Advancing Organ Donation: can we really make it happen?

Transcription

1 Advancing Organ Donation: can we really make it happen? Current Strategy and thoughts out of the box Mr Chris Rudge FRCS National Clinical Director for Transplantation

2 Agenda Current Strategy Is it working? What more do we know? How can we improve it? What else could we do?

3 Agenda Current Strategy Is it working? What more do we know? How can we improve it? What else could we do?

4 Organs for Transplants January Recommendations Legal and ethical issues Clarified roles Acute hospital Trusts Departments of Health/NHS Review of co-ordination & retrieval Training Public promotion Target 50% increase in donation over 5 years

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

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

7 Review of Donor Transplant Recommendation Coordination 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: 189/246 DTCs & 13/29 team managers now recruited; all new teams now established

8 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: Donation Ethics Committee established, first meeting held Feb 2010 Legal matters: Guidance published

9 Legal guidance Guidance published in England and Wales (November 2009) and Scotland (May 2010)

10 Donation Champions Recommendation Each Trust should have an identified clinical donation champion and a Trust donation committee to help achieve this Well underway. 185/191 Clinical Leads appointed. 155/177 Donation Committees in place

11 Donation Committee 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

12 Summary 1 Good progress with the infrastructure Coordinators Clinical Leads Donation Committees Good progress with legal and ethical support Legal Guidance Donation Ethics Committees Progress with everything else Training Public awareness (>17m on ODR) Research

13 Agenda Current Strategy Is it working? What more do we know? How can we improve it? What else could we do?

14 Trends in donation and transplantation Donors Transplants Number 4000 Transplant list Year

15 Trends in donation and transplantation Donors Transplants Number 4000 Transplant list Year

16 Deceased Donors Number * Year

17 Deceased Donors 1000 DBD DCD Number Year

18 Agenda Current Strategy Is it working? What more do we know? How can we improve it? What else could we do?

19 The falling potential for DBD BSD Patients DBD donors /5 2005/6 2006/7 2007/8 2008/9 2009/10

20 Predicted steady-state DBD donors Predicted /5 2005/6 2006/7 2007/8 2008/9 2009/10

21 Potential for DBD donation - Trends in key rates (Apr - Sep) Percentage (%) BSD testing rate Referral rate Family consent / authorisation rate Conversion rate (potential to actual)

22 90 DBD conversion rate by English SHA 80 East of England 70 Percentage (%) / / /2010 (Apr - Sep) Year

23 40 DCD conversion rate by English SHA North East 30 Percentage (%) / / /2010 (Apr - Sep) Year

24 There are: What more do we know? Summary Fewer patients with BSD likely Fewer patients with BSD diagnosis Fewer possible DBD donors Static number of actual DBD donors Large variations across the UK in both DBD and DCD performance

25 Agenda Current Strategy Is it working? What more do we know? How can we improve it? What else could we do?

26 How can we improve it? More DBD donors Admit more patients to ICU Diagnose BSD in emergency medicine Understand the variation across the UK

27 How can we improve it? More DCD donors Understand the variation across the UK Consensus Report in preparation Donation from emergency medicine Consensus Meeting held on 4 th October

28 How can we improve it? More organs Better donor management for DBD donors Perfusion systems Hypothermic perfusion Normothermic perfusion re-conditioning Ex vivo lung perfusion

29 Cardiopulmonary Transplantation Unit Freeman Hospital Newcastle Upon Tyne Institute of Cellular Medicine Ex vivo lung perfusion (EVLP) the Newcastle experience Program started in 2008 Pre clinical phase of program included 5 lungs Clinical phase of the program so far 11 lungs 4 lung transplants performed from donor lungs originally clinically rejected for transplantation

30 Ex vivo lung perfusion model

31 Improvement of lung graft during EVLP 1 hour post perfusion 6 hours post perfusion

32 Clinical Transplant from EVLP

33 Marginal Organs EVLP September 2010 Lund 7 Patients All Early Survivors Toronto Survivors (NB 17 DCD) Europe Madrid 6 all Cat 2 DCD Vienna 6 UK 12 Patients 2 Manchester 6 Harefield 4 Newcastle

34 Agenda Current Strategy Is it working? What more do we know? How can we improve it? What else could we do?

35 What else could we do? Move potential donors to a dedicated donation facility

36 What else could we do? Move potential donors to a dedicated donation facility Move a donation facility to the donor

37 What else could we do? Move potential donors to a dedicated donation facility Move a donation facility to the donor Limit transplants to people who are registered on the ODR

38 What else could we do? Move potential donors to a dedicated donation facility Move a donation facility to the donor Limit transplants to people who are registered on the ODR Lower our expectations

39 What else could we do? Move potential donors to a dedicated donation facility Move a donation facility to the donor Limit transplants to people who are registered on the ODR Lower our expectations Accept a lower transplant success rate Measure outcomes from the time of listing, as well as from transplantation

40 What else could we do? Move potential donors to a dedicated donation facility Move a donation facility to the donor Limit transplants to people who are registered on the ODR Lower our expectations Put ICU doctors in charge of donation