Organ Donation Annual Report. April 2011 to March 2012.

Transcription

1 Organ Donation Annual Report April 2011 to March Dr RM Kitson Consultant ITU and Anaesthesia Clinical Lead for Organ donation. Final report: 15 th May

2 Introduction Promotion of organ donation remains a national priority. Approximately 7000 to 8000 people in the UK require a transplant at present and this number increases by about 8% per annum. In the 2010 to 2011 report from the NHSBT, it was documented that there were 7,800 patients waiting for a transplant at the end of March 2011, and a further 2,783 were temporarily suspended from transplant lists. Sadly, 511 patients died while waiting for their transplant [1] The profile of how organs are donated has changed. The balance between donation from live donors and deceased donors changed. There was a 5% increase in the number of deceased donors to 1,010, the largest number there has ever been in the UK. However, the number of living donors fell by 2% to 1,045; living donors thus still account for more than half of the total number of organ donors. Of the deceased donors, the number of donors after brain death (DBD) increased by 2% to 637, while the number of donors after circulatory death (DCD) increased by 11% to 373. The key statistic is that the number of patients whose lives were saved or improved by an organ transplant increased by 1% to 3,740. Data for is still being clarified and formatted into an annual report but statistics off the NHSBT data-base indicate: o There has been an increase in the number of deceased donations to o Of these 40% are now DCD donations, which is an increase o There are 7636 patients awaiting organs; 84% of these are awaiting kidneys. [2] Currently only 30% of the UK population are registered on the Organ Donation Register. Consent for donation remains one of the lower rates internationally and has largely been unchanged for the most of the last decade. This topic, namely improving consent rates has been the focus of a recent guideline published by NICE [3] Key areas of progress in Continuing promotion of organ donation at Tameside hospital Updating of Organ Donation policy to incorporate the changes recommended in NICE clinical guidelines 135 First successful DCD (Diagnosis of Cardiac Death) organ donation in the Trust from ICU Two DBD organ donations in the Trust from ICU Appointment of new Specialist Nurse for Organ Donation (SNOD) 2

3 Details of annual progress. 1. Policy development / clinical governance The Organ donation policy for the Trust was amended and updated, and was uploaded in April The key areas of change in the policy were: o Incorporation of the recommendations from NICE CG135 (detailed below) o Adjustment of the protocol for DCD donation to reflect alterations on the theatre configuration, availability of outreach critical care and availability of a dedicated area in recovery to facilitate stabilisation of potential donors o New required referral proformas for the ED and for ITU 2. Organ donation committee and work-streams A new Specialist Nurse for Organ Donation (SNOD) was appointed in early 2012, reflecting changes in the organisation of SNODs within the North-west. The new SNOD is Alison Toyne, who divides her commitments between Tameside and UHSMT at Wythenshawe. Work-streams have included ongoing education of nursing staff in target areas, such as the Intensive Care Unit (ICU) and the Emergency department (ED). Both areas are represented on the ODC and are active in considering appropriate patients for potential organ donation. The first successful organ retrieval from a Diagnosis of Cardiac Death (DCD) patient from ICU took place in Feb The process ran very smoothly and reinforced the value of a robust protocol describing the expected pathway. The membership of the ODC in comprised of: Mr P Dylak Dr Ross M Kitson Dr N Contractor Ms Alison Toyne Ms Keely Hart Caroline Holt Andrew Dolan Karen Rowland Sandra Wood Karen Mulholland Director of nursing (chair) Consultant ITU/ anaesthesia and Clinical Organ donation Lead (CLOD) Consultant ED Specialist Nurse Organ Donation (SN-OD) Specialist Nurse Organ Donation (SN-OD) Risk management Team Leader Theatres Business manager (theatres) Senior Nurse ITU Link nurse A&E 3. NICE CG 135 The CG135 made a number of significant recommendations which have been incorporated into the Organ Donation Policy version 2. These include, but are not limited to: 3

4 o The idea organ donation should be a usual aspect of end-of-life care planning o Earlier identification of donors via use of clinical triggers and earlier subsequent SNOD referral o Use of a multi-disciplinary team to approach relatives about organ donation. Ideally this should involve some of the team caring for the patient. o Stipulation of skills required for various levels of staff involved in discussions about organ donation and also recommendations with regard the process of obtaining consent 4. Audit data on organ donation and potential organ donors at TGH. Data is presented for April 2011 to March 2012 ED 197 deaths, 7 of these were ventilated. 0 likely brain stem dead (DBD). Of the 7 ventilated, 0 had contraindications to donation, 3 were not referred (missed potentials). Of the remaining 4, all were referred, 1 declined by transplant teams so no approach made, 1 approach by SNOD and family refused, 1 family consent (SNOD approach) but then Coroner refused, 1 SNOD attended but coroner refused (as due to assault) ICU 58 deaths, 56 of these were ventilated. 5 likely brain stem dead, 4 were referred and tested, 1 not referred (became unstable and treatment withdrawn). Of the 4 likely brain stem dead that were referred, 1 was declined by transplant teams, 1 family approached by SNOD (consent taken then positive virology and unable to donate), 2 DBD donors (First donor liver kidneys and corneas; Second donor liver, kidneys, heart valves, skin) 15 planned for withdrawal of treatment, 12 contraindicated (due to MOF; malignancies), remaining 3 were referred, two approached by ITU staff prior to referral to SNOD and both families declined. One accepted for DCD donation (donated kidneys). The data is shown in graphic form in appendix 1. 4

5 References 1. NHSBT. Activity report 2010/2011- Transplant Activity in the UK. Accessed at plant_activity_report.asp 2. Activity statistics as of week ending April 20 th Accessed at 3. NICE Clinical Guideline 135: Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation. Published December Accessed at 5

6 Appendix 1: Data from potential donor audit (April 2011 to December 2011) (i) Emergency Department (ED) 197 deaths in the ED 0 diagnosis brain-stem death (DBD) 7 ventilated patients in whom treatment was to be withdrawn (DCD) 4 patients referred to SNOD 3 patients not referred to SNOD Missed potential DCD donation 1 declined by transplant team 1 declined by family 1 agreed by family but declined by coroner 1 declined by coroner; family not approached PDA summary (9 months) 2 approaches- 1 consented (50%) 7 potential DCD donors, 4 referred (57%) No organ donors. 6

7 (ii) ITU 56 ventilated patients who died 5 patients with likely brain-stem death (DBD) 36 patients with deterioration (not withdrawal) 15 patients with planned withdrawal 4 brain-stem tested 4 referred to SNOD 1 not tested (unstable, withdrawn) 1 not referred Missed potential DCD donation 12 had contraindication to donation (malignancy; MOF) 3 referred to SNOD 2 organ donations 1 declined by transplant team 1 consent obtained but unable to donate (virology) 2 Families approached and declined 1 DCD organ donation PDA summary (9 months) 7 approaches, 5 consented (71%) 15 potential referrals to SNOD, 4/5 DBD and 3/15 DCD referred = 7/20 (35%) 7