Donation after Brain-Stem Death DBD Dr Fran O’Higgins Dr Dale Gardiner Dr Gerlinde Mandersloot 9th July 2013 Suggest a local CLOD to present data

Session Objectives Present regional data for DBD Understand that DBD gives better organs than DCD Increase rate of neurological confirmation of death by increasing confidence in the Diagnosis of Death Increase quality of DBD organs adoption of extended care bundle and compliance with the six early interventions in donor optimisation collaboration in Scout pilot Session Chair or CLOD presenting regional data Organ Donation Past, Present and Future

Dr Fran O’Higgins Bristol Royal Infirmary Regional Data Dr Fran O’Higgins Bristol Royal Infirmary SOUTH WEST

Donation after Brain Death (DBD) Mechanically ventilated patient where death has been confirmed using neurological criteria. 36 donors (2012-2013) 20.0 % decrease (from 5 years ago) Explain what DBD is Organs that can be donated The number of DBD donors in region (2012-2013 = last year) and the rise over the last 5 years region has seen. Lungs Heart Small Intestine Kidneys Liver Pancreas SOUTH WEST

Donation in the South West Team 2003-2013 11.0% 60.7% -20.0% “Seen this slide already” – in 1st session Organ Donation Past, Present and Future 5

Donation in the South West Team 2003-2013 If we just look at DBD over the last 10 years, like many regions we can see that DBD is falling. Organ Donation Past, Present and Future 6

kidneys intestine lungs pancreas liver heart best transplant outcome favours DCD DBD kidneys intestine lungs Slide to show why for certain organs DBD is best Hearts and small intestine currently only from DBD Pancreas and liver better outcomes with DBD compared to DCD Only lungs and kidneys equivalent pancreas liver heart

South West Neurological death testing rate -------- National rate 87 82 76 74 86 78 73 ND tested (%) 20 40 60 80 100 Team Eastern London Midlands North West Northern Ireland Scotland South Central East Wales Yorkshire 5th We are 5th. Comment… 1 April 2012 to 31 March 2013, data as at 4 April 2013 Organ Donation Past, Present and Future

South West Neurological death testing rate Large spread 1 April 2012 to 31 March 2013, data as at 4 April 2013 Organ Donation Past, Present and Future

Tied 10th Mean no. of organs donated per DBD donor SOUTH WEST Mean no. of organs donated per DBD donor Northern (1st) : Every 10 donors save 4 more lives than we do Tied 10th Donor optimization is important in DBD. If we could optimise and donate like the Northern region does: for every 10 donors they save 4 more lives than we do. [I know this headline comment is a stretch of the truth but will grab the attention for Gerlinde’s talk] Optimization and retrieval surgeon acceptance is of course a two way process and this thanks may be to our surgeons in the audience as much as to those on the donation side. 1 April 2012 to 31 March 2013, data as at 4 April 2013 Organ Donation Past, Present and Future