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Organ donation Peter Bishop Clinical lead for organ donation

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  • Organ donationPeter BishopClinical lead for organ donation

  • Number of deceased donors and transplants in the UK

    1 April 1999 - 31 March 2009 - patients on the active transplant lists at each year

    Chart1

    77724285354

    77323115532

    74522475604

    77723885654

    77023965673

    75122416142

    76421966698

    79323857234

    80923817655

    90025607877

    Donors

    Transplants

    Transplant list

    Year

    Number

    Sheet1

    YearDonorsTransplantsTransplant list

    1996-199785526335054

    1997-199879625275248

    1999-200077724285354

    2000-200177323115532

    2001-200274522475604

    2002-200377723885654

    2003-200477023965673

    2004-200575122416142

    2005-200676421966698

    2006-200779323857234

    2007-200880923817655

    2008-200990025607877

  • Number of deceased donors and transplants in the UK

    1000+ patients die on transplant waiting list each yearAccess to waiting lists is cappedLive related liver transplants50% mortality rate for CF patients awaiting transplants 1 April 1999 - 31 March 2009 - patients on the active transplant lists at 31 March

    Chart1

    77724285354

    77323115532

    74522475604

    77723885654

    77023965673

    75122416142

    76421966698

    79323857234

    80923817655

    90025607877

    Donors

    Transplants

    Transplant list

    Year

    Number

    Sheet1

    YearDonorsTransplantsTransplant list

    1996-199785526335054

    1997-199879625275248

    1999-200077724285354

    2000-200177323115532

    2001-200274522475604

    2002-200377723885654

    2003-200477023965673

    2004-200575122416142

    2005-200676421966698

    2006-200779323857234

    2007-200880923817655

    2008-200990025607877

  • Donors pmp

    Chart1

    6

    13

    16

    21

    22

    23

    24

    25

    26

    28

    34

    Deceased donors per million population 2007

    Deceased Donors Per Million Population 2007

    Sheet1

    Deceased donors per million population 2007Series 2Series 3

    Greece62.42

    UK134.42

    Germany161.83

    Italy212.85

    Ireland22

    Austria23

    Portugal24

    France25

    US26

    Belgium28

    Spain34

  • Organ Donors in SpainNumbers & Annual Rate (p.m.p)

    55068777883286596010371032115512501334134513351411

    Chart1

    14.3

    17.8

    20.2

    21.7

    22.6

    25

    27

    26.8

    29

    31.5

    33.6

    33.9

    32.5

    33.7

    Number

    Sheet1

    NumberSeries 2Series 3

    198914.32.42

    17.84.42

    199120.21.83

    21.72.85

    199322.6

    25

    199527

    26.8

    199729

    31.5

    199933.6

    33.9

    200132.5

    33.7

  • Organ Donation TaskforceTerms of referenceTo identify barriers to donation and transplantation and recommend solutions within existing operational and legal frameworks in EnglandElisabeth Buggins CBE

  • A UK Model for DonationNHSBTDepartment of HealthAcute Hospital TrustsMore donorsNational ODOEffective co-ordination and retrieval Education, training and auditPublic engagementFundingResolution of ethical and legal issuesPerformance Management TrainingPublic recognitionClinical leadsEmbedded co-ordinatorsDonation committees

  • Key recomendationsA UK-wide Organ Donation Organisation should be established

    The establishment of the Organ Donation Organisation should be the responsibility of NHS Blood and Transplant.

    Urgent attention is required to resolve outstanding legal, ethical and professional issues in order to ensure that all clinicians are supported and are able to work within a clear and unambiguous framework of good practice. Additionally, an independent UK-wide Donation Ethics Group should be established.

    All parts of the NHS must embrace organ donation as a usual, not an unusual event. Local policies, constructed around national guidelines, should be put in place. Discussions about donation should be part of all end-of-life care when appropriate. Each Trust should have an identified clinical donation champion and a Trust donation committee to help achieve this.

    Minimum notification criteria for potential organ donors should be introduced on a UK-wide basis. These criteria should be reviewed after 12 months in the light of evidence of their effect, and the comparative impact of more detailed criteria should also be assessed.

    Donation activity in all Trusts should be monitored. Rates of potential donor identification, referral, approach to the family and consent to donation should be reported. The Trust donation committee should report to the Trust Board through the clinical governance process and the medical director, and the reports should be part of the assessment of Trusts through the relevant healthcare regulator. Benchmark data from other Trusts should be made available for comparison.

    BSD testing should be carried out in all patients where BSD is a likely diagnosis, even if organ donation is an unlikely outcome.

    Financial disincentives to Trusts facilitating donation should be removed through the development and introduction of appropriate reimbursement

    The current network of DTCs should be expanded and strengthened through central employment by a UK-wide Organ Donation Organisation. Additional co-ordinators, embedded within critical care areas, should be employed to ensure a comprehensive, highly skilled, specialised and robust service. There should be a close and defined collaboration between DTCs, clinical staff and Trust donation champions. Electronic on-line donor registration and organ offering systems should be developed.

    A UK-wide network of dedicated organ retrieval teams should be established to ensure timely, high-quality organ removal from all heartbeating and nonheartbeating donors. The Organ Donation Organisation should be responsible for commissioning the retrieval teams and for audit and performance management

    All clinical staff likely to be involved in the treatment of potential organ donors should receive mandatory training in the principles of donation. There should also be regular update training

    Appropriate ways should be identified of personally and publicly recognising individual organ donors, where desired. These approaches may include national memorials, local initiatives and personal follow-up to donor families

    There is an urgent requirement to identify and implement the most effective methods through which organ donation and the gift of life can be promoted to the general public, and specifically to the BME population. Research should be commissioned through Department of Health research and development funding.

    The Department of Health and the Ministry of Justice should develop formal guidelines for coroners concerning organ donation

  • Donation committeeNon clinical Chair Mr Gerald CotemanClinical lead for organ donationIntensive care clinical and nursingEmergencyPhysicianPaediatriciansBereavement ChapliancyPALS

  • Princess Alexandra ITU Deaths

  • ITU Donor Potential and Organ Donors

  • Financial disincentivesNHSBT fixed rate tariff 2086 per donor NHSBT finance 1 PA to support the work of the CLOD2000pa to support the donation committee

    Critical care capacity

  • Future activityEmbedded donor coordinatorLocal awareness Donor registerNon heart beating programmeEnd of life policyTissue donation

    **Euro 2008 analogy **