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Donor Identification and Referral . Jeremy Brown Huw Twamley 4 th June 2013 . LONDON. 1. Regional Data. Jeremy Brown. LONDON. 2. 100. 98. 97. 95. 95. 93. 91. 89. 89. 88. 87. 86. 80. 84. 60. Referral rate (%). 40. 20. 0.

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donor identification and referral

Donor Identification and Referral

Jeremy Brown

Huw Twamley

4th June 2013

LONDON

1

regional data

Regional Data

Jeremy Brown

LONDON

2

slide3

100

98

97

95

95

93

91

89

89

88

87

86

80

84

60

Referral rate (%)

40

20

0

North

South

South

South

South

Eastern

London

Midlands

Northern

Scotland

Yorkshire

Northern

East

West

West

Wales

Ireland

Central

Team

-------- National rate

DBD referral rate

LONDON

2nd

1 April 2012 to 31 March 2013, data as at 4 April 2013

3

Organ Donation Past, Present and Future

Organ Donation Past, Present and Future

slide4

100

19

5

30

16

9

13

23

18

20

1

21

15

12

3

4

22

2

11

28

17

24

10

8

80

7

27

29

60

Referral rate (%)

40

20

0

6

25

14

26

0

10

20

30

40

50

60

Number of neurological death suspected patients

Hospital

National rate

95% Lower CL

95% Upper CL

99.8% Lower CL

99.8% Upper CL

London DBD referral rate

1 April 2012 to 31 March 2013, data as at 4 April 2013

4

Organ Donation Past, Present and Future

Organ Donation Past, Present and Future

slide5

100

80

81

80

72

72

65

60

60

59

Referral rate (%)

56

54

54

52

40

42

20

0

North

South

South

South

South

Eastern

London

Northern

Scotland

Midlands

Northern

Yorkshire

East

West

West

Wales

Ireland

Central

Team

-------- National rate

DCD referral rate

LONDON

Tied 3rd

1 April 2012 to 31 March 2013, data as at 4 April 2013

5

Organ Donation Past, Present and Future

Organ Donation Past, Present and Future

slide6

100

9

3

15

24

17

28

80

6

22

10

20

21

2

11

13

19

7

27

60

1

5

8

Referral rate (%)

4

16

40

12

25

26

20

18

23

29

0

30

14

0

10

20

30

40

50

60

70

80

Number of imminent death anticipated patients

Hospital

National rate

95% Lower CL

95% Upper CL

99.8% Lower CL

99.8% Upper CL

London DCD referral rate

6

Organ Donation Past, Present and Future

Organ Donation Past, Present and Future

identification and referral

Identification and Referral

Dr Huw Twamley

North West Regional CLOD

7

timely identification and referral of potential organ donors

Timely Identification and Referral of Potential Organ Donors

www.odt.nhs.uk

Organ Donation Past, Present and Future

session objectives
Session Objectives

9

Organ Donation Past, Present and Future

Organ Donation Past, Present and Future

  • Understand difficulties with donor identification and referral
  • Recognise benefits of improving elements of the process
    • Increased identification and referral
    • Timely referral
    • Responsiveness to referral
  • Consider which of the proposed methods of identification and referral may work in your hospital
uk rates of referral
UK rates of referral

91%

52%

Organ Donation Past, Present and Future

Organ Donation Past, Present and Future

overall timings
Overall timings

Organ Donation Past, Present and Future

Organ Donation Past, Present and Future

potential donor
Potential donor

83 year old

OOH PEA cardiac arrest

Downtime 15-20 minutes

Known hypertensive ( three anti-hypertensives)

Benign Prostate Hyperplasia

Organ Donation Past, Present and Future

Organ Donation, Past, Present and Future

best interests
Best Interests

Recipient

Potential Donor Family

Potential Donor

Organ Donation Past, Present and Future

aims of strategy
Aims of Strategy
  • 100% Identification of potential Donors
  • 100% Referral of Potential Donors
  • 100% Timely Referral
  • Implement NICE Guidance

The consideration of donation should be core ICU / ED and part of all end of life care plans.

Timely referral promotes this possibility

Organ Donation Past, Present and Future

slide15

100

19

16

5

30

9

23

13

20

18

1

21

15

12

3

22

4

2

11

28

17

24

10

8

80

7

29

27

60

Referral rate (%)

40

20

0

6

14

25

26

0

10

20

30

40

50

60

Number of neurological death suspected patients

Hospital

National rate

95% Lower CL

95% Upper CL

99.8% Lower CL

99.8% Upper CL

London DBD referral rate

1 April 2012 to 31 March 2013, data as at 4 April 2013

15

Organ Donation Past, Present and Future

slide16

100

9

3

15

24

17

28

80

6

22

10

20

21

2

11

13

19

7

27

60

1

5

8

Referral rate (%)

4

16

40

12

25

26

20

18

23

29

0

30

14

0

10

20

30

40

50

60

70

80

Number of imminent death anticipated patients

Hospital

National rate

95% Lower CL

95% Upper CL

99.8% Lower CL

99.8% Upper CL

London DCD referral rate

16

Organ Donation Past, Present and Future

nice guideline 135
NICE Guideline 135

Organ Donation Past, Present and Future

british medical association 2012
British Medical Association 2012

The research data -------- showed that the use of clinical triggers and a requirement to refer according to standard criteria led to an increase in both referrals and donors. It is hoped that implementation of the NICE guideline will result in early and consistent donor referral.

Organ Donation Past, Present and Future

general medical council 2010
General Medical Council 2010

I”f a patient is close to death and their views cannot be determined, you should be prepared to explore with those close to them whether they had expressed any views about organ or tissue donation, if donation is likely to be a possibility.”

“You should follow any national procedures for identifying potential organ donors and, in appropriate cases, for notifying the local transplant coordinator.”

Decisions to limit or withdraw treatments in potential DCD donors MUST be in compliance with national End of Life Care policy.

Organ Donation Past, Present and Future

uk donation ethics committee
UK Donation Ethics Committee

“There is no ethical dilemma if the treating clinician wishes to make contact with the SN-OD at an early stage, while the patient is seriously ill and death is likely, but before a formal decision has been made to withdraw life-sustaining treatment.”

[“Benefits] include establishing whether there are contra-indications for organ donation……

Other practical and organisational factors might be relevant – if the SN-OD is based at a distant location then early contact can help to minimise distressing delays for the family.”

Organ Donation Past, Present and Future

objectives benefits and outcomes
Objectives, benefits and outcomes

All potential donors are identified and referred

All patients are given the option of donation

Access to clinical advice

Prompt donor optimisation

Resolution of potential legal obstacles

Early assessment of marginal donors

Early tissue typing / screening

Planning the family approach

Reduction in delays for families and units

All donors are referred in a timely fashion

SN-ODs are deployed in a way that improves responsiveness

Increased donor numbers

Improved consent / authorisation rates

Increase in donor organs

Better experience for families and staff

Organ Donation Past, Present and Future

nhsbt strategy
NHSBT Strategy
  • Implementation not publication
  • Key area for collaboration between hospitals and donor care teams
  • Very clear emphasis on benefits
    • How not who
  • Suite of options
  • Clarity over implementation

Organ Donation Past, Present and Future

strategy proposals
Strategy proposals
  • Every hospital should have a written policy for the identification and timely referral of all potential donors
  • Every donating area within a given hospital adopts a consistent approach
  • As far as possible ‘decouple’ early referral from individual clinician

Donation Committees and SN-OD teams should collaborate to develop and implement a policy that ensures that all potential donors are identified and referred in a timely fashion.

Organ Donation Past, Present and Future

1 daily visit by sn od
1. Daily visit by SN-OD

Organ Donation Past, Present and Future

2 early daily phone call
2. Early daily phone call

Organ Donation Past, Present and Future

3 daily icu team safety brief
3. Daily ICU team safety brief

Organ Donation Past, Present and Future

north bristol trust icu safety brief
North Bristol Trust ICU Safety Brief

Organ Donation Past, Present and Future

4 standard operating procedure
4. Standard Operating Procedure

Organ Donation Past, Present and Future

midlands standard operating procedure
Midlands Standard Operating Procedure

Organ Donation Past, Present and Future

5 nurse led referrals
5. Nurse led referrals

Organ Donation Past, Present and Future

summary
Summary
  • Donation should be a element of end of life care
  • Make identification and referral routine business of the unit.
  • This decouples early referral from the individual clinician caring for the patient
  • Implement or develop a solutions /policy for your individual hospitals adopt to timely referral
  • Ensure consistency within a given hospital

Organ Donation Past, Present and Future

what are the barriers to implementing the nice guidelines in your unit any solutions
What are the barriers to implementing the NICE guidelines in your unit: any solutions?
  • Whichever is the earlier, either:
  • Use trigger factors in patients with a catastrophic brain injury
  • The absence of one or more cranial nerve reflexes
  • AND a GCS of 4 or less that is not explained by sedation
  • And / or a decision is made to perform brainstem death tests.
  • The intention to withdraw life-sustaining treatment in patients with a life-threatening or life-limiting condition which will, or is expected to, result in circulatory death.

Organ Donation Past, Present and Future