Dr Paul Murphy National Clinical Lead, Organ Donation · PDF fileNational Donation Congress,...

National Donation Congress, March 2012

Dr Paul MurphyNational Clinical Lead, Organ Donation

NHS Blood and Transplant


0 10 20 30 40

deceased donors pmp, 2010

Ireland

Sweden

Denmark

Netherlands

Canada

Germany

United Kingdom

Finland

Czech Rep

Slovenia

Norway

Italy

Austria

Belgium

Croatia

Portugal

Spain

50% increase in deceased donation by 2013


Consent / authorisation

Neurological determination of death

Donation after Circulatory Death

Donation from ED

Donor identification and referral

Donor optimisation

UK Potential Donor Audit


Consent / authorisation

Neurological determination of death

Donation after Circulatory Death

Donation from ED

Donor identification and referral

Donor optimisation

Local PDA data


National donation organisation

UK-wide community of donation leads

Specialist nurses

Local clinical leads

Donation Committee chairs

12 regional collaboratives

600

700

800

900

1000

1100

1200

1300

2005 2006 2007 2008 2009 2010 2011 2012

year

don

ors

There has been fantastic progress between 2008 and 2011.


National donation organisation

UK-wide community of donation leads

Specialist nurses

Local clinical leads

Donation Committee chairs

12 regional collaboratives

600

700

800

900

1000

1100

1200

1300

2005 2006 2007 2008 2009 2010 2011 2012

year

do

no

rsWe need 1200 donors annually to meet the Taskforce objective of a 50% increase


Urgent attention is required to resolve

outstanding legal, ethical and

professional issues in order to ensure

that all clinicians are supported and

able to work within a clear and

unambiguous framework of good

practice. Additionally, an independent

UK-wide Donation Ethics Group

should be established.

Recommendation 3

Guidance is fine, but it is the implementation that counts!


600

700

800

900

1000

1100

1200

1300

2005 2006 2007 2008 2009 2010 2011 2012

year

do

no

rs

Whole hospital approach to donor identification and assessment

More timely referral

Initial assessment prior to withdrawal or limitation of

treatment

Initial focus on the Emergency Department

Collaborative approach to consent

/ authorisation

NHS BT strategies for 2012-13

Why should a person s wish to donate be denied because they are dying the in the wrong place?


600

700

800

900

1000

1100

1200

1300

2005 2006 2007 2008 2009 2010 2011 2012

year

do

no

rs

Whole hospital approach to donor

identification and assessment


Initial assessment prior to withdrawal or limitation of treatment

Initial focus on the Emergency

Department

Collaborative approach to consent / authorisation


Why should a person s wish to donate be denied because a doctor uses the wrong words at the wrong time?


These issues should not be particularly difficult, or even that costly to resolve. Overcoming them will require leadership, boldness and willingness to change established practice. The prize for doing so is considerable.

Organ Donation Taskforce, 2008

Scotland

Northern

NorthWest Yorkshire

Midlands

Wales

NI

South West

SouthCoast


How can the incidence of brain death and DBD vary so much?

DBD donors pmp

cDCD donors pmp

SpainActual

Potential32

50 600?

United KingdomActual

Potential

10.3

18

4.7

8

0 10 20 30 40


Ireland

Sweden

Denmark

Netherlands

Canada

Germany

United Kingdom

Finland

Czech Rep

Slovenia

Norway

Italy

Austria

Belgium

Croatia

Portugal

Spain

cDCD: controlled donation after circulatory death


Lower incidence of brain

injury (complacent)

Better outcomes from

treatment (arrogant)

Different approach to the

role of critical care in

patients with catastrophic

brain injury (intriguing)

DBD donors pmp

cDCD donors pmp

SpainActual

Potential

32

50 60

0

?

United KingdomActual

Potential10.318

4.78

cDCD: controlled donation after circulatory death

Potential donors who are denied admission to ICU will go largely unrecognised by the Potential

Donor Audit


Professional Responsibilities

if the responsible doctor comes to the

reasonable conclusion that further

continuance of an intrusive life support

system is not in the best interests of the

patient, he can no longer lawfully continue

that life support system: to do so would

constitute the crime of battery and the tort

of trespass to the person.

Lord Browne-WilkinsonAiredale NHS Trust v Bland [1993] AC 789, 883

Bland

The Courts gave doctors in the UK the authority, and perhaps even the obligation, the withdraw life support that is of no benefit.


Professional Restrictions

Does the lack of critical care capacity in the UK mean that end of life care is something that others must deliver?


End of life Categories (% patients)

Unsuccessful CPR

Brain death

Treatment limitation

Treatment withdrawal

Active shortening of dying process

NorthernDenmark, Finland, Ireland, Netherlands, Sweden, UK

10.2 3.2 38.2 47.4 0.9

CentralAustria, Belgium, Czechia, Germany, Switzerland

17.9 7.6 34.1 33.8 6.5

SouthernGreece, Israel, Italy, Portugal, Spain, Turkey

30.1 12.4 39.6 17.9 0.1

Range between countries 5 - 48 0 - 15 16 - 70 5 - 69 0 - 19

End-of-Life Practices in European Intensive Care UnitsSprung et al, 2003. JAMA 290: 790-797.


600

700

800

900

1000

1100

1200

1300

2005 2006 2007 2008 2009 2010 2011 2012

year

do

no

rs

Whole hospital approach to donor

identification and assessment


Initial assessment prior to withdrawal or limitation of treatment

Initial focus on the Emergency

Department

Collaborative approach to consent / authorisation


Current strategies are enough to deliver the original Taskforce objective


600

800

1000

1200

1400

1600

2005 2006 2007 2008 2009 2010 2011 2012 2013+

year

do

no

rs

but different approaches may be needed to deliver more ambitious increases.

0 10 20 30 40


Ireland

Sweden

Denmark

Netherlands

Canada

Germany

United Kingdom

Finland

Czech Rep

Slovenia

Norway

Italy

Austria

Belgium

Croatia

Portugal

Spain

Dr Paul Murphy National Clinical Lead, Organ Donation · PDF fileNational Donation Congress,...

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