Organ Donation and Transplantation
Strategic Performance Update
Sally Johnson
26 March 2015
Overview
• Performance against ODT strategic targets
• Overview of planned initiatives and timescales
• Updates on actions and progress against each outcome
Taking Organ Transplantation
to 2020: Outcomes
1. Action by society and individuals will mean that the UK’s organ
donation record is amongst the best in the world and people
donate when and if they can.
2. Action by NHS hospitals and staff will mean that the NHS
routinely provides excellent care in support of organ donation
and every effort is made to ensure that each donor can give as
many organs as possible.
3. Action by NHS hospitals and staff will mean that more organs
are usable and surgeons are better supported to transplant
organs safely into the most appropriate recipient.
4. Action by NHSBT and Commissioners means that better
support systems and processes will be in place to enable more
donations and transplant operations to happen.
Taking Organ Transplantation
to 2020: Outcome Measures
1. Consent Rate – 80% by 2020
2. Deceased Organ Donors per million population – 26pmp by
2020
3. Increase Organ Utilisation – 5% by 2020
4. Patients Transplanted per million population – 74 pmp by 2020
Headlines
• Activity levels recovered end 2014. Variable since with drop in
potential BSD patient in January & February.
• Donor and transplant numbers below 2013/14 levels
• Latest forecast: 1,300 donors and 3,362 deceased donor
transplants
• Performance against all four strategic objectives is red
Measure 1 – Consent rates
Consent rate (%) by ODR status
100%
80%
On ODR
Overall consent rate
60%
40%
Stage 1 – 100% of those on ODR
20%
Stage 2 – increase consent from those not on
ODR
Quarter
Q3
Q2
2014/15 Q1
Q4
Q3
Q2
2013/14 Q1
Q4
Q3
Q2
2012/13 Q1
Q4
Q3
Q2
2011/12 Q1
Q4
Q3
Q2
0%
2010/11 Q1
Consent rate
Not on ODR
Measure 1 - Consent rates by Region
Consent rate (%) by ODS team, Apr 2014 - Jan 2015 (as at 9 Feb)
90%
South West = 82%
80%
70%
Consent rate (%)
60%
Overall
50%
DBD
DCD
Overall target
40%
DBD target
DCD target
30%
20%
Some teams already at world class levels
10%
0%
Eastern
London Midlands North Northern N Ireland Scotland South
West
Central
South
East
South
Wales
South Yorkshire
West
UK
Measure 1 – ODR percentage
% population on ODR by former SHA, February 2015
45%
41%
40%
40%
36%
35%
31%
30%
34%
34%
WALES
NORTHERN
IRELAND
33%
31%
29%
30%
% population on ODR
36%
34%
27%
25%
20%
15%
High levels of ODR registration help
10%
5%
0%
NORTH
EAST
NORTH
WEST
YORKSHIRE EAST AND EAST OF LONDON
AND THE
WEST
ENGLAND
HUMBER MIDLANDS
SOUTH
EAST
COAST
SOUTH
CENTRAL
SOUTH
WEST
SCOTLAND
UK
Former SHA
Note: Population data are not available for the Organ Donation Services Team areas
Measure 2 – Donors pmp
Donors pmp by former SHA of donating hospital, Feb 2014 - Jan 2015
35.0
Donors pmp
#1. Spain = 35.3
#2. Croatia = 33.5 = North East
#3. Portugal = 27.8 = Northern Ireland
30.0
2019/20 target
2014/15 target
Donors pmp
25.0
20.0
15.0
10.0
Some teams already match world class or come close
5.0
0.0
NORTH
EAST
NORTH
WEST
YORKSHIRE EAST AND EAST OF LONDON
AND THE
WEST
ENGLAND
HUMBER MIDLANDS
SOUTH
EAST
COAST
SOUTH
CENTRAL
SOUTH
WEST
SCOTLAND
WALES
NORTHERN
IRELAND
UK
Former SHA
Note: Population data are not available for the Organ Donation Services Team areas
Measure 2 – Donors pmp
Potential, eligible and actual donors pmp,
by former SHA of donating hospital, Feb 2014 - Jan 2015
200
Potential donors pmp
Eligible donors pmp
There is still the opportunity to do better
175
Actual donors pmp
150
pmp
125
100
75
50
25
0
NORTH
EAST
NORTH
WEST
YORKSHIRE EAST AND EAST OF
AND THE
WEST
ENGLAND
HUMBER MIDLANDS
LONDON
SOUTH
EAST
COAST
SOUTH
CENTRAL
SOUTH
WEST
SCOTLAND
WALES
NORTHERN
IRELAND
UK
Former SHA
Note: Population data are not available for the Organ Donation Services Team areas
Apr -10
0
Month
Jan-15
Dec-14
Nov-14
Oct-14
Sep -14
Aug -14
Jul-14
Jun-14
May-14
Apr -14
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep -13
Aug -13
Jul-13
Jun-13
May-13
Apr -13
Mar-13
Feb-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep -12
Aug -12
Jul-12
Jun-12
May-12
Apr -12
Mar-12
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep -11
Aug -11
Jul-11
Jun-11
May-11
Apr -11
Mar-11
Feb-11
Jan-11
Dec-10
20
Nov-10
Oct-10
Sep -10
Aug -10
120
Jul-10
Jun-10
May-10
Number of donors
Measure 2 – Donor Numbers
Deceased donors per month
140
DCD
DBD
2015/16 monthly target
2013/14 & 2014/15 monthly average
114
110
100
80
60
40
The trend is still upwards: variation is the challenge
Measure 2 – Performance against target
Number of eligible, consented and actual donors,
and organs transplanted
1300
Eligible donors
Consented eligible donors
Actual donors
Organs transplanted
1200
1100
1000
900
800
700
Organ Utilisation can be a challenge
600
500
400
300
Quarter
Source: UK Potential Donor Audit as at 9 February 2015. Patients aged over 75 years and cardiothoracic ICUs are excluded.
Additional source: UK Transplant Registry for organs transplanted from all deceased solid organ donors
Q3
Q2
Q1 2014/15
Q4
Q3
Q2
Q1 2013/14
Q4
Q3
Q2
Q1 2012/13
Q4
Q3
Q2
Q1 2011/12
Q4
Q3
Q2
Q1 2010/11
200
Number of families approached and consented annually
3500
Did not consent
Consented
Number of eligible donor families approached
3000
2500
2000
1242
1183
1676
1736
1319
1201
1042
1500
1000
1378
1488
500
1745
No of consents may increase but
donors fall & still too many refusals
0
2010/11
2011/12
2012/13
2013/14
Estimated 2014/15*
* Based on data to 31 Dec 2014
Active kidney transplant list
7248
22% fall in 6 years
5667
Year end
Measure 3 – Changes in donor demographics
Age of deceased donors
DBD
Percentage (%)
• Proportionally fewer donors are
aged 70+
Percentage (%)
100
90
16
20
3
16
3
7
17
15
80
70
24
22
28
60
31
9
DCD
15
16
25
28
26
23
23
25
22
33
31
31
29
33
3
3
3
3
3
40
53
51
50
44
47
20
10
0
26
25
22
50
30
21
23
24
13
15
7
7
4
6
8
43
4
2014/15 Based on activity to 1 March
24
• For kidneys, there appears to
be less appetite to use the
higher risk donors in the most
recent year, while for livers
there is no such trend.
• Kidney offer decline rates are
higher in the last two years for
extended criteria donors.
Measure 4 – Transplant numbers
Deceased donor transplants pmp by former SHA of recipient residence,
Feb 2014 - Jan 2015
90.0
Transplants pmp
2019/20 target
2014/15 target
80.0
70.0
Transplants pmp
60.0
50.0
40.0
30.0
Allocation schemes distribute organs to different areas of the UK
20.0
10.0
0.0
NORTH
EAST
NORTH
WEST
YORKSHIRE EAST AND EAST OF LONDON
AND THE
WEST
ENGLAND
HUMBER MIDLANDS
SOUTH
EAST
COAST
SOUTH
CENTRAL
SOUTH
WEST
SCOTLAND
WALES
NORTHERN
IRELAND
UK
Former SHA
Note: Population data are not available for the Organ Donation Services Team areas
Factors influencing performance
• 5% fewer DCD donors
• Proportionally fewer donors aged 70+
• For kidneys, there appears to be less appetite to use higher risk
donors, while for livers there is no such trend
• Kidney offer decline rates are higher in the last two years for extended
criteria donors
• ¼ of potential DCD are still not referred
• Decreased SNOD availability (change to cohort recruitment &
maternity/sick leave) – impacting on staff embedding time
• Delay to the Public Behaviour Change Campaign
Tactical Actions being taken to address
donor and transplant numbers
• All regional teams examining individual consent data and taking
appropriate action
• Monthly PEER review/ Action Learning Set training being organised in 9
teams (London, Yorkshire & Midlands already done) with Practice
Development Specialist team to review each consent and refusal
• Monthly RCLOD/CLOD telecons in South West and South Wales
• CQUIN launch in Oxford
• Integrated care pathway in Midlands
• Values based cohort recruitment: successfully recruited 25 WTE &
exploring ability to establish ‘bank’ contracts
• Annual consent rate training for all SN-ODS
Outcome 1 – Strategic Initiatives
• Public Behaviour strategy:
– Christmas campaign; Sign for Life football club campaign; extension
of government partnerships; Faith Action Plan activities eg Muslim
Scholar meetings; National Transplant Week moved to September
• New ODR to be launched 2015/16
• Options for donation incentives to be considered by UKDEC
• Wales: extensive campaign to support decision making ahead of new
legislation
• Scotland: continue marketing campaign supplemented by E-book for
schools
• Northern Ireland held a ‘talk to your family day’
• ‘A Mother’s story’ video
Outcome 2: Strategic Initiatives
• Workforce Strategy- from April designated requester pilot in North West
and Yorkshire & paper triage of potential donors starts
• ODT National Hub – business case
• Coroners project: evidence being evaluated. James Neuberger to
speak at Coroners training conference
– Portfolio of evidence gathered – further evaluation required
– Survey on relationships between staff and coroners about to be
launched
• RCoA Guidelines for the Provision of Intensive Care Services includes
specific organ donation guidance
• Organ donation established in medical training using ODT materials
• Diagnosis of death <2months under review
Outcome 3 – Strategic Initiatives
• Accredited training programme for retrieval surgeons in development:
working with Royal College of Surgeons and Dutch Transplant
Service
• Phase 2 of ‘Scout’ project starts in April
• Joint (with NHS England) peer review of Cardiothoracic units due to
complete by April. Includes discussion of organ utilisation.
• Ante-mortem interventions workshop next week
• Funding for service development of new perfusion technologies (NRP
& EVLP)
• Appointing Clinical Lead for Organ Utilisation to address variations
Outcome 4 – Initiatives
• NORS Review complete: moving into implementation phase
• New consent training programme for Specialist Nurses being rolled
out.
• ODT Hub outline business case being finalised for May Board
• Project to reduce use of paper forms for transplant follow-up,
working with the UK Renal Registry, underway.
• Duty Office continuing to explore new ways of working eg Case
Management
• Donation Congress – March
Future challenges
• Operational Funding – resolved for 2015/16 but HDs not able to
make recurrent commitment in some cases
• Development funding: funding model under discussion by ODT
Sustainable Funding Group.
• Living donation tariff now promised for 2016/17: financial
impact on NHSBT unclear.
• Creating a culture of continuous improvement throughout to
donation and transplantation community
• Building ODT capacity to deliver key projects
Deceased donors &
transplants
Donors
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
2020 is still achievable!
Transplants
Target figures to 2020
Measure 2 – Performance against target
International Experience
USA
Spain
Breakthrough Collaborative
30
40
25
35
Early initiatives
To 40pmp Initiative
20
30
15
25
10
• Major initiatives have had an impact
• They have often been followed by an
initial slump
• Further initiatives, such as in Spain,
have been successful
Croatia
40
35
30
25
20
15
10
5
2013
2012
2011
2010
2009
2008
2007
2006
0
2005
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
15
2002
20
0
2001
5