BTS Congress, March 2018 Overview of organ donation and transplantation Rachel Johnson Statistics and Clinical Studies NHS Blood and Transplant
Organ Donation and Transplantation: the headlines Subject Cardiothoracic organ transplantation New Kidney Offering Scheme Organ Utilisation National Organ Retrieval Service Patient based Liver Offering Scheme Speaker Sally Rushton Lisa Mumford Chris Callaghan Kate Martin John O Grady
Organ Donation and Transplantation: the headlines Subject Cardiothoracic organ transplantation New Kidney Offering Scheme Organ Utilisation National Organ Retrieval Service Patient based Liver Offering Scheme Organ Donation Quality in Donation Pancreas and islet session Speaker Sally Rushton Lisa Mumford Chris Callaghan Kate Martin John O Grady Full session at 2pm today Thurs pm
Outline Trends in deceased organ donors and transplants Living kidney donation - Non-directed altruistic donors The ODT Hub Useful resources
Trends in deceased organ donors and transplants
Deceased donors and transplants Highest number of deceased donors in the UK last year - 1413 - resulting in 3710 transplants Figure 2.1 Number of deceased donors and transplants in the UK, 1 April 2007-31 March 2017, and patients on the active transplant list at 31 March 9000 Over the last ten years 8000 7000 6000 7661 7907 8012 7814 7645 7335 7026 6943 6469 6388 17% decrease in waiting lists Number 5000 4000 3000 2384 2569 2660 2706 2916 3118 Donors Transplants Transplant list 3508 3340 3528 3710 56% increase in transplants (all organs) 2000 1000 0 1212 1320 1282 1364 1413 809 899 959 1010 1088 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 Year 75% increase in deceased organ donors
Number Deceased donors DBD vs DCD donors Age of deceased donors 900 800 700 600 500 400 300 200 609 611 200 288 DBD Donors 652 624 637 436 373 335 DCD Donors 780 772 705 540 507 510 785 829 579 584 100 90 80 70 60 50 40 30 20 3 3 3 3 5 8 10 11 12 15 14 13 15 11 13 14 17 15 18 20 23 22 22 22 22 23 22 25 26 26 24 24 23 25 26 25 22 25 24 49 53 50 50 48 46 42 38 37 37 39 36 36 70+ 60-69 50-59 18-49 0-17 100 10 0 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 0 8 7 8 5 7 4 4 4 3 4 4 4 4 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Increase in deceased donors this year? 900 DBD donor ages: April-February 800 121 70+ Taken from the weekly statistics : www.odt.nhs.uk Number 700 600 500 400 24 81 131 35 88 147 43 97 145 49 117 156 57 120 166 73 135 152 68 133 176 87 152 188 102 143 164 168 223 60-69 50-59 300 200 165 168 176 161 189 181 182 172 189 200 35-49 100 0 122 127 106 102 92 85 120 106 121 123 41 26 27 26 22 37 27 29 34 32 1 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Age 0-17 18-34 April-February 35-49 50-59 60-69 70+ 18-34 <18
YTD = end Jan Potential Donor Audit recent trends
What about transplant rates this year? Kidney txs DD 8% LD 3% SPK 11% Pancreas 7% P islets 42% Liver txs 5% Heart txs Lung txs 15% Taken from the weekly statistics : www.odt.nhs.uk
Living kidney donation non-directed altruistic donors
Number Non-Directed Altruistic Kidney Donors (NDADs) 120 107 110 100 80 94 84 87 60 60 40 35 26 20 12 16 0 3 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year
Number Non-Directed Altruistic Kidney Donors by donating hospital, 2007-2017 70 64 60 55 50 49 48 48 47 40 33 33 30 20 10 22 20 25 17 11 19 9 23 24 14 8 19 18 11 17 0
NDADs - by donating hospital & receiving centre only donations direct to list included, 2007-2017
Donation pathways Direct to Waiting List Short Chain Long Chain 2007 2012 2015 AD Exception! If match for high priority patient on waiting list AD AD WL D1 R1 Paired Exchange pairs D1 D2 R1 R2 WL WL
Donation pathways Direct to Waiting List Short Chain Long Chain 2007 2012 2015 AD Default pathways from Jan 2018 AD AD WL D1 R1 Paired Exchange pairs D1 D2 R1 R2 WL WL
No. of donations Non-Directed Altruistic Kidney Donors 140 Long chains Donation type 120 100 80 60 Short chains 3 22 23 21 26 26 Into chain Direct to list 40 20 0 3 2007 2008 12 16 2009 2010 2011 26 35 57 85 87 2012 2013 2014 2015 73 59 61 2016 2017
No. of transplants Non-Directed Altruistic Kidney Donor Transplants 140 Long chains Donation type 120 100 80 60 Short chains 3 22 23 22 23 33 21 37 38 26 26 Extra transplants Into chain Direct to list 40 20 0 3 2007 2008 12 16 2009 2010 2011 26 35 57 85 87 2012 2013 2014 2015 73 59 61 2016 2017 By December 2017: 635 Donations 791 Transplants
Total Living Kidney Donor Transplants Rise in both paired and altruistic living donor kidney transplants
Total Living Kidney Donor Transplants Fall in incompatible living donor kidney transplants
The ODT Hub Transforming the organ donation and transplantation pathway MAKING IT SAFER, SIMPLER, SUPPORTIVE
So far we have. Safely implemented new heart and routine lung allocation schemes Using new Hub IT platform Automating processes no more white board in Hub Operations (Duty Office)! Implemented Urgent and Super-urgent lung offering schemes Designed and developed a systematic donor assessment process for all referrals
We are now working on.. Final testing to implement a new national liver offering scheme Building and testing the new donor referral and assessment process for national roll out in 2018 Automating and simplify processes within Hub Operations
Number of calls to and from Hub Ops Jul-14 Oct-14 Jan-15 Apr-15 Jul-15 Oct-15 Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 % of Hub Ops offers 2018/19 plans for ODT Hub Finalising Business Case but we expect to be working on: New kidney offering scheme New HTA-A and B forms (donor information and transplant confirmation) Ensuring capacity for increased workload 25000 20000 15000 10000 5000 0 Number of calls to and from Hub Ops 12,000 20,000 % of organ offers going through Hub Ops 100% 80% 60% 42% 40% 20% 85% 0% Month Number of calls to and from Hub Ops Monthly
Useful resources
Resources ODT website www.odt.nhs.uk
Resources online tools Transplant tools Relative Chance of Kidney Transplant (adult and paediatric) Calculated Reaction Frequency (crf) Living donor kidney incompatible pairs Matchability calculator crf calculator for living donors in KSS UKELD calculator www.odt.nhs.uk/transplantation/tools-policies-and-guidance/calculators/
Resources NHSBT Clinical Trials Unit
Resources NHSBT Clinical Trials Unit Why use us? Knowledge of organ donation and transplantation Friendly, helpful and professional team Fully registered (with UK Clinical Research Collaboration) Access to UK Transplant Registry data: Sample size calculations Trial outcomes (cost effective) Contact: Phone: 01223 588088 Email: CTU@nhsbt.nhs.uk Web: www.nhsbt.nhs.uk/clinicaltrialsunit Twitter: @NHSBT_CTU Come and talk to us on our BTS stand!
Summary Deceased donors & transplants set to hit record high again this year Non-directed altruistic donors making an increasingly valuable contribution to kidney transplantation The ODT Hub updating organ offering schemes and streamlining processes Useful resources see www.odt.nhs.uk and come and see NHSBT Clinical Trials Unit today!
Acknowledgements Transplant unit and other hospital staff and Specialist Nurses for Organ Donation for provision of data to the UK Transplant Registry @NHSBT_Stats @NHSBT_CTU www.odt.nhs.uk BTS Congress, March 2018