Midlands Organ Donation Services Team Regional Data Update Midlands Organ Donation Services Team

Actual deceased donors in the UK Individual Hospital Donation Reports April 2014- September 2014 (detailed report and summary) - sent to CEO’s 20th November. SNOD’s can provide further detail with regards to these reports if required. Review of National Data April/ September 2014 and Projected April/ March 2014/2015 Data. No of DBD’s predicting slight increase 780 2013/2014 784 2014/2015. No of DCD’s predicting decrease 540 2013/2014 474 2014/2015. (-66 DCD) 1 April 2005 to 30 September 2014, data as at 14 October 2014

Actual deceased donors- Midlands team Midlands Team Data April/ September 2014 (46 DBD and 25 DCD). Mirrors the National Picture + 5 DBD’s & - 15 DCD’s. Non proceeding April – September 2014/2015 (44) 22 PTA Non proceeding April – September 2013/2014 (29) 11 PTA Nationally ‘There is a need to address and quantify the impact of Non Proceeding DCD’s’. Ella Popitt will discuss in more detail. DePPaRT – Death Prediction and Physiology after the Removal of Therapy. Dale to discuss in more detail. 1 April 2005 to 30 September 2014, data as at 14 October 2014 Hospitals are allocated to teams using the current team allocations, not the allocation at the time of donation

Actual deceased donors Midlands 1 of the busiest teams. In addition to 71 proceeding donors (DCD and DBD) facilitated by the team April – September 2014. Team also facilitated an additional 49 non proceeding donors (44 DCD and 5 DBD). 1 April 2014 to 30 September 2014, data as at 14 October 2014

Mean no. of organs donated per donor Outcome 3. Action by NHS Hospitals and staff means that more organs are usable...and surgeons are better supported to transplant organs safely into the most appropriate recipients. Organs donated per donor. As a Collaborative aware of a number of initiatives to increase the number of organs retrieved and transplanted per donor. Organ Ox, Regional Normothermic Perfusion – could increase number of organs Tx by a further 5%. DCD kidney screening. QUOD - Quality in Organ Donation (QUOD) Project. Research will lead to better biomarkers of organ function and help clinicians decide which organ will be best for which recip. Hannah one of the QEH Scouts will be presenting later re a case whereby a potential DBD on a Balloon Pump was managed successfully resulting in a Heart and Lung retrieval and transplant. 1 April 2014 to 30 September 2014, data as at 14 October 2014

Midlands donors, organs and transplants Taking Organ Transplantation into 2020 (UK Strategy). Strategy clearly states measures for success – likely to take longer than seven years to achieve these measures fully- but they represent world class performance and should be the UK aspiration. UK’s rates of organ utilization already compares well with other countries. 94% of actual donors result in a least 1 transplant, compared with 86% Spain and 87% US. 1 April 2005 to 30 September 2014, data as at 14 October 2014 Hospitals are allocated to teams using the current team allocations, not the allocation at the time of donation

DBD- Neurological death testing rate Testing Target 81%. 1 April 2014 to 30 September 2014, data as at 14 October 2014

DBD- Midlands Neurological death testing rate Testing rates do vary from Trust to Trust. Data relating to Neurological Death Testing Rates included in Hospital Trust reports and also accompanying Midlands Organ Donation Services Team report (can be reviewed for bench marking) 1 April 2014 to 30 September 2014, data as at 14 October 2014

Reasons why neurological tests were not performed (primary reason) Patient haemodynamically unstable 6 Biochemical/ endocrine abnormality 4 Family declined donation 4 Other 4 Continuing effects of sedation 3 Clinical reason/ Clinicians decision 2 Cardiac arrest despite resuscitation 1 Inability to test all reflexes 1 SNOD advised that donor was not suitable 1 Treatment withdrawn 1 27 Cases

DBD referral rate Target 95%, therefore exceeding target 1 April 2014 to 30 September 2014, data as at 14 October 2014

DCD referral rate Target 75% and therefore under target. 1 April 2014 to 30 September 2014, data as at 14 October 2014

Referrals Attended % Attendance DBD DCD Non proceeding DBD/ DCD Jan 104 66 63% 8 5 13 Feb 97 50 52% 6 9 Mar 102 53 Apr 60 64% May 76 39 51% 10 4 June 113 83 73% 7 July 64 Aug 96 58 60% 3 Sep 100 68 68% 12 Team on average take 90 -100 referrals a month. Team managers have supported the team since June in taking referrals 1 day week each (undertaken in North West and Yorkshire Team). Will increase to 1 week a month each from Feb 2015.

Team Managers Taking Referrals Impact so far..... Early days..... Hope to see increase in % of referrals attended...

DBD approach rate Target for DBD approach rate 93.5% and therefore Midlands Team over target. 1 April 2014 to 30 September 2014, data as at 14 October 2014

DCD approach rate Target for DCD approach rate 46.4% and therefore Midlands Team over target. Approach rate is calculated by Number of eligible DCD donors/ Number of eligible DCD donors whose family was approached. The approach rate does not take into account the number of eligible DCD donors whom are deemed non eligible donors following discussion with transplant centre's prior to approach. It is assumed that some of these patients were assessed for suitability with transplant centre’s and deemed not medically suitable/ not eligible and therefore not approached. 1 April 2014 to 30 September 2014, data as at 14 October 2014

DBD SN-OD involved Target DBD SNOD attendance 85%. Hopefully TM’s taking referrals will ensure quicker response from on call SNOD to attend potential donor referral and hence be involved in the planning and making of the approach to families re donation. April – September Data DBD Consent Rate SNOD and Clinician 69% vs. Clinician only 67%. 1 April 2014 to 30 September 2014, data as at 14 October 2014

DCD SN-OD involved Target 73%. April – September Data DCD Consent Rate SNOD and Clinician 50% vs. Clinician only 38%. 1 April 2014 to 30 September 2014, data as at 14 October 2014

DBD consent rate 1 April 2014 to 30 September 2014, data as at 14 October 2014

DBD SN-OD consent rate 1 April 2014 to 30 September 2014, data as at 14 October 2014

DBD no SN-OD consent rate 1 April 2014 to 30 September 2014, data as at 14 October 2014

DCD consent rate 1 April 2014 to 30 September 2014, data as at 14 October 2014

DCD SN-OD consent rate 1 April 2014 to 30 September 2014, data as at 14 October 2014

DCD no SN-OD consent rate 1 April 2014 to 30 September 2014, data as at 14 October 2014

Consent Behavioural Change Strategy Workforce Planning Welsh Opt Out Legislation ACCORD Clinical Pathway Donor Recognition Consent is our focus for the remainder of the year and continuing for many years to come. Over the past 5 years considerable gains have been made in maximising Organ Donation in the UK. One element of the pathway ‘Consent’ is resistant to change. It has been suggested that public promotion and societal engagement may improve Consent Rates. There is evidence that the way in which the possibility of donation is presented to a grieving family can have a critical impact – upon the decision they make. Current professional guidance clearly advocates involving the SNODs in the planning of the family approach Number of local initiatives and national initiatives underway to increase consent. The collaborative today will discuss some of these initiatives...