Organ Donation and
Transplantation
Strategic Performance Update
27 March 2014
Overview
• Overview of planned initiatives and timescales
• 2013/14 Performance against ODT strategic targets
• 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.
Outcome 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.
Yr 1
Develop national strategies to promote a shift in behaviour and
increase consent and test progress with regular public surveys.
The relevant Government Health Departments should explore with Education
Departments the possibility of incorporating donation and transplantation issues
into schools curricula.
All Governments should provide regular reports to Parliament/Assembly on
progress in their nation and Health Ministers should have a duty to promote
organ donation and transplantation effectively leading to a significant
improvement in public attitudes and consent for organ donation.
There should be national debates to test public attitudes to radical
actions to increase the number of organ donors. For example,
whether those on the Organ Donor Register should receive higher
priority if they need to be placed on the transplant waiting list.
Ensure that the introduction of a system of deemed consent to
organ and tissue donation in Wales as described by the Human
Transplantation (Wales) Bill is as successful as possible and learn
from this experience.
Develop a community volunteer scheme to support trust/health
board donation committees to promote the benefits of donation in
local communities, particularly amongst groups with little tradition
of organ donation.
Following the experience in the USA, ensure everyone who has
made a decision to donate during their life has their wishes
honoured, if they die in circumstances where donation is possible
Yr 2
Yr 3
Yr 4
Yr 5
Yr 6
Yr 7
Outcome 1 – Performance against
target 2013/14
Outcome 1 – Regional variations in
performance
Consent/Authorisation Rate 2013/14 YTD
100
90
80
70
60
50
40
30
20
10
0
Outcome 1 - Progress
• Public Behaviour strategy presented to earlier
describes evidence based approach to changing
public behaviour.
• Human Transplantation (Wales) Bill proceeding with
£2m to be spent on communication strategy.
• New advanced consent training programme for SNs
underway.
• Utilising national forums such as British
Transplantation Society Congress to open a national
debate
Outcome 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.
Yr 1
End of Life Care standards should promote BSD testing as the
preferred method of diagnosing death, where this can be achieved
and is in the best interests of the patient.
End of Life Care practices should be reviewed to establish
whether they might be adjusted so as to promote donation after
DBD.
Establish a National Referral Service to improve support to
hospitals.
Scope the potential for donation following unexpected cardiac
arrest in the UK, learning from the pilot programme in Scotland.
Families of potential donors will only be approached by someone
who is both specifically trained and competent in the role, training
packages and accreditation will be provided to those who wish to
develop this competence.
Work collaboratively to reduce instances of objection to organ
donation from the coroner and procurator fiscal service and the
police.
Publish hospital data to include: brain stem death testing rates,
donor referral rates, family approach rates, Specialist Nurse
involvement and other key measures.
Yr 2
Yr 3
Yr 4
Yr 5
Yr 6
Yr 7
Outcome 2 – Performance against
target 2013/14
Deceased Organ Donation pmp
50
40
30
Deceased Organ
Donation pmp
20
10
0
2012/13
Q1
Q2
Q3
Outcome 2 – Progress
• National Referral Service vision agreed
• Project to work with Coroners and Police underway:
gathering data on impact of coronial refusals and
building relationships with Coroners & their teams
• Hospital specific data routinely published on NHSBT
clinical website
Outcome 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.
Yr 1
Improve donor management for potential cardiothoracic donors,
providing a 24/7 service to assist if pilot schemes prove effective.
Review what pre-mortem interventions could legally and ethically
be undertaken to maximise the potential for organ donation (such
as the administration of heparin, elective ventilation etc.).
Evaluate new techniques and technologies for the preservation of
retrieved organs with a view to their use in the UK.
Develop a system of peer review that is underpinned by a set of
agreed standards for retrieval/transplant centres.
Provide guidance on levels of acceptable risk in relation to offered
organs, particularly from extended criteria donors, relevant to the
individual recipient’s needs and wishes.
Publish centre-specific risk-adjusted patient survival from listing as
well as from transplantation.
Ensure clinicians are aware of and follow, best practice to
increase patient and graft survival.
Yr 2
Yr 3
Yr 4
Yr 5
Yr 6
Yr 7
Outcome 3 – Performance against
target 2013/14
Outcome 3 - Progress
• Data from ‘Scout’ project to improve cardiothoracic
donor management indicates an increase in cardiac
donation.
• Peer Review system (with NHS England and other
commissioners): aims & objectives being agreed with
stakeholders. Proposals due in autumn.
• UK DEC consulting on an ethical framework for DBD
donation.
• New perfusion technologies: Horizon Scanning event
held for clinical community & working group
established.
Outcome 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.
Yr 1
Yr 2
Yr 3
Yr 4
Yr 5
Develop a workforce strategy for the organ donation service which will
tailor the service to the needs of individual hospitals and seek to provide
a workforce that is focused on supporting the potentially conflicting
demands of providing a service to the donor family, donor management
and donor co-ordination.
Subject to variations in Government policy, agree a formal contract for
organ donation with hospitals specifying how hospitals and the NHSBT
donation service work together to achieve excellence
Regional Collaboratives to lead local improvement in organ donation,
retrieval and transplant practices and in local promotion of donation and
transplantation.
Ensure that transplant centres have the capacity and surgical expertise
and other clinical skills to meet the demands for transplantation as
donor numbers increase.
Develop training programmes to sustain and increase clinicians’ organ
donation understanding and expertise.
Optimise the processes, timescales, resources and supporting IT at
every stage of the pathway from donor identification to long-term
survival.
Review the current processes for donor characterisation (especially for
microbiology and tissue typing).
Develop and implement a training and accreditation programme for all
retrieval surgeons and extend this to supporting post-mortem
technologies when these are introduced.
Investigate the feasibility and implications for the provision of a 24/7
provision of expert histopathology advice.
Surgical
capacity
Theatre
capacity
Yr 6
Yr 7
Outcome 4 – Progress (1)
• NORS Review: independent chair appointed & plans in
development.
• New objectives for Regional Collaboratives & CLODs
developed. CLODs & Donation Committees Chairs
surveyed.
• Workforce Strategy and SNOD role review in progress:
meetings for staff, literature review, benchmarking in
progress ahead of discussion with external
stakeholders.
• Organ donation training proposal for ICU trainees
agreed – needs funding.
Outcome 4 – Progress (2)
• Training and accreditation programme for retrieval
surgeons in development: engaged with Royal
College of Surgeons.
• Operational Improvement Process Workshops for Duty
Office held and initial process improvements
underway.
• Review of IT systems and applications undertaken:
initial stakeholder discussions being held to build
understanding of the need for a programme of
improvement.
Outcome 4 – Performance against
target 2013/14
Performance against Strategic Targets
Final Target
Outcome
Target
Target date
1
80%
31 March
2020
2
26 pmp
3
4
2012/13
performance
2013/14 performance
Target
Q1
Q2
Q3
57%
61.5
%
58.8%
59.7%
59.6%
31 March
2020
19.1 pmp
19.8
pmp
19.5#
20.5#
20.9#
Increase of
5%
31 March
2020
Baseline year
0%
0.5%
0.6%
2.5%
5.0%
74 pmp
31 March
2020
49 pmp
50.3
pmp
50.0#
53.0#
55.0#
1 Consent/authorisation for organ donation – aim for consent/authorisation rate above 80%.
2 Deceased organ donation – aim for 26 deceased donors per million population.
3 Organ utilisation – aim to transplant 5% more of the organs offered from consented, actual donors.
4 Patients transplanted – aim for a deceased donor transplant rate of 74 pmp.
# based on rolling 12 month period.
Q4
Year to
Date
59.4%
2.7%
Strategy Governance Groups
2020 Strategy Stakeholder Group
2020 Oversight Group
Chaired by Prof Gurch Randhawa
Chaired by Elisabeth Buggins
Initial meeting held: organisation
specific plans due for discussion
in May (4 HDs, Professional
Bodies etc).
First meeting held in January,
group have agreed to share
examples of good practice and
initiatives prior to next meeting in
May at which Public Behaviour
Strategy will be discussed.
Future challenges
• Operational Funding – secured for 2014/15 but
urgently need longer term agreements.
• Delivering cost improvements quickly – especially
where politically sensitive or IT dependent.
• Funding for major developments:
–
–
–
–
Public Behaviour Strategy
Workforce & Role Redesign Strategy
New Perfusion Technologies
Replacing creaking IT systems and applications