Taskforce Implementation – Progress and Results Chris Rudge FRCS National Clinical Director for Transplantation Renal CDs Meeting 12 March 2010

Organ Donation Taskforce Made 14 recommendations Clarified roles –Acute hospital Trusts –Departments of Health/NHS Review of co-ordination & retrieval Training Legal and ethical issues Public promotion Target – 50% increase in donation over 5 years

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

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

National Organ Donation Organisation Recommendations A UK-wide Organ Donation Organisation should be established The Establishment of the Organ Donation Organisation should be the responsibility of NHS Blood and Transplant Complete

Review of Donor Transplant Coordination Recommendation The current network of Donor Transplant Co-ordinators should be expanded and strengthened through central employment by a UK-wide Organ Donation Organisation Well underway: >75 additional DTCs recruited, 11/12 new teams established

Review of Organ Retrieval Recommendation A UK-wide network of dedicated organ retrieval teams should be established to ensure timely, high-quality organ removal from all heartbeating and non-heart beating donors New commissioning contracts in place, major changes planned for 2010/11

Removing Financial Disincentives Recommendation Financial disincentives to Trusts facilitating donation should be removed through the development and introduction of appropriate reimbursement Complete – reimbursement for all donors from April 2008 (now £2,055). Accurate tariff under development

Promotion with the Public A role for us all Recommendation 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 Major public campaign launched on 2 nd November Research coordination group now active

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

Ethico-legal Uncertainties Dying but not yet dead Non heart beating donation Transfer from Emergency Medicine Donor stabilisation Early referral to DTC Early consultation of ODR

Ethical, Legal and Professional Issues Recommendation Urgent attention is required to resolve outstanding legal, ethical and professional issues to ensure that clinicians are able to work within a clear and unambiguous framework of good practice. Additionally, an independent UK-wide Donation Ethics Group should be established Ethical issues: Sir Peter Simpson appointed Chair, members appointed, 1 st meeting held on 6 th Jan 2010 Legal matters: Guidance published in November 2009

November 2009 in England and Wales. Scottish guidance awaited.

Coronial Issues Recommendation The Department of Health and the Ministry of Justice should develop formal guidelines for coroners concerning organ donation Guidance expected shortly

Training, Education and Professional Development Recommendation All clinical staff likely to be involved in the treatment of potential organ donors should receive mandatory training in the principles of donation. There also be regular update training NHSBT: Professional Development Programme for CLODS, non clinical chairs etc DH: National Training Group established

Recognition of Donors Recommendation 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 Loveseat Memorial Glasgow Workshop was held on September 11 th 2009 Priorities now being pursued

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

Donation Champions Recommendation Each Trust should have an identified clinical donation champion and a Trust donation committee to help achieve this. Well underway. 171/194 Clinical Leads for Organ Donation appointed. 101/180 Donation Committees and Chairs

Embedded Donor Transplant Co-ordinator Recommendation Additional co-ordinators, embedded within critical care areas, should be employed… There should be a close and defined collaboration between donor co-ordinators, clinical staff and clinical leads Well underway: 51% of hospitals have an embedded DTC. Collaboratives of embedded donor co-ordinators and CLODs being established

Performance Management Local governance Recommendation Donation rates should be monitored. Rates of potential donor identification, referral, family approach and consent should be reported. The Trust Donation Committee should report to the Trust Board and the reports should be part of the assessment of Trusts through the relevant healthcare regulator Underway. Donation Activity supplied to all Trusts from August 2009

Support for the Collaborative Central training and development Sound ethical and legal framework Collaborative of critical care and donor transplant co-ordination Trust Donation Committee Adequate resource Trust executive support

Deceased donors, transplants and active transplant list in the UK

Deceased heartbeating donors (DBD)

Deceased non-heartbeating donors (DCD)

Living donors

Kidney transplants

Kidney transplants and active transplant list

Europe: Deceased Donors 34.2

Europe: Deceased Donors

Falling incidence of brainstem death

Incidence of BSD in 2007 SpainUK No of patients diagnosis of BSD Population (m) BSD pmp

Summary Good progress in implementation of the infrastructure changes Increasing DCD, static DBD Future focus will be on: –Improving DBD –Improving DCD –Donation from Emergency Medicine