Organ Donation Update - GICU

Progress at St Georges 2014 – 2015 2013 – 2014 43 Donors 27 donors DBD 33 DCD 10 136 organs retrieved and transplanted. 2013 – 2014 27 donors DBD 23 DCD 4 101 organs retrieved and 80 transplants So far this year we have 38 donors South East Organ Donation Team. Pager: 07659 590 529

Dashboard GICU Data Source Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Referrals PDA 100% n/a 0%   Timely referrals Planned Approach with SNOD 50% BSD Testing Rates N/A Totals - Potential DBD/DCDs 1 DBD 3 DCD 1DBD 2DCD 0 DCD 1DBD 1DCD 2DBD 1 DCD All consultant approaches and all declines- December on boxing day

Achievements so far, April 2015- December 2015 NICU- 33 Consents, 26 proceeded = 95 organs retrieved GICU- 3 Consents, 3 proceeded, 12 organs retrieved CTICU- 7 Consents, 7 Proceeded, 18 organs retrieved For DBD 100% referral rate overall (96.4%- National) For DCD 94.1% referral rate overall (82.5%-National)

Achievements 2014-2015 NICU 35 consents. 29 proceeded. = 110 organs retrieved. GICU 14 consents. 11 proceeded = 35 organs retrieved. CTICU 8 consents. 3 proceeded = 9 organs retrieved. For DBD 100% referral rate overall For DCD 94.6% referral rate overall Over to Marietta 1 uncontrolled death 1 contraindication (found post consent) Overall 29 referrals Over to Anthea & Joe (1 all centre's declined & 1 PTA) Over Matt & Leanne ( 2 PTA + 1 ACDecline)

Year to date GICU- 3 proceeding donors 12 organs being transplanted 7 Kidneys 2 Livers 2 Lungs 1 Pancreas

Non proceeding consents Factors affecting conversion rates: All centres decline PTA Uncontrolled

Why bother? Savings after transplant Over a 100% cost saving Renal Costs per patient per annum Dialysis £28,967 Cost over 10 years - £ 289, 677 Savings after transplant Over a 100% cost saving (X17 kidneys = £3 179 000!) Benefit to the patient Benefit to the economy Transplantation costs per patient Assessment & transplant £52, 443 After 1st year £35, 430 Costs per year £7,274 Cost over 10 years - £ 102, 716

Challenges GICU Coroner Variations in approach Clarity on consenting before BSDT Telephone approaches Telephone consents

Requesting Donation Families need to understand the patient has died (ie BSD) or that death is inevitable before they are approached to think about donation Brain Stem Death Tests/withdrawal of treatment and Organ Donation are separate issues Collaborative approach is key

Approaching a Family for Consent for Organ Donation - 3 Key Stages Huddle! Planning Confirming understanding & acceptance of loss Discussing donation

Integral Part of End of Life Care – Nursing Guidance Wherever possible, assess the dying person’s wishes regarding organ, tissue and body donation. Whole body donation can only be agreed by individuals themselves & not by anybody else on their behalf after death. If an individuals wishes regarding organ & tissue donation were not formally recorded before death, consent can be sought from a nominated representative or someone else in a qualifying relationship. Care before death p.8 points 5-8 Published 2011, due review April 2014 www.endoflifecareforadults.nhs.uk

You know, We know. Do they know? South East Organ Donation Team. Pager: 07659 590 529

Who Should Be Asked? No Religions oppose donation No Ethnic Groups opposed to donation Each family is individual – no assumptions should be made on the basis of ethnicity, culture or religion Every Family Should Be Given The Choice – even if they are not present and planning to not return to the unit

Key Aspects Donation is not a tick box exercise Donation is a flexible process to meet the needs of families Telephone approach/consent is common Families can bring up donation prior to BSDT Drs decision on when to test & if pre conditions met.

Kirstie Tancock Cystic Fibrosis 6 months to live Double lung transplant 2011 as a 21yr old while in ICU. Love on the Transplant Waiting List Chronic rejection 2 years post op. Received 2nd lung transplant Autumn 2013 http://kirstie-2ndchanceatlife.blogspot.co.uk/ South East Organ Donation Team. Pager: 07659 590 529

Tree of Life memory day.

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