1. Organ Utilisation Strategy
Professor John Forsythe

2. UK Strategy –
Taking Organ Transplantation to 2020
Targets for deceased donors and transplants
Target figures to 2020

3. Age of UK deceased donors
% of donors

4. Age of deceased donors – UK vs Spain (2015)

5. Discard rates for kidneys from deceased donors, 2014
% of retrieved kidneys not transplanted N=
No. kidneys retrieved
¹ 2012 data
Source: ONT – Spain data, OPTN - US data
ANZ - Australia data, NHSBT - UK data
24% overall
10% overall
19% overall

6. Adult DBD kidney offer decline rates
EXTENDED CRITERIA Offer decline rates vary from 36% at Leeds to 77% at Leicester
STANDARD CRITERIA Offer decline rates vary from 24% at Leeds to 69% at Leicester

7. Offer decline rates vary from 17% at Birmingham to 70% at Newcastle
Adult elective liver offer decline rates
DCD liver
Offer decline rates vary from 23% at King’s college to 78% at Newcastle
DBD liver
Offer decline rates vary from 17% at Birmingham to 70% at Newcastle

8. Offer decline rates vary from 19% at Guy’s to 94% at Newcastle
Pancreas offer decline rates
DCD pancreas
Offer decline rates vary from 19% at Guy’s to 94% at Newcastle
DBD pancreas
Offer decline rates vary from 39% at Guy’s to 71% at Edinburgh and Newcastle

9. Adult heart offer decline rates
Offer decline rates vary from 67% at Papworth to 90% at Newcastle and Harefield

10. Median waiting time to transplant
Lower 95% confidence limit
Upper 95% confidence limit
30 months UK average
14 months months

11. Strategy Length of donation-transplantation process
Support to use of higher risk donor organs
Local MDT process and challenge
Better information
DCD donor assessment
Use of Fast Track/Simultaneous offering

12. DBD donation process
10.5 hours longer

13. DCD donation process
8.5 hours longer

14. DBD retrieval operation start times
Shift in time of day from 2-5 am to 6-12 am

15. Offering and retrieval planning
DBD
DCD

16. Post meeting Stick to referral times Delay once only
Delay for specified time as maximum
Night-time retrieval?
Streamline donor characterization…..

17. Better Information

18. Reasons for retrieved organs not being transplanted (2015/16)
KIDNEY
N=276

19. Reasons for retrieved organs not being transplanted (2015/16)
LIVER
N=168

20. Support for Higher Risk Donors

21. Donors with cod as drug overdose
Drug overdose as COD includes deaths from polypharmacy, paracetamol overdose, and alcohol poisoning
Slide courtesy of Sarah White, Sydney. Data from NHSBT, ANZOD and OPTN

22. Support
SaBTO advice
Aide memoire
Incidents and events
Consent

23. Introduction to TRANSPLANT APP

24. Options of diseases to select

25. Example A Hepatitis C Patient with a UKELD score of 55
What will happen to 100 people like me post-registration

26. Reasons for decline
We send monthly reports to all transplant centres detailing each offer they have received and whether they accepted or declined, with the reason for decline. We indicate whether the organ was transplanted elsewhere. These reports are used in transplant centre MDT meetings and lead to changes in practice.

27. Challenge Advisory groups Named patient allocation
Patient involvement/Consent

28. DCD donor assessment

29. DCD donor assessment Actual donors of those referred: DBD 47% DCD 9%
Referred to SNOD
SNOD attended
Family approached
Actual donors
Organs Transplanted
2014/15
DBD
1679
1563
1291
783
2604
DCD
5718
3579
2131
496
1132
Actual donors of those referred:
DBD 47% DCD 9%

30. DCD donor assessment Review of evidence suggested:
Inconsistent practice by SNODs in handling of DCD referrals
Clinical donor criteria that never resulted in transplantation of donor organs
New DCD assessment
process agreed with
clinical support to
improve efficiency in the
DCD pathway

31. DCD donor assessment
Potential DCD donors excluded on basis of past non-donation/tx:
Regular review and dialogue with clinical community to ensure viable potential donors not missed (as novel technologies come into use)

32. DCD donor assessment 12 months data (Dec 2015-Nov 2016)
DCD referrals
6182
Absolute contraindication?
No %
Yes %
DCD exclusion?
No 3469
56%
Yes 1550
25%
SNOD overrides
131
% of our referrals

33. DCD donor assessment 12 months data (Dec 2015-Nov 2016)
DCD referrals
6182
Absolute contraindication?
No %
Screening call made to transplant centres
Yes %
Yes 1340
22%
DCD exclusion?
No 2260
37%
No 3469
56%
Yes 1550
25%
Screening centre decision
SNOD overrides
131
Not acceptable
936 – 70%
Acceptable %
% of our referrals

34. Use of Fast Track offering

35. Fast Track Offering Schemes
Fast track schemes are designed to maximise the utilisation of organs available for transplantation
Simultaneous offering to speed up allocation
Offers are sent to all eligible centres via SMS, pager or fax
Centres have 45 minutes to respond to the offer via telephone
No response is assumed to be a declined offer
More than one centre accepts - organ allocated to centre highest on list or rota
This is done by simultaneous offering of an organ, by the ODT duty office, to speed up the allocation process

36. Trigger points for fast track offering
Kidney deemed unsuitable
Kidney
5 centres declined donor/organ reasons (3 DCD)
Accrued 6hrs CIT
(3hrs DCD, 12hrs multi-organ)
Pancreas deemed unsuitable
Pancreas
4 centres declined donor/organ reasons (3 DCD)
Pancreas removed
Proposed: after 6 hrs of offering or 3 centres declined for same donor reason
At or after cross-clamp the liver is declined/ not yet accepted
Liver
At removal or already removed
Heart and
lungs
To be removed within 90mins
First organ offered
Organs
retrieved
Organs transplanted
Further details can be found in the organ allocation policies available at

37. % fast tracked (of those donated)

38. Activity- transplanted
of those fast tracked
N fast tracked: 0% 0% 3%
15%
34%
37%
55%
63%

39. Introduction of Pancreas Fast Track Scheme
Number of pancreases offered 6 times or more has reduced from 23% to 13%
Number of offers

40. Simultaneous Offering
Higher risk donors eg viral risk
Scheme and response requires agreement
Organ specific

41. Reasons why donation did not proceed following consent/authorisation6%
34 families 7%
7 families
15% families who withdraw because process too long
2015/16 data: 104 DBD families, 546 DCD families

42. Enhanced Retrieval response?

43. Resource

44. DBD kidney offer decline rates

46. Summary www.odt.nhs.uk/odt
Donors becoming more complex and offering taking longer
Many more organs offered than are ever accepted
High offer decline rate with wide centre variation
Reasons for decline reported to centres monthly for review
Much that can be done

47. Acknowledgements
Transplant unit, H&I laboratory and other hospital staff and Specialist Nurses for Organ Donation for provision of data to the UK Transplant Registry
RTSM, February 2017