Recommendation 11 of the Organ Donor Task Force (2008) was that:
“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.”
There has been little progress to date in this area.
In Australia and New Zealand, all intensive care trainees must undertake the compulsory Australasian Donor Awareness Program (ADAPT). An outline of the one-day course is given in Appendix A. Course size for ADAPT is usually restricted to 15 and is run several times a year in each jurisdiction. ADAPT is delivered in two formats – Medical ADAPT (intended for both trainees and clinical specialists of intensive care and emergency care) and General ADAPT (intended for nurses including intensive care, emergency departments and operating theatre nurses, allied health professionals, social workers, and others involved in donation). APAPT is only the first part of a larger Professional Education Package (PEP), further described in Appendix A. The funding, coordination and delivery of the PEP comes directly from the national organ procurement organisation and courses are free to attend.
In Spain all residents in Critical Care do a specific course organised by the Spanish society of intensive care (SEMICYUC) in coordination with the national agency for organ donation (ONT). See Appendix B. There are three or four courses every year. It's a two-day course (20 h) with 4 hours of simulations. Residents usually take the course during their 3rd or 4th year of specialisation. It would appear, from the programme, that critical care staff have little direct involvement in uncontrolled Donation after Circulatory Death and this is not taught.
Email correspondence with Canada and USA donation clinicians has revealed a lack of national courses in donation, but an interest in establishing one, perhaps on an international scale using the model of ATLS. Current education in organ donation in the USA is delivered predominantly by the organ procurement organisations.
A variety of education activities have been run in the UK, including education days and simulations, but these are generally voluntary, ad hoc, locally focused and lack any national endorsement. Indeed it is unknown how many such courses exist in the UK and a survey of content and structure might prove helpful.
If recommendation 11 of the ODTF is to be satisfied, there is a need to establish medical training in donation in the UK.
The initial development could focus on medical trainees, current medical staff or a mixture of both. The advantage of focusing on trainees is they are a more manageable target audience, and have curriculum and training competencies that must be satisfied.
Possible trainee target audience:
All intensive care medicine trainees
All emergency medicine trainees
All neurosurgical trainees
Anaesthetic trainees (“if you are going to pull a tube, have you considered organ donation”)
Stroke physician trainees
Faculty and Royal Colleges (traditionally the UK faculties and colleges approve courses, they do not fund (or deliver) courses).
Appendix A: Australia and New Zealand
Elements of the Professional Education Package (PEP)
The PEP comprises three distinct, consecutive elements:
Unit 1 – Introductory training – Australasian Donor Awareness Program (ADAPT)
The Australasian Donor Awareness Program (ADAPT) is a one-day workshop that provides introductory training on the clinical processes involved in organ and tissue donation, the grief experienced by families facing the death of a loved one, and principles of sensitive communication. ADAPT is delivered in two formats – Medical ADAPT (intended for both trainees and clinical specialists of intensive care and emergency care) and General ADAPT (intended for nurses including intensive care, emergency departments and operating theatre nurses, allied health professionals, social workers, and others involved in donation).
Unit 2 – FDC Core Workshop
The FDC Core Workshop is a two-day workshop designed to build on ADAPT and provide health professionals with a more detailed theoretical understanding of grief and the communication needs specific to families dealing with death and considering the opportunity of organ and tissue donation. The FDC Core Workshop is intended chiefly for health professionals with some involvement in family conversations about consent to donation, such as intensivists, emergency specialists, bedside nurses, social workers, and donor coordinators.
Unit 3 – FDC Practical Workshop
The FDC Practical Workshop is one-day workshop that builds on ADAPT and the FDC Core Workshop, and provides participants with the opportunity to practice their skills of sensitive communication, particularly in challenging scenarios, through group activities and role-plays. It is designed chiefly for the health professionals responsible for raising the option of donation with families and seeking their consent, but will also be available to broader audiences within the donation sector.
Appendix B: Spain
ENGLISH TRANSLATION (Google Translator and my best guess)
Organ donation and transplantation for intensive care residents.
Spanish Model by Rafael Matesanz
Results of the Donation and Transplantation Programme
Clinical Diagnosis of Brain Death: aetiology, preconditions, clinical tests including apnoea, observation period and infratentorial pathology.
Diagnosis of Brain Death in Complicated Cases
Ancillary testing: neurophysiological
Ancillary testing: cerebral blood flow
Evaluation and selection of organ and tissue donors.
How can we expand the donor pool? Expanded donor criteria.
General maintenance of the organ donor.
Maintenance of the donor heart.
Maintenance of the donor lung.
Maastricht Type III and IV donation. 15 mins
4 x1 hour simulations
Workshop on brain death.
Workshop on the maintenance of the multi-organ donor.
Workshop in transcranial doppler.
Family interview workshop.
Postoperative care in heart transplant patients.
Postoperative care in lung transplant patients.
Postoperative care in liver transplant patients.
The intensivist and transplant coordinator: teamwork
Workshop transcranial Doppler sonography simulator (30mins)
Clinical cases of brain death
Clinical cases on the selection and maintenance of the multi-organ donor.