Organ Donation & Transplantation
in Ireland – Changing times
Aileen Counihan
Transplant Co-ordinator
Beaumont Hospital
Organ Procurement Centre Team
National Service for Organ Procurement
– Current Location – Beaumont Hospital
Donor Coordinating Team
– 24hr on call service for ICUs nationally
Recipient Co-ordination
– 24hr call for renal transplant service
The Donor Co-ordinator Role
24hr call to deal with all enquiries pertaining to Organ Donation
Responsible for the technical and logistical arrangements.
Involved in the donation process from referral, retrieval & to the
transplantation of the organs.
– Care of the Donor, the Family of the Donor, the Donor Hospital
staff, the Transplant Team, & Transplant recipients.
Recipient Co-ordinator Role
Referral for Renal & Pancreas Transplant
Management of Transplant waiting list
Coordination of Deceased Donor Transplants
Live Donor Transplant Programme
Kidney Transplantation
Kidney transplantation is considered the best treatment
option for patients in end stage renal failure
Not all patients are suitable for transplant
– Only 33% of patients with kidney failure are on
transplant waiting list
When transplant is not the best option
Clinical reasons :
– History of recent cancer
– Major surgery
– Severe cardiac problems or advanced blood vessel disease
Patient choice:
– decide that transplantation is not for them.
– can opt to stay on dialysis.
Renal Transplantation
Live Donor Transplant
– from a family member/spouse/friend
– Paired Exchange
Deceased Donor Transplant
– Brain Death Donor
– Non Heart Beating Donor.
Recipient Evaluation for Transplant
Standard workup :
– Full Blood Profile
– Tissue type x 2
– Virology < 3mths
– Chest Xray & Abdo U/sound
– Cardiac Tests, Stress ECG, Cardiac Echo
– Coronary Angio ( if indicated)
– Dental Clearance
– Smear Test for female patients
– PSA for men > 50yrs
Other tests determined by age/cause of failure
– Copy of all results to Transplant Office with a detailed referral letter
Evaluation for Transplant
Some patients may require further assessment
Test results may require further investigation.
Patient is sent an appointment with an information
booklet about transplant
All patients are seen at the transplant assessment clinic
in Beaumont
Meet with Transplant Surgeon & Co-ordinator
Pre-Transplant Clinic
Assess suitability for transplant
Surgery explained
Opportunity to ask questions , encourage patients to bring someone
with them to clinic
Option of Live Donation given
Importance of contactability, urgency, keeping healthy & well reiterated
Follow up phone call
Letter to patient to inform approved for Transplant & regular blood
samples for antibody screening while on the pool
Letter from H&I when activated
Further Screening
– Other tests may be required
– Anaesthetic assessment
– Patients to lose weight or to monitor weight
– Reassurance while on the list
– Patients over 2 years
– Patients suspended for a prolonged period of time
– Older patients
Waiting Time
Currently 29 months.
Factors influencing time on list
– Patients with a high antibody level
– Patient BMI
– Increasing number of patients on list
– Donor supply
Acknowledging the Donation
Donor and donor family will be foremost on recipients’
mind
Anonymity Maintained
– Encourage recipients to write to donor family and can
be done via the Transplant Co-ordinators
Information leaflet
Attend the Annual Service of Remembrance and
Thanksgiving
Circle Of Life Garden in Salthill
Organ Donor Web Site
Donor Families shared experiences
Transplant Recipient success stories
Gratitude of Recipients & Comfort received by Donor Families
Commemorative Garden
Statistics
Deceased Donors/Transplants in Ireland
(Organ Procurement Centre)
700
600
500
Transplants
Donors
Waiting List
400
300
200
100
20
12
20
10
20
08
20
06
20
04
20
02
20
00
19
98
0
Potential Live Donor
Patients will be asked if they wished to consider a Live Donor
Transplant
Potential donors to contact the transplant co-ordinators directly
Initial suitability would be discussed with them – Blood Group
Compatible
Arrangements made for H&I screening
Information on Live donation given
Only one donor can go forward to workup
Live Kidney Donation
Donor must be fully informed and aware of risks and benefits of
procedure
No risk to the potential donor
The decision to donate must be voluntary, no coercion or
inducement
The transplant must have a good chance of providing a good
outcome for the recipient.
Ethical Issue
– Exposes an otherwise healthy person to the risks of major
surgery entirely for the physical benefit of another individual
Living Donation Programme
Information for Live Donor Recipient
Donor work up period 3 months approx
– Medical suitability, extensive screening
– Immunological screening
– Independent clinical & psychological review
Donor work up confidential
Isolating period for recipient
Recipient remains under the care of nephrology team
Suspended from list, when donor deemed suitable
Setting date for surgery
LRD and Deceased Renal
Transplant activity in Ireland
200
150
LRD
Deceased
100
50
Year
2011
2008
2005
2002
99
96
93
90
87
84
81
78
75
0
72
Kidney Transplants
250
Changing Role of Transplant Office
No responsibility for Organ Procurement
– Perceived conflict of interest
– Independent Service
Recipient Coordination
– 24 hour on call for renal/pancreas transplant
– Liaise with Renal Unit Staff
– Patient education
Co-ordinate Live Donation Programme
Responsibility of Transplant Office
Co-ordination of
Renal/Pancreas
Transplantation
Patient in workup
-Referral
-Further review
-Activation on list
Patient on pool
-Health status
-Weight
-Contact details
-Suspension
Live donation
-Donor referral
-Co-ordinate donor
workup
-Referral for PKE
Organ Procurement Office
Donor Co-ordinators
HSE Team
Renal/Pancreas
Transplant Centre
-Referral
Liver Transplant
Centre
-Referral
Heart & Lung
Transplant Centre
- Referral
Thank You All
Further information
www.beaumont.ie
www.icmed.com
www.strangeboat.org
www.ika.ie
www.coe.int