2 NHS Highland Organ Donation Committee Annual Plan

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1 Highland NHS Board 5 February 2013 Item 5.10 NHS HIGHLAND ORGAN DONATION COMMITTEE ANNUAL REPORT Report by Kevin Holliday, Clinical Lead for Organ Donation; Deborah Gallagher, Specialist Nurse for Organ Donation & Gillian McCreath, Donation Committee Chair on behalf of Dr Ian Bashford, Board Medical Director/Executive Lead The Board is asked to: Endorse the primary message of The Organ Donation Taskforce Report of 2008, that the national organ donation programme is a core activity of NHS Highland. 1 Background and Summary Transplant medicine both saves lives and restores quality of life. It frees people from the burdens of healthcare, and reduces the burden on healthcare providers. However, the potential benefits of organ transplantation are limited by the availability of organs for transplant. This report outlines the developments within NHS Highland to contribute to the supply of organs for donation. 2 NHS Highland Organ Donation Committee Annual Plan There is a long history of active recruitment to the organ donation Register within NHS Highland, aided by the Specialist Nurse in Organ Donation and a network of enthusiastic volunteers. Making organ donation usual rather than unusual across the area covered by NHS Highland is a principle of the report and guides the supporting actions. A copy of the Annual Plan is attached. Identification of potential organ donors, their referral and subsequent management within Raigmore Hospital will continue to be a priority in the coming year. 3 Contribution to Board Objectives By ensuring an effective contribution to the national transplant programme, this work will support NHS Highland contributing to the successful service provided to patients with organ failure throughout Scotland and their return to independent lives. Maximising the potential of patients within NHS Highland to benefit from organ transplants, will support better health of our population locally, and a better service by effective use of resources. 4 Governance Implications Staff Governance The report highlights a number of objectives which will support staff to deliver the service including education programme and recruitment of Lead Nurses.

2 Clinical Governance Work is ongoing to introduce a Policy on Organ Donation within Raigmore Hospital and is overseen by appropriate committees as highlighted in the Report. Monitoring is ongoing of National Audit Standards Financial Impact There are no financial implications associated with the Report 5 Planning for Fairness Organ retrieval activity occurs within acute care services and has an impact on these activities. Through this annual plan, it is our intention to ensure fairness to organ donors and recipients, in addition to all other patients requiring care to be provided acutely. Other areas of focus include looking at remote and rural issues and making contact with ethnic minorities within NHS Highland. 6 Engagement and Communication The Annual Plan has been composed in co-ordination with NHS Blood and Transplant and their plan for the national organ donation programme. Recruitment to the Organ Donation Register is co-ordinated nationally, supported by a publicity campaign and local recruitment drives, funded and facilitated by NHS Blood and Transplant. There is also significant work ongoing locally to raise the profile, including an article in NHS Highland s Newspaper (January 2013). Kevin Holliday Deborah Gallager Gillian McCreath Clinical Lead for Specialist Nurse for Chair Organ Donation Organ Donation Organ Donation Committee NHS Highland NHS Highland NHS Highland 25 January

3 NHS Highland Annual Organ Donation Plan

4 Contents 1. Executive Summary Report from the Organ Donation Committee (ODC) Hospital Organ Donation Team Structure Organ Donation Rates / PDA Benchmarking 2011/ Performance against 2011/12 Objectives Strategic Direction and Issues to be addressed Objectives for 2012/13 and Monitoring Arrangements

5 1. Executive Summary Organ Transplants- a triumph of modern medicine Organ transplants do more than save lives; organ transplants restore dependent patients to active and independent lives. Over the last fifty years the attention of both the public and health care professionals has been captured by developments in transplant medicine. Support for organ donation is widespread among healthcare professionals and the public. However, demographic conditions and disease prevalence contribute to an increasing gap between the demand for organs and their supply. This results in three patients a day dying while awaiting a transplant (UK figures.) While organ donation is widely accepted by society, there have been societal, ethical, professional and practical barriers which limit its benefits. The purpose of this document is to ensure the appropriate contribution of NHS Highland to the national need for organs to transplant. This aligns with support of the Scottish Government for the Organ Donation Taskforce Report of 2008 and Working together to Save Lives ODTF Report Organ retrieval activity places unusual demands on healthcare organisations. Opportunities for cadaveric organ donation occur infrequently and haphazardly. When opportunities arise they do so among the competing priorities of other acute healthcare activities, especially in emergency departments, theatre and critical care areas. When meeting the demands of the death of their patient, healthcare professionals can be additionally burdened by the complex ethical and organisational requirements of facilitating the process of organ retrieval. The ODTF reports recognise the difficult circumstances in which cadaveric organ donation occurs, and also that as individuals or as organisations, staff groups facilitating cadaveric organ donation are isolated from identifying the benefits of organ transplant both geographically and administratively (by the requirement of anonymous organ donation for the recipient.) These factors can combine to obstruct opportunities for organ retrieval. Consideration of organ donation should be a normal part of end of life care. An organ retrieval process should be viewed as a routine activity of acute care areas. Making Organ Donation Usual, Rather Than Unusual throughout NHS Highland is therefore the principal theme of this report. 3

6 2. Report from the Organ Donation Committee (ODC) The implementation of an effective organ donation programme within the Highlands is aided by a national network co-ordinated by NHS Blood and Transplant. NHSBT have co-ordinated the national plan for recruitment to the Organ Donation Register (ODR.) They have provided a programme and continuing resources for staff with responsibilities for organ donation within health boards. They have facilitated the introduction of a national Potential Donor Audit (PDA) which will assess the effectiveness of donation efforts at a local level. There is along history of active recruitment to the Organ Donation Register within NHS Highland, aided by the Specialist Nurse in Organ Donation and her network of enthusiastic volunteers. It is clear that activities to recruit to the ODR are now being centrally co-ordinated by NHSBT and that the emphasis of the NHS Highland Organ Donation Committee should adjust to ensure operational implementation of policies, by incorporating organ donation practice into clinical areas. This will be the main thrust of the Organ Donation Committee in 2013 and constitutes a reassessment of priorities. Within Raigmore Hospital we have benefited from the presence of a nurse with organ donation responsibilities, a presence which predates the current national programme. We have an active organ donation programme centred on the Intensive Care Unit, where there has been successful introduction of new initiatives such as the donation of organs after circulatory death (DCD). Challenges remain in making organ donation a more regular consideration at the time of end of life decisions, particularly in the emergency department and surgical and medical directorates. These activities are monitored by a potential donor audit which is reported nationally. Evidence from this (see pages) indicates that the performance of our organ donation programme compares well with national data. The Rural District General Hospitals within NHS Highland show activity in the field of organ donation by referring patients to the Specialist Nurse in Organ Donation. This is encouraging. We need to address the difficulties of facilitating organ donation in patients in our RDGHs and ensure that appropriate management plans are in place. It is clear that there is a political will to ensure that patients in rural populations are included in the organ donation programme, however there are specific difficulties encountered in remote and smaller hospitals, which need to be appropriately explored and addressed. 4

7 3. NHS Board Organ Donation Team Structure NHS Highland NHSBT NHS BOARD ASSISTANT DIRECTOR Anthony Clarkson HOSPITAL MANAGEMENT TEAM CRITICAL CARE DIRECTOR Dr Charles Lee, Head of Service, Intensive Care REGIONAL CLINICAL LEADS Dr Joyce Stuart Dr Stephen Cole REGIONAL MANAGER Lesley Logan TEAM MANAGER Liz Waite DONATION COMMITTEE CHAIR Gillian McCreath CLINICAL LEAD (CLOD) Dr Kevin Holliday SPECIALIST NURSE (SNOD) SN Deborah Gallagher SN Louise Beattie NHS Highland DONATION COMMITTEE CRITICAL CARE CN Gwen Calder CN Alison Fraser Dr Charles Lee EMERGENCY DEPARTMENT Dr Andrew Rowlands SN Beverley MacLennan THEATRE Kenny Clark, Theatre Manager END OF LIFE Facilitators Derek Brown, Hospital Chaplain LAY MEMBER Carol MacFarlane MORTUARY REPRESENTATIVE David Scott COMMUNICATIONS REPRESENTATIVE Mamie Thompson 5

8 4. Organ Donation Rates / PDA Benchmarking 2011/12 Donation after Brain Death 2011/12 (2010/11 figs in brackets) DBD Critical Care Patients with Suspected Neurological Death 3 ( 3 ) Referred 3 ( 3 ) BSDT Performed 3 ( 3 ) Confirmed BSD and Medically Suitable 3 ( 3 ) Family Approached 3 ( 3 ) Authorisation Given 2 ( 2 ) Donation Proceeded 2 ( 2 ) Organs Retrieved 6 (8 ) Identification of Neurological Death (ND)% 100 (100) Neurological Death Testing (NDT) % 100 (100) Referral Rate of Patients Confirmed % 100 (100) Approach Rate% 100 (100) Authorisation Rate % 67 (67) Conversion Rate % 67 (67) 6

9 Donation after Circulatory Death 2011/12 (2010/11 figs in brackets) No. Patients for whom Imminent Death was Anticipated DCD Critical Care 13 (13) Referred to the SNOD 9 (4) No. Where Treatment was Withdrawn N/A No. Potential DCD Donors 3 (2) Family Approached 2 (1) Authorisation to Donation 0 (0) Donation Proceeded 0 (0) Organs Retrieved 0 (0) Referral Rate of Patients Confirmed (ND) % 69 (31) Approach Rate 67 (50) Authorisation Rate % 0 (0) Conversion Rate % 0 (0) 7

10 PDA Benchmarking Rates Overall NHS Highland data compares very well to national levels of activity. There are areas worthy of attention, but these are relatively minor. Raigmore Hospital Raigmore Hospital has a strong tradition of retrieving organs from patients who have suffered a death of their brain stem. This is reflected in an excellent performance on the audit data for donation of brain death (DBD). Historically, the staff of the Intensive Care Unit have achieved a 100% authorisation rate from relatives when approached to consider organ donation. This has been a significant achievement which is still remarked upon nationally. There is evidence that Donation after Circulatory Death (DCD) is continuing to develop. Prospective donors by DCD are being identified and referred to the SNOD. It is notable that there have been no authorisations by relatives after DCD within the audited period, particularly in the light of such good figures for DBD. However, DCD has occurred in Raigmore prior to the audited period, and the audited numbers remain small (less than 5 opportunities.) When successful authorisations occur it will not take long for the figures to become more favourable. This aspect of the audit shall be kept under review by the ODC and ITU Head of Service. PDA has been initiated in Raigmore Emergency Department. Currently there are no significant returns, but from next year data will be available, using the same dataset as ITU. PDA Beyond Raigmore The Potential Donor Audit has begun in Raigmore Emergency Department but numbers overall (less than 20 patients) are not yet yielding significant information. Similarly, the PDA is in the process of being implemented in the RDGHs. 8

11 5. Performance against 2011/12 Objectives Objectives for 2011/12 Actions Required to Deliver Objective Measurable Outcome / Milestones Delivery Lead Completion Date Outcome Increase numbers of Highland residents on the Organ Donor Register Active recruitment to ODR within NHS Highland Maintain our position on the Scotland-wide register DG Ongoing. The population of NHS Highland has shown their support for the principle of Organ Donation by signing onto the Organ Donation Register. NHSH continues to have ODR rates which exceed the Scottish average. In Hospital development raising awareness in areas with greatest potential for donations (Raigmore). Including Liverpool Care Pathway. Education and awareness programme throughout the hospitals Local data gathered and entered into NHSBT National Potential Donor Audit. DG/KH Ongoing Both DG and KH have been active within departments and throughout the region promoting organ donation.. Delivery of National Audit Standards Implementation of system to gather data for audit of potential donors Degree of completion of national dataset included in Annual Report of PDA from NHSBT DG/LB December 2013 Introduction of the NHSBT PDA has been implemented in the Belford Hospital and in Raigmore ITU and Emergency Department. It remains ongoing in other acute areas within NHS Highland. Having Organ Donation lead nurses in each hospital department.. Continue an Education programme around the hospitals Number of leads recruited DG/ LB Ongoing Recruitment of Lead nurses will follow the educational programme. 9

12 Objectives for 2011/12 Actions Required to Deliver Objective Measurable Outcome / Milestones Delivery Lead Completion Date Outcome Promotion of Organ Donation throughout the acute care facilities within secondary care of NHS Highland Discussions with Clinicians locally. Recruitment of local leads Data from PDA Number of local leads Paul Campbell, KH DG/LB Ongoing Ongoing development of Organ Donation Policy/ Care Pathway. 10

13 6. Strategic Response to Issues to be addressed In the last year we have welcomed a new Chair onto NHS Highland ODC, Gillian McCreath. This gave us the opportunity to present an overview of activities to date and re-examine our priorities. Over the past four years recruitment to the Organ Donation Register has remained a significant priority of the NHS Highland Organ Donation Committee. Recruitment to the ODR is now being co-ordinated nationally, within a national publicity campaign and local recruitment drives funded and facilitated by NHSBT. We have been successful in making contact with groups composed largely of people form ethnic minorities within NHS Highland, such as the Pilipino Association and the local Muslim community. However, while local activities aimed at recruiting to the ODR will continue, these shall not be our primary priority for In 2010 NHSBT appointed a Clinical Lead for Organ donation within the remote and rural populations of Scotland. We have, therefore, welcomed Dr Paul Campbell onto our committee. The appointment of Dr Campbell gives recognition to the difficulties of facilitating organ retrieval in hospitals which are both small and geographically remote. However, the communities served by these hospitals give their support to organ donation, and reasonably expect to benefit from organ transplantation, which adds weight to the need to discuss organ donation capabilities within all the acute care areas within NHS Highland. Within NHS Highland most organ donation activity is centred around Raigmore Hospital, because of its larger acute care facilities. Optimisation of the process of identification of potential organ donors, their referral and subsequent management within Raigmore Hospital is, therefore, our first priority in

14 7. Objectives for 2013 and Monitoring Arrangements Objectives for 2012/13 Actions Required to Deliver Objective Measurable Outcome / Milestones Monitoring Method Delivery Lead Delivery Date Introduce a Hospital Policy on Organ Donation within Raigmore Hospital Discussion and finalisation of policy with appropriate clinical groups Implementation of Care Pathway for Potential Organ Donors PDA KH By August 2013 ITU- Discussion on Minimum Notification Criteria for referral to SNOD PDA KH By August 2013 ITU and theatres- Discussion on recommended logistical process to facilitate organ donation, particularly DCD Feedback after organ retrieval procedures. KH By August 2013 Acute Care areas in Surgical Departments, Medical Unit and Emergency Departmentdiscussion to ensure organ donation becomes a usual part of end of life decisions PDA KH/DG/DB By August

15 Objectives for 2012/13 Actions Required to Deliver Objective Measurable Outcome / Milestones Monitoring Method Delivery Lead Delivery Date Establish a Network of Organ Donation Leads throughout Acute Care Areas Raise awareness, Recruit as Leads, Regional Education Day June 2013 Number of Leads Attendance at Educational Day DG/KH Continue to support recruitment to ODR within NHS Highland National reporting of ODR rates National report DG/ NHSBT ongoing Facilitate dialogue on the logistical difficulties in promoting organ retrieval in the smaller and more remote acute care areas within NHS Highland. Likely to be addressed after Operational Policy implemented (after August 2013) 13