. Formally establish subgroups with the following responsibilities:
–Consultative
–Education and training
–Research, statistics and audit
–Service development
–Performance