2013 Organ Donation Strategy & Beyond


“In January 2008 the Organ Donor Taskforce (ODTF) published its report setting out 14 recommendations which, if implemented in full, should enable the UK to increase the number of deceased organ donors by 50% from a baseline of 809 donors. All four national governments endorsed the recommendations, participated in the ODTF Programme Delivery Board and provided resources to enable the recommendations to be implemented. Nearly four years later the recommendations have largely been implemented. Deceased donor numbers are up by 34% and we recognise that this increase is predominantly made up of an increase in DCD donors and that donors in general are becoming older and heavier. There is still a significant gap between the need and availability of organs for transplant.”

So the 2013 Strategy discussion paper begins. A remarkable 5 years, but a long way to go.
Even the 50% will be a close thing. At week 20, 19th August, the UK is heading toward 44% only, and thus will fall short of the ‘magical 50% goal’. 50% was chosen as this is what Spain achieved when they first started to increase their donation numbers.
The 2013 strategy would like to set out to achieve another 50% over the coming 5 years. If successful this would put the UK into the upper tier of world donation figures.

Yet the majority of the UK donation success has been achieved though Donation after Circulatory diagnosed Death (DCD), 45% of all deceased donation, not Donation after neurologically (brain) diagnosed death (DBD), where organ quality for transplant outcome is generally superior. Has the rise of DCD been one of robbing Peter to pay Paul, as some transplant surgeons insist, or instead one of giving a potential to donate when previously there was none, as many in intensive care believe?

I’ll save that for another post, but it is probably worth reflecting on the Taskforce’s 14 recommendations.

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). I hold the work in this area as one of the key reasons for the UK progress.

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 decifering funnel plots takes some time.

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.
- not done

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

So all up, considerable progress, but much more yet to do, and a distinct tailing off of success, as the recommendations go from 1 to 14.