North West London Annex 1 – Presentation handouts Network Event Organ donation: the DH taskforce report and critical care A report from the Network Event held on 7 October 2010
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Overview of organ donation Overview of organ donation in the UK in the UK Anthony Gordon Senior Lecturer / Consultant Clinical Lead for Organ Donation Centre for Peri-operative & Critical Care Medicine Imperial College / Charing Cross Hospital October 2010 Organ donation taskforce 2008 1
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Number Number of deceas of deceased ed dono donors & & tran transplants in U splants in UK 2
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Organ donation taskforce 2008 14 recommendations accepted in full by Government believe will increase organ donation by 50% in 5 years Making donation usual, not unusual Recommendations Recommendation 1 & 2 – UK wide service • A UK wide Organ Donation Organisation, the responsibility of NHSBT Recommendation 3 - Legal & ethics • Resolve of outstanding ethical, legal and professional issues. • Clear frameworks of good practice 3
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Recommendations Recommendation 4 – Making donation ‘usual’ • Donation should feature in all end of life care pathways. • Appointment of clinical donation champions and Trust donation committees Recommendations Recommendation 5, 6 & 7 - Monitoring • Minimum notification criteria to DTC • Monitoring of Trust performance • BSD testing in all patients where BSD is a likely diagnosis Recommendation 8 – Costs of donor management • Reimbursement costs for the donation expenses incurred 4
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Recommendations Recommendation 9 – Donor Transplant Coordination • Central employment • Increasing DTC numbers and embedding within Trusts. • Development of electronic offering systems Recommendation 10 – Retrieval teams • Commissioning of dedicated organ retrieval teams UK wide Recommendations Recommendation 11 – Training • Mandatory training in the principles of donation Recommendation 12 – Honouring donation • Personal & public recognition where desired Recommendation 13 & 14 – Promoting donation • General public, BME population • Coroner 5
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Inequalities of Access Ethnic Minority Groups Obstacles to donation • Improved outcomes • Diagnosis of brain stem death • Consent rates • Place of death • Mode of death • Donor management • Operational hurdles 6
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Obstacles to donation • Improved outcomes • Diagnosis of brain stem death • Consent rates • Place of death • Mode of death • Donor management • Operational hurdles Falling incidence of brainstem death 2500 BSD possible diagnosis 2000 Patient confirmed BSD 1500 1000 500 0 2003/04 2004/05 2005/06 2006/07 2007/8 2008/9 7
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Obstacles to donation • Improved outcomes • Diagnosis of brain stem death • Consent rates • Place of death • Mode of death • Donor management • Operational hurdles UK Potential donor audit, 2004-8 Were there any absolute medical contraindications to Audited deaths of patients (n=46 801) heartbeating solid organ donation? Was the patient ever on mechanical ventilation? Yes (n=42 749) No (n=4052) Yes (n=42 749) No (n=4052) Was the issue of heartbeating solid organ donation considered? Was brain stem death a likely diagnosis? No (n=273) Yes (n=2467) Yes (n=4166) No (n=38 583) Were the next of kin approached for permission? Were brain stem tests performed? Yes (n=2320) No (n=147) Yes (n=2857) No (n=1309) Was consent given by the next of kin? Was brain stem death confirmed? Yes (n=1379) No (n=941) No (n=103) Yes (n=2754) Did donation occur? Were there any absolute medical contraindications to heartbeating solid organ donation? Yes (n=1244) No (n=135) 8
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Possibly BSD • 350 missed potential donors in 1 year Was brain stem death a likely diagnosis? • 172 actual donors Yes (n=4166) No (n=38 583) • 619 additional Were brain stem tests performed? transplanted patients Yes (n=2857) No (n=1309) • extra 2.8 donors pmp Reasons for not BSD testing Reasons for not testing (approx 350 / year) Reasons for not testing (approx 650 / year) others 0.7 coroner 0.7 contra-indication to donation (including age) 6.1 problems w ith testing 8.4 family-related 11 14.6 residual neurological function 28.1 unknow n 30.4 cardiovascular instability 0 10 20 30 40 % total 9
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Common response during coning Lack of capacity to consent Mental Capacity Act 2005 Mental Capacity Act 2005 Treat adult patients who lack capacity consent “reasonably believe their actions to be in the person’s best interests.” 10
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust What is the patient’s best interest? “A person’s best interests depend on their individual circumstances … …the courts have established that best interests are wider than simply treating a person’s medical condition and include a person’s social, emotional, cultural and religious interests.” DOH guidance 2009 Obstacles to donation • Improved outcomes • Diagnosis of brain stem death • Consent rates • Place of death • Mode of death • Donor management • Operational hurdles 11
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Consent rates in Europe Increasing consent rates Organ Donor Register • 96% would accept donation • 12% on ODR (45% say they would join) Public engagement • Media campaign www.or www.organdonation.nhs.uk www.or www.organdonation.nhs.uk andonation.nhs.uk or call andonation.nhs.uk or call or call 0300 123 23 23 or call 0300 123 23 23 0300 123 23 23 0300 123 23 23 • Timely, sensitive approach to family • Ensure understand / accept BSD / donation • “Collaborative” approach 12
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Obstacles to donation • Improved outcomes • Diagnosis of brain stem death • Consent rates • Place of death • Mode of death • Donor management • Operational hurdles Donation from Emergency department Donation can occur from A&E • More challenging? 2 Specialist nurses - organ donation (DTCs)? 4-hour wait suspended • For that patient • For all patients? 13
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Donation from Emergency department N. Thames Obstacles to donation • Improved outcomes • Diagnosis of brain stem death • Consent rates • Place of death • Mode of death • Donor management • Operational hurdles 14
Overview of organ donation in the UK - Dr Anthony Gordon ICU Senior Lecturer and clinical lead for organ donation Imperial College Healthcare NHS Trust Donation after cardiac death Non heart-beating donation After cardiac death organs rapidly cold perfused Organs then retrieved Controlled v Uncontrolled • planned vs unplanned • Maastricht categories III v II (IV- BSD) Planned withdrawal of life supporting treatment DCD is not “new” 15
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