UK Organ Donation Strategy and key NHS Blood and Transplant Documents

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Summary Guide
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Full Guidance
Taking Organ Transplantation to 2020, published in 2013
The aim is to match world-class performance in organ donation and transplantation

4 Measures of success:

1. Achieve consent / authorisation rate above 80% (baseline 57%).
2. Achieve 26 deceased donors per million population (pmp) (baseline 19.1 pmp).
3. Transplant 5% more of the organs offered from consented, actual donors.
4. Achieve a deceased donor transplant rate of 74 pmp (baseline 49 pmp).

Achieved by an evolution of NHS services and a revolution in public behaviour are required to achieve this.

4 streams of action:
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 useable 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.
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Approaching the families of potential organ donors. NHS Blood and Transplant best practice guide, 2012.

Brings the evidence base and UK guidance into one document.

Emphasis is on three distinct stages.
The principles adhered to are those of being sensitive to the family’s needs, giving them time and privacy, ensuring they understand that either death has occurred or that it is inevitable, and providing the family with sufficient information that is in an understandable format and which anticipates their likely concerns.
NHSBT best practice guidance for approaching the families of potential organ donors, 2013
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Timely identification and referral of potential organ donors: a strategy for implementation of best practice. NHS Blood and Transplant best practice guide, 2012.

Brings the evidence base and UK guidance into one document.

The emphasis is on timely referral to the specialist nurses for organ donation and strategies are suggested for how hospitals can achieve this.
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Building on progress: where next for organ donation policy in the UK, published by the British Medical Association Medical Ethics Committee in 2012

A wonderful summary of UK donation activity with some controversial proposals.
The potential impact of an opt out system for organ donation in the UK: an independent report of the Organ Donation Taskforce, 2008
  • Called for my the Prime Minister Mr Gordon Brown
  • The report did not recommend the UK moving to presumed consent.
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Taskforce members had a wide range of views at the outset. However, after examining the evidence, the Taskforce reached a clear consensus in recommending that an opt out system should not be introduced in the UK at the present time. The Taskforce concluded that such a system has the potential to undermine the concept of donation as a gift, to erode trust in nhs professionals and the government, and negatively impact on organ donation numbers. It would distract attention away from essential improvements to systems and infrastructure and from the urgent need to improve public awareness and understanding of organ donation. Furthermore, it would be challenging and costly to implement successfully. most compelling of all, we found no convincing evidence that it would deliver significant increases in the number of donated organs.
Organ Donation Taskforce, 2008
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Organs for Transplant, a report from the Organ Donation Taskforce, 2008

Ambition 50% increase in deceased donation over five years.

Achieved in 2013!

Organ Donor Taskforce 2008,
14 Recommendations
(and my report card)

Recommendation 1
A UK-wide Organ Donation Organisation should be established.
- done

Recommendation 2
The establishment of the Organ Donation Organisation should be the responsibility of NHSBT.
- done

Recommendation 3
Urgent attention is required to resolve outstanding legal, ethical and professional issues in order to ensure that all clinicians are supported and are able to work within a clear and unambiguous framework of good practice. Additionally, an independent UK-wide Donation Ethics Group should be established.
- done (though will never be finished, but substantial progress has been made, especially in Donation after Circulatory Death). The work in this area was one of the key reasons for the UK success in achieving the 50% increase in deceased organ donations.

Recommendation 4
All parts of the NHS must embrace organ donation as a usual, not an unusual event. Local policies, constructed around national guidelines, should be put in place. Discussions about donation should be part of all end-of-life care when appropriate. Each Trust should have an identified clinical donation champion and a Trust donation committee to help achieve this.
- done (the infrastructure is now in place, it just needs to be actioned each and every time). With Recommendation 3 and 9, this is a key reason for the UK progress. The local donation team (Chair, clinical lead and specialist nurse) is the powerhouse behind UK organ donation progress.

Recommendation 5
Minimum notification criteria for potential organ donors should be introduced on a UK-wide basis. These criteria should be reviewed after 12 months in the light of evidence of their effect, and the comparative impact of more detailed criteria should also be assessed.
- done with the NICE guidance.

Recommendation 6
Donation activity in all Trusts should be monitored. Rates of potential donor identification, referral, approach to the family and consent to donation should be reported. The Trust donation committee should report to the Trust Board through the clinical governance process and the medical director, and the reports should be part of the assessment of Trusts through the relevant healthcare regulator. Benchmark data from other Trusts should be made available for comparison.
- done, though more work on how the data is presented is required.

Recommendation 7
BSD testing should be carried out in all patients where BSD is a likely diagnosis, even if organ donation is an unlikely outcome.
- good progress (though will always need ongoing work)

Recommendation 8
Financial disincentives to Trusts facilitating donation should be removed through the development and introduction of appropriate reimbursement.
- done

Recommendation 9
The current network of DTCs should be expanded and strengthened through central employment by a UK-wide Organ Donation Organisation. Additional co-ordinators, embedded within critical care areas, should be employed to ensure a comprehensive, highly skilled, specialised and robust service. There should be a close and defined collaboration between DTCs, clinical staff and Trust donation champions. Electronic on-line donor registration and organ offering systems should be developed.
- done and embedding specialist nurses into hospitals a key achievement - keeping them there is the next pressure.

Recommendation 10
A UK-wide network of dedicated organ retrieval teams should be established to ensure timely, high-quality organ removal from all heartbeating and nonheartbeating donors. The Organ Donation Organisation should be responsible for commissioning the retrieval teams and for audit and performance management.
- This roles into transplantation. Some infrastructure changes have been made and are welcome, but the job is not done, especially when compared to the progress in other areas.

Recommendation 11
All clinical staff likely to be involved in the treatment of potential organ donors should receive mandatory training in the principles of donation. There should also be regular update training.
- barely started

Recommendation 12
Appropriate ways should be identified of personally and publicly recognising individual organ donors, where desired. These approaches may include national memorials, local initiatives and personal follow-up to donor families.
- done with the Order of St John Award for Organ Donation launched in 2013

Recommendation 13
There is an urgent requirement to identify and implement the most effective methods through which organ donation and the ‘gift of life’ can be promoted to the general public, and specifically to the BME population. Research should be commissioned through Department of Health research and development funding.
- not done

Recommendation 14
The Department of Health and the Ministry of Justice should develop formal guidelines for coroners concerning organ donation.
- some progress only