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Organ Utilisation Strategy

Explore Professor John Forsythe's strategies to achieve 2020 targets for deceased donors and transplants in the UK. Discover data on donor age, discard rates, offer decline rates, and wait times. Learn about initiatives for better information, donor assessment, and faster processes in organ transplantation.

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Organ Utilisation Strategy

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  1. Organ Utilisation Strategy Professor John Forsythe

  2. UK Strategy – Taking Organ Transplantation to 2020 Targets for deceased donors and transplants Target figures to 2020

  3. Age of UK deceased donors Age % of donors

  4. Age of deceased donors – UK vs Spain (2015)

  5. Discard rates for kidneys from deceased donors, 2014 No. kidneys retrieved N= 2986 14754 2432 700 24% overall 19% overall % of retrieved kidneys not transplanted 10% overall Source: ONT – Spain data, OPTN - US data ANZ - Australia data, NHSBT - UK data ¹ 2012 data

  6. Adult DBD kidney offer decline rates EXTENDED CRITERIA Offer decline rates vary from 36% at Leeds to 77% at Leicester STANDARD CRITERIA Offer decline rates vary from 24% at Leeds to 69% at Leicester

  7. Adult elective liver offer decline rates DCD liver Offer decline rates vary from 23% at King’s college to 78% at Newcastle DBD liver Offer decline rates vary from 17% at Birmingham to 70% at Newcastle

  8. Pancreas offer decline rates DCD pancreas Offer decline rates vary from 19% at Guy’s to 94% at Newcastle DBD pancreas Offer decline rates vary from 39% at Guy’s to 71% at Edinburgh and Newcastle

  9. Adult heart offer decline rates Offer decline rates vary from 67% at Papworth to 90% at Newcastle and Harefield

  10. Median waiting time to transplant Upper 95% confidence limit Median Lower 95% confidence limit 30 months UK average 14 months 43 months

  11. Strategy • Length of donation-transplantation process • Support to use of higher risk donor organs • Local MDT process and challenge • Better information • DCD donor assessment • Use of Fast Track/Simultaneous offering www.odt.nhs.uk/odt

  12. DBD donation process 10.5 hours longer

  13. DCD donation process 8.5 hours longer

  14. DBD retrieval operation start times Shift in time of day from 2-5 am to 6-12 am

  15. Offering and retrieval planning DCD DBD

  16. Post meeting • Stick to referral times • Delay once only • Delay for specified time as maximum • Night-time retrieval? • Streamline donor characterization…..

  17. Better Information

  18. Reasons for retrieved organs not being transplanted (2015/16) KIDNEY N=276

  19. Reasons for retrieved organs not being transplanted (2015/16) LIVER N=168

  20. Support for Higher Risk Donors

  21. Donors with cod as drug overdose Drug overdose as COD includes deaths from polypharmacy, paracetamol overdose, and alcohol poisoning Slide courtesy of Sarah White, Sydney. Data from NHSBT, ANZOD and OPTN

  22. Support • SaBTO advice • Aide memoire • Incidents and events • Consent

  23. Introduction to TRANSPLANT APP

  24. Options of diseases to select

  25. Example A Hepatitis C Patient with a UKELD score of 55 What will happen to 100 people like me post-registration

  26. Reasons for decline We send monthly reports to all transplant centres detailing each offer they have received and whether they accepted or declined, with the reason for decline. We indicate whether the organ was transplanted elsewhere. These reports are used in transplant centre MDT meetings and lead to changes in practice.

  27. Challenge • Advisory groups • Named patient allocation • Patient involvement/Consent

  28. DCD donor assessment

  29. DCD donor assessment Actual donors of those referred: DBD 47% DCD 9%

  30. DCD donor assessment • Review of evidence suggested: • Inconsistent practice by SNODs in handling of DCD referrals • Clinical donor criteria that never resulted in transplantation of donor organs • New DCD assessment • process agreed with • clinical support to • improve efficiency in the • DCD pathway

  31. DCD donor assessment Potential DCD donors excluded on basis of past non-donation/tx: Regular review and dialogue with clinical community to ensure viable potential donors not missed (as novel technologies come into use)

  32. DCD donor assessment 12 months data (Dec 2015-Nov 2016) DCD referrals 6182 Absolute contraindication? No 5019 81% Yes 1163 19% DCD exclusion? Yes 1550 25% No 3469 56% SNOD overrides 131 3600 - 58% of our referrals

  33. DCD donor assessment 12 months data (Dec 2015-Nov 2016) DCD referrals 6182 Absolute contraindication? Screening call made to transplant centres No 5019 81% Yes 1163 19% Yes 1340 22% No 2260 37% DCD exclusion? Yes 1550 25% No 3469 56% Screening centre decision SNOD overrides 131 Not acceptable 936 – 70% Acceptable 404 - 30% 3600 - 58% of our referrals

  34. Use of Fast Track offering

  35. Fast Track Offering Schemes • Fast track schemes are designed to maximise the utilisation of organs available for transplantation • Simultaneous offering to speed up allocation • Offers are sent to all eligible centres via SMS, pager or fax • Centres have 45 minutes to respond to the offer via telephone • No response is assumed to be a declined offer • More than one centre accepts - organ allocated to centre highest on list or rota

  36. Trigger points for fast track offering Kidney deemed unsuitable Kidney 5 centres declined donor/organ reasons (3 DCD) Accrued 6hrs CIT (3hrs DCD, 12hrs multi-organ) Pancreas deemed unsuitable 4 centres declined donor/organ reasons (3 DCD) Pancreas removed Pancreas At or after cross-clamp the liver is declined/ not yet accepted Proposed: after 6 hrs of offering or 3 centres declined for same donor reason Liver At removal or already removed Heart and lungs To be removed within 90mins Organs retrieved Organs transplanted First organ offered Further details can be found in the organ allocation policies available at www.odt.nhs.uk/transplantation/guidance-policies/

  37. % fast tracked (of those donated)

  38. Activity- transplanted of those fast tracked N fast tracked: 458 428 21 8 77 182 13 31 3% 0% 0% 15% 34% 37% 55% 63%

  39. Introduction of Pancreas Fast Track Scheme Number of pancreases offered 6 times or more has reduced from 23% to 13% Number of offers

  40. Simultaneous Offering • Higher risk donors eg viral risk • Scheme and response requires agreement • Organ specific

  41. Reasons why donation did not proceed following consent/authorisation 6% 34 families 7% 7 families 15% families who withdraw because process too long 2015/16 data: 104 DBD families, 546 DCD families

  42. Enhanced Retrieval response?

  43. Resource

  44. DBD kidney offer decline rates

  45. Summary • Donors becoming more complex and offering taking longer • Many more organs offered than are ever accepted • High offer decline rate with wide centre variation • Reasons for decline reported to centres monthly for review • Much that can be done www.odt.nhs.uk/odt

  46. Acknowledgements Transplant unit, H&I laboratory and other hospital staff and Specialist Nurses for Organ Donation for provision of data to the UK Transplant Registry www.odt.nhs.uk RTSM, February 2017

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