Title Organ and tissue donation at SASH Presented by: Dr Somi - PowerPoint PPT Presentation

Trust Board – 29 September 2011 Agenda item: 3.1 Title Organ and tissue donation at SASH Presented by: Dr Somi Desikan – Clinical Lead Organ Donation Authors: Dr Desikan and Miss Emma Little – Specialist Nurse Organ Donation 1

Contents Background Organ Donation Task Force (ODTF) SASH Organ Donation Committee (ODC) Activity in last 3 years Future

10 15 20 25 30 35 40 0 5 Deceased Donors pmp 2009 S p a i P n o r t u g a B l e l g i u m A u s t r i a E s t o n i a F r a n c e N o r w a y I t a l y E i r C e z e c h R F i n l a n d C r o a t S i a l o v e n i S a l o v a k i a U G K e r m a n y L a t v L i a i t h u a n D i a e n m a r H k u n g a r y S w e N d e e t h n e r l a n d s

Background  Organ donation rate historically low in UK  7800 patients waiting for organ donation  3 deaths daily – > 1000 deaths / annum waiting for transplant  Barriers to donation – Uncommon event, but can occur 24/7 – Identification + Referral from donor hospitals – Education and Training – Disincentive to donor hospitals

Number of deceased donors and transplants in the UK, 1 April 2000 - 31 March 2010, Figure 2.1 and patients on the active transplant lists at 31 March 8000 7797 7980 7877 7655 7000 7219 6698 6000 6142 5673 5654 5604 5532 5000 Donors Number Transplants Transplant list 4000 3000 2699 2645 2552 2388 2396 2385 2381 2311 2247 2241 2196 2000 1010 958 899 809 793 777 1000 773 745 770 751 764 0 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010-11 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

Organ Donation Task Force ( ODTF)  Set up in 2006, DOH published ODTF report in 2008  Recommended sweeping changes to improve UK donor rates  1. Identification and Referral  2. Donor co-ordination  3. Organ retrieval  Aim – Increase organ donation by 50% in 5 years – Implementation 14 key recommendations

A UK Model for Donation NHSBT National ODO Effective co-ordination and retrieval Acute Hospital Education, training and audit Trusts Public engagement More donors Clinical leads Embedded co-ordinators Department of Health Donation committees Funding Resolution of ethical and legal issues Performance Management Training Public recognition

When is it possible? Organ donation - Hospital of our size Potential D.B.D 2 - 5 p.a Potential D.C.D – 8 p.a ( Any time of day/night, easy to miss – identification Pt’s on breathing machine’s Most likely in ICU / ED – rarely in theatre / recovery Overall majority pt have a catastrophic brain injury

SASH Organ Donation Committee (ODC)  Set up in September 2009  Chaired by Trust NED : Mrs Norma Christson  Clinical Lead (CLOD) : Dr Somi.Desikan  Specialist Nurse (SNOD) : Miss Emma Little  Reps from Outreach, Emergency Medicine, Palliative care, Theatres, Chaplain and PALS

O.D.C Achievements to date  Onsite Resident SN-OD provided by NHS Blood and Transplant  SASH Organ Donation Policy  Identifying Local Barriers  Organs per Donor have increased – through donor oprimisation  Local Organ Donation Strategy written  Annual study day for all staff – Excellent feedback  SASH Represented - Regional Collaborative Programme  CLOD - completed National Donation Development Programme 2009/10  Organ donation and transplant awareness- Road shows  Links with Harefield Hospital to improve Donor Optimisation  Potential Donor Audit in all Critical Care areas  CCDG / Morbidity and Mortality – standing items  E.D Consultant– represented SASH at DOH Donation Scoping event 2010  Donor Memorial - in progress

Surrey and Sussex Healthcare NHS trust Organ Donation Committee focus 2011.12  Increase Diagnosis of Diagnosis of Brain Stem death (DBD), including vigilance of potential cases outside of the usual ICU environment, e.g. Emergency Department / Theatre Recovery.  Increase DBD and increase Donation after Cardiac Death (DCD) referrals according to National Minimum Notification Criteria  Increase Donation after Cardiac death  Increase donation from Emergency Departments  Increase donation consent rates – by optimising the donation pathway  Increase the quality and quantity of donated organs for transplant – optimise donor management strategy

In Numbers Year Number of patients donated organs Number of transplants ( lives saved) Other Tissue Donations ( E.G Cornea, Heart Valves, Skin) April 2008 to March 2009 2 (1 DCD / 1 DBD) 5 (Includes kidneys and liver) 6 Corneal Donors – 11 recipients April 2009 to March 2010 5 – D.B.D 15 Includes lung, liver, kidneys and 15 Corneal Donors – 29 Recipients pancreas) 7 Multi tissue Donors April 2010 to March 2011 2 - DBD 7 (Includes lung, liver, kidneys and 15 Corneal Donors – 30 recipients pancreas) 1 multi tissue Donor

Financial – Donor Reimbursements made from NHSBT to SASH Reimbursements received by SASH for organ donations 2008 to 2009 £ 6000.00 2009 to 2010 £ 10275.00 2010 to 2011 £ 10368.00

Trust Executives and Board Trust Executives and Board Doesn’t it cause some Not really on problems for critical our agenda care capacity? Aware of the benefits, but Aware of the benefits, but not a priority target for not a priority target for us? us?

Why it should be a priority for SASH board Postcodes RH1-6, and CR3-5 surrounding SASH 149,040 individuals have actively expressed their choice to donate via O.D.R – our local population are telling us they  want to donate, and we need to respond appropriately by optimising the donation pathway internally 65 patients waiting for transplant locally (NHSBT data)  Kidney 57 Kidney / Pancreas 2  Heart 1  Lungs 2  Liver 3  These patients use our local services, as well as tertiary transplant centres  Complex cases when cared for locally  Nationally 3/patients die everyday on the transplant list.  Satellite Renal Dialysis Unit (Crawley hospital) – Social / Financial/ Environmental impact –Satellite Dialysis for 1 patient / annum costs £22,152, produces 4.3 ton CO2, consumes 62,400 L water /annum. Compared to Renal Transplant, £17,000 (yr 1), reduces to £5000 / p.a for medication only - transplant is cost saving, importantly patient outcomes improve physically / socially. Reduction environmental impact Tissue Donation – Ophthalmology Service locally is an end user of corneal grafts

What O.D.C need from SASH Board 1. Endorsement and Continue Supporting O.D.C 2. Include Organ + Tissue Donation into Trust Strategy 3. Assist O.D.C recovering Donor Reimbursements 4. Make Donation - part of Mandatory Training – (recent complaint from patient family) 5. Assist recovering O.D Committee funding – unable to access 3 yrs 6. Make – Donation a usual not an unusual event Donation a usual not an unusual event