Taskforce Implementation – Progress and Results

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

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

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

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

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

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

7. Review of Organ Retrieval New commissioning contracts in place, major changes planned for 2010/11 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

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

9. Promotion with the PublicA role for us all Major public campaign launched on 2nd November 2009. Research coordination group now active 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

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

11. 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

12. Ethical, Legal and Professional Issues Ethical issues: Sir Peter Simpson appointed Chair, members appointed, 1st meeting held on 6th Jan 2010 Legal matters: Guidance published in November 2009 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

13. November 2009 in England and Wales. • Scottish guidance awaited.

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

15. Training, Education and Professional Development NHSBT: Professional Development Programme for CLODS, non clinical chairs etc DH: National Training Group established 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

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

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

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

19. Embedded Donor Transplant Co-ordinator Well underway: 51% of hospitals have an embedded DTC. Collaboratives of embedded donor co-ordinators and CLODs being established 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

20. Performance ManagementLocal governance Underway. Donation Activity supplied to all Trusts from August 2009 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

21. 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

22. Deceased donors, transplants and active transplant list in the UK

23. Deceased heartbeating donors (DBD)

24. Deceased non-heartbeating donors (DCD)

25. Living donors

26. Kidney transplants

27. Kidney transplants and active transplant list

28. Europe: Deceased Donors 34.2

29. Europe: Deceased Donors 14.7 34.2

30. Falling incidence of brainstem death

31. Incidence of BSD in 2007

32. 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