National Donation Congress, March 2012
Dr Paul MurphyNational Clinical Lead, Organ Donation
NHS Blood and Transplant
National Donation Congress, March 2012
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
National Donation Congress, March 2012
Consent / authorisation
Neurological determination of death
Donation after Circulatory Death
Donation from ED
Donor identification and referral
Donor optimisation
UK Potential Donor Audit
National Donation Congress, March 2012
Consent / authorisation
Neurological determination of death
Donation after Circulatory Death
Donation from ED
Donor identification and referral
Donor optimisation
Local PDA data
National Donation Congress, March 2012
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 Congress, March 2012
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
National Donation Congress, March 2012
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!
National Donation Congress, March 2012
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?
National Donation Congress, March 2012
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 a doctor uses the wrong words at the wrong time?
National Donation Congress, March 2012
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
National Donation Congress, March 2012
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
deceased donors pmp, 2010
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
National Donation Congress, March 2012
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
National Donation Congress, March 2012
National Donation Congress, March 2012
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.
National Donation Congress, March 2012
Professional Restrictions
Does the lack of critical care capacity in the UK mean that end of life care is something that others must deliver?
National Donation Congress, March 2012
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.
National Donation Congress, March 2012
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.
National Donation Congress, March 2012
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.
National Donation Congress, March 2012
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
Current strategies are enough to deliver the original Taskforce objective
National Donation Congress, March 2012
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
deceased donors pmp, 2010
Ireland
Sweden
Denmark
Netherlands
Canada
Germany
United Kingdom
Finland
Czech Rep
Slovenia
Norway
Italy
Austria
Belgium
Croatia
Portugal
Spain
National Donation Congress, March 2012