New Organ Donation Plan 2014-2017 - Sydney Local Health Districtslhd.nsw.gov.au/planning/pdf/OrganDonationPlan2014_2017.pdf · 2014. 8. 13. · 2 Sydne oca ealt istrict rga onatio

Organ Donation for Transplantation Plan

2014-2017

The photographs in this book are of organ donation recipients. Most were taken at the Royal Prince Alfred Hospital Gift of Life ceremonies 2012-2014.

1 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017

Introduction ..................................................................................................................2

Organ Transplantation at RPA .....................................................................................4

Enhancing Organ Donation at RPA .............................................................................5Diagram 1: NSW Organ and Tissue Donation Service Request Rates (RPA vs. NSW hospitals) .................. 6

Diagram 2: NSW Organ and Tissue Donation Service Request Rates (RPA vs. NSW peers) ....................... 6

Diagram 3: NSW Organ and Tissue Donation Service Consent Rates (RPA vs. NSW hospitals) ................. 7

Diagram 4: NSW Organ and Tissue Donation Service Consent Rates (RPA vs. NSW peers) ...................... 7

Diagram 5: NSW Organ and Tissue Donation Service Donation Rates (RPA vs. NSW hospitals) ................ 8

Diagram 6: NSW Organ and Tissue Donation Service Donation Rates (RPA vs. NSW peers) ..................... 8

Strengths .....................................................................................................................10

Challenges...................................................................................................................10

Strategies ....................................................................................................................10

Conclusion ................................................................................................................... 12Table 1: RPA Organ Donation Trajectory for Request, Consent and Actual Donor Rates .........................13

Diagram 7: RPA Organ Donation Trajectory for Request, Consent and Actual Donor Rates ....................13

Appendix .................................................................................................................... 14Table 2: Organ Donation for Transplantation Plan ................................................................................. 14

Contents


Sydney Local Health District (SLHD) is committed to being an Australian leader in organ donation to support the world leading transplantation services that are provided by Royal Prince Alfred Hospital (RPA). Yet it is clear that significant progress will need to be made to achieve this goal.

Access to organ donation for transplantation is essential to ensure the best outcomes are achieved for people with end stage disease such as kidney, liver, heart, lung or pancreas failure or for people receiving tissue donation (bone, corneas or skin) to improve the quality of their lives. It has long been recognised that Australia’s organ donation for transplantation system does not meet the nation’s present demand for organ transplantation and is unlikely to meet its future needs without significant change. This is especially so given that the demand for transplanted organs is anticipated to continue to grow with the ageing of Australia’s population and the increased incidence of lifestyle diseases such as obesity, Type 2 diabetes, Hepatitis C, cancer and pancreatitis.

Waiting list numbers for organ transplantation have not changed significantly over the past decade. A majority of those patients on organ transplant waiting lists are awaiting kidney transplants, with livers and lungs the next most frequent organs in demand.

A wide range of data on organ donation for transplantation in Australia, including rates of donation, characteristics of organ donors and rates and outcomes of organ transplantation, are collected and made available. Although significant progress has been made in NSW in partnership with the Commonwealth to reform and improve organ donation across Australia, the rate of organ and tissue donation in NSW at 14.2 dpmp is still lower in comparison to other states in Australia and other countries. Data indicate that the overall number of

organ donors in Australia has increased significantly over the past 5 years, with some variation evident between jurisdictions. The median rate of donors per million people (dpmp) for Australia has grown from 12.1 dpmp in 2008 to 16.9 dpmp in 2013. South Australia has consistently out-performed the other states, with a median rate of 20 dpmp while Spain has a dpmp of 34, almost twice the Australian rate.

Data on the percentage of people who were potential organ donors would benefit from testing through an external audit to identify any international differences in the potential donor pool.

Spain currently has the highest rate of organ donation in the world. There are a number of factors that contribute to this; of importance is the national approach taken by Spain to organ donation. As a result, many other countries have drawn on aspects of Spain’s organ donation for transplantation sector in an attempt to improve their own rates. Australia and NSW have implemented some elements of the Spanish system. Elements of the Spanish system that have been emulated by other countries include the National coordination of all aspects of the organ procurement and transplantation system, dedicated organ donation coordinators and transplant teams within hospitals, and presumed consent legislation.

In Spain, the Organizacion Nacional de Trasplantes (or National Organisation for Transplants-ONT) coordinates organ donation for transplantation activities. This agency maintains waiting lists specifically for emergency tranplants, registries, compiles statistics and operates training programs for medical professionals. Within each hospital, specific organ transplant units operate on-call under the direction of designated organ transplant coordinators, all hospitals in Spain have intensivists full/part-time dedicated to organ donation. Coordinators,

Introduction

Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 3 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017

mostly ICU clinicians, work within an intensive care unit and are responsible for detection of possible donors, support for the diagnosis of death, donor maintenance, donor and organ evaluation, providing information and counselling to families, and for the organ retrieval process. Regional coordination centres monitor activities in all hospitals. Coordination teams work independently from the surgeons who are involved in the process of transplantation; however, all activities are coordinated between both teams.

The Spanish National health system comprises all facilities and public services devoted to health, with public health care available for almost the entire population.

Organ transplantation has a specific budget allocation which funds:

• The organ procurement network

• The salaries of coordinators and retrieval teams whilst involved in transplantation activities

• Any tests to determine donor suitability

• ICU bed costs

• Training and education programs.

The reimbursement by National and Regional authorities of hospital costs related to the transplantation process is seen as being of key importance in sustaining the involvement of all hospitals in the organ donation process.


RPA has the only liver transplant unit and the largest kidney transplant unit in NSW. RPA and SLHD are part of the NSW and national effort to improve organ donation for transplantation. Over many years, RPA clinicians have played an active role at a state and national level in the development of strategies to support best practice in organ donation for transplantation, for example, the Director of RPA's Intensive Care Unit has been seconded to a leadership role in NSW as the State Medical Director of the NSW Organ and Tissue Donation Service (OTDS) ‘DonateLife NSW’. The Clinical Director for Gastroenterology and Liver is president of the Transplantation Society of Australia and New Zealand. RPA’s clinicians are also actively involved in the State organ retrieval service.

RPA is an international leader in liver and kidney transplantation. It has been a pioneer in the fields of kidney and liver transplantation since 1967. RPA performed its first deceased kidney transplant in 1967, first living donor transplant in 1973 and performed the first liver transplant in NSW in

1986. In 2005, the hospital performed the first liver, kidney and pancreas transplant in Australia. In 2012/13, RPA undertook 71 liver transplants and 81 kidney transplants. RPA works closely with other transplantation units at Westmead (kidney and pancreas), Prince of Wales (kidney), and St Vincents (heart and lung) and is a key member of DonateLife.

It is logical, therefore, that SLHD, (in particular RPA), continues to take a leading role in the development of systems that maximise the potential organ donor pool in NSW.

It is important to note that the donation rate in NSW has risen significantly over the last few years and that Dr Robert Herkes and the team at the NSW Organ and Tissue Donation Service and the Australian Government Organ and Tissue Authority (AOTA) should be supported and congratulated for this outcome. This has resulted in a significant increase in the number of both kidney and liver transplants performed by RPA's transplantation units over the last 12 months.

RPA is one of the premier teaching hospitals in Australia and is the most complex tertiary and quaternary health facility in NSW. It has one of the largest ICUs in Australia (over 50 beds). Its emergency, intensive care, pathology and diagnostic services make it well placed to support organ donation for transplantation.

In 2012, the NSW Minister for Health launched the Increasing Organ Donation in NSW Government Plan at Royal Prince Alfred Hospital. This plan laid out the strategic direction for organ donation in NSW emphasising the importance of the partnership between NSW and the Commonwealth and the need for new initiatives in addition to strengthening existing commonwealth strategies.

Organ Transplantation at RPA


In 2013, SLHD recognised that its organ donation Request, Consent and Actual Donor rates at RPA were not increasing at the rate being achieved by some other hospitals in NSW. A SLHD Organ and Tissue Donation Steering Committee was established chaired by the Director of Operations of the District with membership including the specialist organ donation medical clinicians, the Director of Critical Care, the Clinical Director Gastroenterology and Liver, ICU clinicians, the General Manager RPA. Representatives of ShareLife provided advice to the Committee.

Dr John Gatward, Organ Donation Specialist prepared a paper on the Process of Organ Donation at RPA which was reviewed by the SLHD Organ and Tissue Donation Steering Committee. The paper identified potential areas for improvement. As Spain is frequently cited as a world leader in organ donation, the Committee undertook a literature review on the Spanish organ donation system and compared this to current practice in NSW and in particular RPA. As a consequence a subsequent paper was then developed ‘The RPA in Spain Concept’. Following this the Committee recommended to the Chief Executive that it would be beneficial to send a team consisting of a manager and two organ donation specialists to Spain to examine their systems and processes first hand. This was supported by both the Chief Executive and the SLHD Board.

Through contacts with ShareLife Australia, SLHD arranged for the team to visit Spain in October 2013. On their return, the team prepared a comprehensive paper analysing differences between the health systems in NSW and Spain and identifying opportunities for enhancing our organ donation for transplantation systems and processes consistent with world best practice.

Following receipt of the above papers, a small working party consisting of Dr Teresa Anderson, Chief Executive SLHD, Ms Deborah Willcox, Director

of Operations, Professor Paul Torzillo, Clinical Director of Critical Care, Professor Geoff McCaughan, Clinical Director of Gastroenterology and Liver, and Dr Maria Gomez, CE Outcomes Australia (the parent body to ShareLife) was established to develop an implementation plan to enhance organ donation for transplantation at RPA aimed at assisting RPA in becoming a National leader in organ donation for transplantation.

In developing the strategies within the SLHD Organ Donation for Transplantation Plan, consultations have also occurred with Dr Robert Herkes, former State Medical Director of the NSW Organ and Tissue Donation Service, Dr Josette Eris, Director of the State-wide Renal Service, and Professor Richard Allen, Professor of Transplantation RPA. Following review by the Board of SLHD further consultation will be undertaken with senior clinicians across RPA and the District to ensure support for the strategies by the broader clinical community.

Despite the excellent work that has been undertaken to date to support organ donation for transplantation at RPA, the working party found that the rates of organ donation are below what is considered world leading practice. Data provided by the NSW Organ and Tissue Donation Service on Request, Consent and Actual donor rates across NSW show that in 2013, RPA’s rates were significantly lower than many of its peers (refer to Diagrams 1-6). Of note is the excellent performance of Royal North Shore. Analysis by the NSW Organ and Tissue Donation Service of the difference between RPA and Royal North Shore suggests that this may be in part explained by significantly different demographics, socio-economics including the higher CALD population in RPA indicating that specific strategies to increase connections with donor families from CALD backgrounds will be required.

Enhancing Organ Donation at RPA


Diagram 1: NSW Organ and Tissue Donation Service Request Rates 2013 (RPA vs. NSW hospitals)

0 20% 40% 60% 80% 100%

88%88%

93%100%

94%82%

100%75%

88%

82%93%

75%100%

75%100%

83%100%100%

64%89%

50%

Total NSW HospitalsTSR

Royal North ShoreRoyal Prince Alfred

ONMLKJI

HGFEDCBA

I K P Q RPAH T U XX

National target

100%

95%

90%

85%

80%

75%

2

27

10 9 15

2

11

1

5

3

17

14

2013 NSW Group A Hospitals - Requests vs Non-Requests (brain death)

Group Perfomancerequest rate

Collaborativebenchmark

Not requested

Requested

Diagram 2: NSW Organ and Tissue Donation Service Request Rates (RPA vs. NSW peers)


Diagram 3: NSW Organ and Tissue Donation Service Consent Rates (RPA vs. NSW hospitals)

0 20% 40% 60% 80% 100%

58%64%

31%55%

94%50%

47%78%

62%

56%36%

67%75%

100%50%

40%75%

100%29%

38%



ONMLKJI

HGFEDCBA

0%

I K P Q RPAH T U XX

National target 75%

100%

80%

60%

40%

20%

0%

12

155

14

6

5

5

8

9

2013 NSW Group A Hospitals - Consents vs Refusals (brain death)

Group Perfomanceconsent rate 57%

Collaborativebenchmark 58%

Refusal

Consent

8

2

41

7

7

Diagram 4: NSW Organ and Tissue Donation Service Consent Rates (RPA vs. NSW peers)


Diagram 5: NSW Organ and Tissue Donation Service Donation Rates (RPA vs. NSW hospitals)

I K P Q RPAH T U XX

National target 70%

100%

80%

60%

40%

20%

0%

16

135

14

8

5

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7

2013 NSW Group A Hospitals - Actual Donors vs Non-Donors (brain death)

Group Perfomanceconsent rate 47%

Collaborativebenchmark 49%

Non-Donors

Actual Donors

9

1

41

6

8

4

Diagram 6: NSW Organ and Tissue Donation Service Donation Rates (RPA vs. NSW peers)

0 20% 40% 60% 80% 100%

44%44%

21%73%

88%35%

40%42%

38%

45%20%

25%63%

50%0%0%

75%100%

18%33%

0%



ONMLKJI

HGFEDCBA


In identifying world leading practice in Organ Donation for Transplantation, the working party utilised a number of resources including the Good Practice Guidelines in the process of Organ Donation (Spanish National Transplant Organisation 2010), the Organ Donation European Quality System (2013) and Increasing Organ Donation in NSW 2012.

Leading practice in the Organ Donation for Transplantation process was identified in the areas of:

• System governance and infrastructure

• Hospital education activities

• Communication strategies

• Audit and Quality Improvement

• Detection

• Brain death diagnosis

• Donor viability

• Donor maintenance

• Organ viability

• Family approach

• Organ recovery

• Organ allocation

• Transplantation

• Organ transplant feedback

• Donor family follow-up.

The working party then documented the current status at RPA against each of these areas. The review indicated that although there are areas where RPA currently has world leading practice, there are other areas where action is required for RPA practice to be at this level. The SLHD Organ Donation for Transplantation Plan is outlined in Table 2 and identifies the actions required, the positions responsible, the time frame, indicative costs and Key Performance Indicators.


In identifying the strategies outlined in the SLHD Organ Donation for Transplantation Plan, the working party considered both the strengths of RPA and the challenges faced in providing world leading organ donation for transplantation. These are outlined below:

Strengths• Highly skilled medical, nursing and allied health

staff who are committed to organ donation for transplantation

• Extensive experience in organ donation for transplantation

• Tertiary and quaternary clinical support services including ICU, ED pathology, diagnostic imaging services

• Strong relationships and networks with the OTDS and other District organ donation for transplantation services.

• An Executive and Board that are committed to improving organ donation for transplantation.

Challenges• Lack of a strong district governance structure for

organ donation for transplantation

• Lack of a dedicated ‘Organ Donation for Transplantation Unit’

• The temporary nature of specialist organ donation medical positions resulting in difficulty retaining senior clinicians.

• The fragility of 24/7 coverage to support after hours organ donation

• Limited reporting to the District Executive and Board on organ donation outcomes

• Limited auditing against best practice.

StrategiesThere are a number of key strategies in the SLHD Organ Donation for Transplantation Plan that the District believes will help to strengthen organ donation for transplantation at RPA and support the state and national efforts to improve organ donation.

These include:

• The establishment of a dedicated Organ Donation for Transplantation Unit at RPA. Staff of the unit will play an active role in the hospital and promote a Whole of Hospital approach to organ donation for transplantation.

• The appointment of a Director of the Organ Donation for Transplantation Unit at RPA who will report to the Chief Executive of SLHD through the Executive Clinical Director of RPA. This new position, in partnership with the University of Sydney, will be a clinical academic who will provide leadership in the development of best practice organ donation within RPA. The Director will work


closely to support the work of DonateLife and the NSW Organ and Tissue Donation Service through teaching and research and the development of evidenced based practice in organ donation. The Director will be an intensivist and can have the opportunity to undertake clinical practice in the RPA ICU as part of the role; however, the dominant role will be as the Director of the Organ Donation for Transplantation at RPA.

• The re-establishment of the Organ Donation for Transplantation Steering Committee chaired by the Chief Executive with membership including the Director of the Organ Donation for Transplantation Unit, the Clinical Director Critical Care, the Clinical Director Gastroenterology and Liver, the Director of ICU, the Director of the Emergency Department, the Head of Departments for Neurology, Neurosurgery and Palliative Care, the Organ Donation Nurse, the Director of the State-wide Renal Service, Professor of Transplantation Surgery, Chief Executive, Outcomes Australia and the General Manager RPA. This committee will provide strategic direction and support to the Organ Donation for Transplantation Unit at RPA and facilitate a Whole of Hospital approach to organ donation for transplantation.

• An increase in the staffing within the team to provide 24/7 coverage through the retention of the organ donation specialist positions funded through the NSW Organ and Tissue Donation Service. These positions will continue to be under the current arrangements with the NSW Ministry of Health to enable the development of a pool of clinicians with expertise in organ donation and support succession planning.

• The appointment of an administration officer to support the work of the team including data collection, development of educational resources and audit.

• The Organ Donation for Transplantation Unit will work closely with all departments within the hospital to support a Whole of Hospital approach to organ donation, including staff within the Emergency Department, Intensive Care Unit, cardiology, neurology, pathology, imaging, transplantation units and administrative areas.

• Review of the education that is currently provided in line with world leading practice. The Organ Donation for Transplantation Unit will work closely with the NSW Organ and Tissue Donation Service and the NSW Ministry of Health.

• Review RPA/SLHD practices for identifying potential donors and our practices for obtaining consent. The Organ Donation for Transplantation Unit will work with ED and ICU staff to review current practices.

• Review, with NSW Ministry of Health, the resources required to increase the number of transplants performed at RPA and in NSW and review opportunities for the development of new kidney transplantation services. At present the liver and kidney transplant units at RPA are at capacity. If there is a significant increase in kidney and liver donations, the capacity to undertake organ transplantations will need to increase at all NSW hospitals undertaking transplantation. Negotiations will need to occur in setting the District’s activity targets.

• Review the National Weighted Activity Units (NWAUs) for organ donation for transplantation. Currently the NWAUs for liver, kidney, pancreas, heart and lung transplants do not cover the full costs of performing these complex procedures. Further work is required with NSW Ministry of Health and the Commonwealth to appropriately cost and fund these procedures.


The District believes that the strategies contained in the SLHD Organ Donation for Transplantation Plan will enhance its ability to be an Australian leader in organ donation to support the world leading transplantation services that are provided by Royal Prince Alfred Hospital. The additional resources contained in the plan will also be available to assist the NSW Organ and Tissue Donation Service and Australia in achieving its goal of NSW and Australia being world leaders in organ donation.

RPA and SLHD are committed to a Whole of Hospital approach to organ donation for transplantation. Improving donation rates relies heavily on the support of ICU and ED doctors so that they can identify potential donors and gain consent from their relatives. To support this, the working party will meet with ICU and ED clinicians to discuss the SLHD Organ Donation for Transplantation Plan and the importance of their roles in its implementation.

SLHD services a population of approximately 580,000 people. If SLHD were to achieve the same organ donation rates as Spain (35 dpmp), it would have approximately 18 donors per year across its hospitals. SLHD has had approximately 6 donors per year for the last 3 years.

The District has also set proposed trajectories for improving its rates of Request, Consents and Actual Donors over the next three years. These are outlined in Table 1 and Diagram 7. The District aims to perform above the National targets in all areas.

Although the District recognises that the targets it has set itself are ambitious, the working party believes that they are achievable with the implementation of the District’s Organ Donation for Transplantation Plan.

Conclusion


Table 1: RPA Organ Donation Trajectory for Request, Consent and Actual Donor Rates

Royal Prince Alfred Hospital Organ Donation Trajectory

YearActual

Request Rate (%)

Forecast Request Rate

(%)

Actual Consent rate

(%)

Forecast Consent rate

(%)

Actual Donation Rate (%)

Forecast Donation Rate (%)

2010 92 67 54

2011 100 50 38

2012 94 53 33

2013 82 82 50 50 35 35

2014 85 70 65

2015 100 80 75

2016 100 85 80

2017 100 90 85

Diagram 7: RPA Organ Donation Trajectory for Request, Consent and Actual Donor Rates

2010 2011 2012 2013 2014 2015 2016 2017

Actual Request Rate (%)Forecast Request Rate (%)

100%

90%

80%

70%

60%

50%

40%

30%

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RPA Organ Donation Rates Trajectory

Actual Donation Rate (%)Forecast Donation Rate (%)

Actual Consent Rate (%)Forecast Consent Rate (%)


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Appendix


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e

fram

eIn

dica

tive

co

stK

PI’s

Syst

em

gove

rnan

ce a

nd

infra

stru

ctur

e

Prot

ocol

s and

pro

cedu

res

for a

ll re

leva

nt s

teps

of

the

dona

tion

proc

ess a

re

in p

lace

Curre

nt P

ract

ice; h

owev

er

they

cou

ld b

e en

hanc

edRe

view

of p

roto

cols

and

proc

edur

es to

be

unde

rtake

n.

Regu

lar a

udit

prog

ram

to

be im

plem

ente

d to

mon

itor

com

plia

nce

Org

an D

onat

ion

for T

rans

plan

tatio

n Un

it, IC

U,

ED S

taff,

Sta

ff

Re

view

of p

roto

cols

and

proc

edur

es c

ondu

cted

.

Regu

lar a

udit

prog

ram

in

plac

e to

mon

itor c

ompl

ianc

e

Hosp

ital

Educ

atio

n

Activ

ities

Trai

ning

of p

rofe

ssio

nals

in/o

utsid

e IC

U an

d ED

on

org

an d

onat

ion

is un

derta

ken,

don

or d

etec

tion

Unde

rtak

en b

ut li

mite

dRe

quire

s enh

ance

men

t St

aff f

rom

the

Org

an D

onat

ion

for T

rans

plan

tatio

n Un

it

Org

an D

onat

ion

train

ing

prog

ram

s for

pro

fess

iona

ls in

/out

side

ICU

and

ED

revi

ewed

and

enh

ance

d

Spec

ific a

nd

cont

inui

ng e

duca

tion

in o

rgan

don

atio

n fo

r tra

nspl

anta

tion

is pr

ovid

ed

to a

ll ke

y sta

ff th

roug

hout

th

e ho

spita

l inc

ludi

ng to

st

aff i

n ad

min

istra

tive

area

s

Unde

rtak

en b

ut li

mite

dRe

quire

s enh

ance

men

tSt

aff f

rom

the

Org

an D

onat

ion

for T

rans

plan

tatio

n Un

it.

Org

an &

Tiss

ue

NSW

Don

atio

n an

d Tr

ansp

lant

atio

n Se

rvice

Spec

ific

and

cont

inui

ng

educ

atio

n in

org

an d

onat

ion

for t

rans

plan

tatio

n pr

ovid

ed

to a

ll ke

y st

aff t

hrou

ghou

t th

e ho

spita

l inc

ludi

ng

adm

inist

rativ

e st

aff

The

Org

an D

onat

ion

for

Tran

spla

ntat

ion

Serv

ice h

as

close

rela

tions

hips

with

all

hosp

ital s

ervi

ces

Unde

rtak

en b

ut li

mite

dRe

quire

s enh

ance

men

tSt

aff f

rom

the

Org

an D

onat

ion

for T

rans

plan

tatio

n Un

it

Rela

tions

hips

stre

ngth

ened

be

twee

n O

rgan

Don

atio

n fo

r Tra

nspl

anta

tion

Unit

and

ot

her h

ospi

tal s

ervi

ces

Com

mun

icatio

n St

rate

gy

Info

rm a

ll st

akeh

olde

rs

of p

rogr

ess o

f the

O

rgan

Don

atio

n fo

r Tr

ansp

lant

atio

n Un

it an

d ou

tcom

es o

f don

atio

n ra

tes

Unde

rtak

en b

ut li

mite

dDe

velo

p br

ochu

res f

or s

taff

and

patie

nts/

fam

ilies

Inclu

de re

sear

ch

and

prog

ress

of n

ew O

rgan

Do

natio

n fo

r Tra

nspl

anta

tion

Unit

GM

RPA

H/ S

taff

from

Stra

tegi

c Re

latio

ns &

Co

mm

unica

tion

Unit

Broc

hure

s dev

elop

ed fo

r st

aff a

nd p

atie

nts/

fam

ily

deta

iling

rese

arch

and

pr

ogre

ss o

f new

Org

an

Dona

tion

for T

rans

plan

tatio

n Un

it

Audi

t and

Q

ualit

y Im

prov

emen

t

Docu

men

tatio

n oc

curs

in

the

clini

cal r

ecor

d of

key

po

ints

in th

e do

natio

n pr

oces

s in

cludi

ng

docu

men

tatio

n of

the

caus

e of

no

dona

tion

An a

udit

syst

em is

cu

rrent

ly in

pla

ce; h

owev

er

coul

d be

enh

ance

d w

ith

regu

lar p

erfo

rman

ce

repo

rts t

o th

e Ch

ief

Exec

utiv

e an

d Bo

ard

(inclu

ding

ben

chm

arki

ng

agai

nst K

PIs)

Revi

ew a

nd e

nhan

ce th

e cu

rrent

au

dit s

yste

m

Deve

lopm

ent o

f a D

ashb

oard

to

mon

itor p

erfo

rman

ce

Staf

f fro

m th

e O

rgan

Don

atio

n fo

r Tra

nspl

anta

tion

Unit

Dire

ctor

of t

he

Perfo

rman

ce U

nit

ED a

nd IC

U st

aff

NSW

Org

an a

nd

Tiss

ue

Curre

nt a

udit

syst

em

revi

ewed

and

enh

ance

d

Dash

boar

d de

velo

ped

to m

onito

r and

repo

rt pe

rform

ance

aga

inst

KPI

s


Org

an

Don

atio

n fo

r Tr

ansp

lant

atio

n Pr

oces

s

Lead

ing

Prac

tice

Curr

ent S

tatu

s

at R

PAA

ctio

ns re

quire

dPo

sitio

ns

Resp

onsi

ble

Tim

e

fram

eIn

dica

tive

co

stK

PI’s

Dete

ctio

n

All p

atie

nts w

ith s

ever

e ne

urol

ogica

l inj

ury

who

re

quire

or m

ay re

quire

ve

ntila

tion

are

iden

tified

as

early

as p

ossib

le (P

ossib

le

Dono

rs)

Curre

nt p

ract

ice; h

owev

er

requ

ires o

ngoi

ng a

udit

Enha

nced

aud

itED

and

ICU

staf

fN

umbe

r of c

omat

ose

patie

nts w

ith d

evas

tatin

g ce

rebr

al le

sion

adm

itted

to

the

ICU

who

are

refe

rred

to

the

Dona

tion

Team

/Num

ber

of c

omat

ose

patie

nts w

ith

deva

stat

ing

cere

bral

lesio

n ad

mitt

ed to

the

ICU

X 10

0

TARG

ET 1

00%

All p

ossib

le d

onor

s de

tect

ed a

nd a

ll ca

rdia

c de

ath

are

notifi

ed

imm

edia

tely

to th

e O

rgan

Don

atio

n fo

r Tr

ansp

lant

atio

n Un

it (T

rans

plan

t Coo

rdin

ator

)

Curre

nt p

ract

iceN

o ch

ange

requ

ired

ED a

nd IC

U st

aff

Org

an D

onat

ion

for T

rans

plan

tatio

n Un

it

Perio

dic

visit

s are

mad

e by

the

Org

an D

onat

ion

for T

rans

plan

tatio

n te

am

to th

e un

its th

at m

anag

e ne

uro-

criti

cal p

atie

nts

outs

ide

of th

e IC

U an

d ED

Does

n’t o

ccur

at t

his s

tage

De

velo

p pr

otoc

olSt

aff f

rom

the

Org

an D

onat

ion

for T

rans

plan

tatio

n Un

it

Num

ber o

f pos

sible

de

ceas

ed D

BD re

ferre

d to

the

dona

tion

team

/ To

tal n

umbe

r of p

ossib

le

dece

ased

DBD

x 1

00

TARG

ET 1

00%

All p

ossib

le d

onor

s cas

es

that

hav

e be

en d

etec

ted

or

refe

rred

by th

e IC

U an

d ED

st

aff a

re m

onito

red

by s

taff

of th

e O

rgan

Don

atio

n fo

r Tr

ansp

lant

atio

n Un

it on

a

daily

bas

is

Does

n’t o

ccur

at t

his s

tage

Deve

lop

prot

ocol

Staf

f fro

m th

e O

rgan

Don

atio

n fo

r Tra

nspl

anta

tion

Unit

Prot

ocol

dev

elop

ed fo

r dai

ly m

onito

ring

of a

ll de

tect

ed

and

refe

rred

poss

ible

don

or

case

s

A sy

stem

is in

pla

ce to

id

entif

y an

d re

cord

all

poss

ible

don

ors w

ho

beco

me

pote

ntia

l org

an

dono

rs

GIV

E tri

gger

has

bee

n im

plem

ente

d in

the

ICU

to

allo

w e

arly

notifi

catio

n of

po

tent

ial d

onor

s

Expa

nsio

n to

the

ED a

nd o

ther

pa

rts o

f the

hos

pita

l. De

velo

p pr

otoc

ol.

Prov

ide

educ

atio

n.

Staf

f fro

m th

e O

rgan

Don

atio

n fo

r Tra

nspl

anta

tion

Unit

Expa

nsio

n of

GIV

E tri

gger

sy

stem

to W

hole

of H

ospi

tal

Prot

ocol

and

edu

catio

n pl

an

deve

lope

d




rgan

D

onat

ion

for

Tran

spla

ntat

ion

Proc

ess

Lead

ing

Prac

tice

Curr

ent S

tatu

s

at R

PAA

ctio

ns re

quire

dPo

sitio

ns

Resp

onsi

ble

Tim

e

fram

eIn

dica

tive

co

stK

PI’s

Brai

n De

ath

Diag

nosis

Brai

n de

ath

is de

clare

d as

so

on a

s it h

appe

nsCu

rrent

pra

ctice

No

chan

ge re

quire

dIC

U/ED

/N

euro

surg

ery

staf

f

All B

rain

Dea

th D

ecla

ratio

n oc

curs

inde

pend

ent o

f w

heth

er th

e pe

rson

is

suita

ble

or n

ot fo

r org

an

dona

tion

Curre

nt p

ract

iceN

o ch

ange

requ

ired

ICU/

ED/

Neu

rosu

rger

y st

aff

The

Org

an D

onat

ion

for

Tran

spla

ntat

ion

Unit

has

a pe

rman

ent p

rese

nce

of

skill

ed c

linici

ans w

ho a

re

able

to d

iagn

ose

brai

n de

ath

The

diag

nosis

of b

rain

de

ath

is un

dert

aken

by

‘des

igna

ted

spec

ialis

ts’ A

s a

rule

thes

e ar

e in

tens

ive

care

clin

ician

s reg

ister

ed b

y th

e Di

stric

t

No

chan

ge re

quire

dIC

U/ED

/ N

euro

surg

ery

staf

fN

umbe

r dec

ease

d p

atie

nts

with

Deva

stat

ing

cere

bral

in

jury

or l

esio

n (D

CIL)

decla

red

brai

n de

ad/

Tota

l num

ber o

f dec

ease

d pa

tient

s with

DCI

L X

100

TARG

ET 5

0%

Dono

r Vi

abilit

y

Clin

ical e

valu

atio

n of

th

e po

tent

ial d

onor

is

unde

rtak

en to

iden

tify

abso

lute

con

train

dica

tions

fo

r org

an d

onat

ion

Curre

nt p

ract

iceN

o ch

ange

requ

ired

Org

an D

onat

ion

for T

rans

plan

tatio

n Cl

inici

an

Decis

ions

on

med

ical

suita

bilit

y ar

e m

ade

by re

leva

nt o

n- c

all

trans

plan

t tea

m, c

linica

l an

d O

rgan

Don

atio

n fo

r Tr

ansp

lant

atio

n Un

it

Curre

nt p

ract

ice.

Audi

t pro

cess

by

the

trans

plan

t tea

m

No

chan

ge re

quire

d to

the

proc

ess.

Add

audi

t pro

cess

by

the

Org

an

Dona

tion

for T

rans

plan

tatio

n Un

it in

con

sulta

tion

with

the

trans

plan

t tea

m

Org

an D

onat

ion

for T

rans

plan

tatio

n Cl

inici

an a

nd th

e Tr

ansp

lant

surg

eon

Num

ber o

f pat

ient

s dec

lare

d br

ain

dead

who

hav

e be

en

eval

uate

d as

org

an d

onor

s /T

otal

num

ber o

f pat

ient

s de

clare

d br

ain

dead

X 1

00

TARG

ET 1

00%

The

poss

ible

don

or is

m

anag

ed in

the

ICU

in

part

ners

hip

betw

een

the

Inte

nsiv

ist a

nd th

e O

rgan

Don

atio

n fo

r Tr

ansp

lant

atio

n Cl

inici

an

Not

cur

rent

pra

ctice

Revi

ew to

occ

ur to

iden

tify

how

dia

logu

e ca

n be

enh

ance

d be

twee

n th

e IC

U, tr

ansp

lant

te

ams

and

Org

an D

onat

ion

for

Tran

spla

ntat

ion

Unit

to m

axim

ise

viab

ility

/func

tion

of th

e or

gans

w

ithou

t com

prom

ising

pat

ient

care

Inte

nsiv

ist O

rgan

Do

natio

n fo

r Tr

ansp

lant

atio

n Cl

inici

an

trans

plan

tatio

n te

am

Prot

ocol

for i

mpr

oved

co

mm

unica

tion

betw

een

Inte

nsiv

ist a

nd O

rgan

Do

natio

n fo

r Tra

nspl

anta

tion

Clin

ician

dev

elop

ed



Org

an

Don

atio

n fo

r Tr

ansp

lant

atio

n Pr

oces

s

Lead

ing

Prac

tice

Curr

ent S

tatu

s

at R

PAA

ctio

ns re

quire

dPo

sitio

ns

Resp

onsi

ble

Tim

e

fram

eIn

dica

tive

co

stK

PI’s

Dono

r M

aint

enan

ce

Early

mai

nten

ance

of t

he

pote

ntia

l don

ors s

uita

ble

for o

rgan

don

atio

n is

in

plac

e

Pote

ntia

l don

ors a

re

prov

ided

with

the

high

est

poss

ible

car

e fo

r the

ir cli

nica

l con

ditio

n; h

owev

er,

furth

er w

ork

is re

quire

d on

tim

ing

of fa

mily

disc

ussio

ns

for o

rgan

don

atio

n

Deve

lop

prot

ocol

Inte

nsiv

ist a

nd

Org

an D

onat

ion

for T

rans

plan

tatio

n Cl

inici

an

Num

ber o

f pot

entia

l DBD

do

nors

app

ropr

iate

ly m

anag

ed N

umbe

r of

pote

ntia

l DBD

don

ors i

n ho

spita

l are

as X

100

TARG

ET 1

00%

Poss

ible

don

ors a

re

man

aged

in th

e IC

U Cu

rrent

pra

ctice

onl

y if

the

patie

nt’s

cond

ition

requ

ires

ICU

No

chan

ge re

quire

dIn

tens

ivist

and

O

rgan

Don

atio

n fo

r Tra

nspl

anta

tion

Clin

ician

No

of p

oten

tial D

BD

dono

rs w

ho su

ffere

d an

un

antic

ipat

ed c

ardi

ac a

rrest

/ To

tal n

umbe

r of p

oten

tial

DBD

dono

rs X

100

TARG

ET <

3%

Org

an V

iabi

lity

Clin

ical e

valu

atio

n an

d bl

ood

test

ana

lysis

of

each

org

an is

und

erta

ken

in o

rder

to d

eter

min

e th

eir s

uita

bilit

y fo

r tra

nspl

anta

tion

Curre

nt p

ract

ice d

ecisi

ons

on m

edica

l sui

tabi

lity

are

mad

e by

the

orga

n do

natio

n se

rvice

, afte

r co

nsul

tatio

n w

ith o

n-ca

ll tra

nspl

ant s

urge

ons

No

chan

ge re

quire

dO

rgan

Do

natio

n a

nd

Tran

spla

ntat

ion

Unit

Num

ber o

f don

ors c

orre

ctly

eval

uate

d/ N

umbe

r of

dono

rs e

valu

ated

X 1

00

TARG

ET 1

00%

Fam

ily a

ppro

ach

Early

and

acc

urat

e in

form

atio

n ab

out t

he

stat

us a

nd p

rogn

osis

of th

e po

ssib

le d

onor

is p

rovi

ded

to fa

mily

mem

bers

Curre

nt p

ract

ice p

re-

mee

ting

case

disc

ussio

ns

are

unde

rtak

en to

en

sure

all

staf

f mem

bers

un

ders

tand

the

role

in

supp

ortin

g do

natio

n Th

ese

disc

ussio

ns in

clude

m

edica

l, nu

rsin

g, p

asto

ral

care

, soc

ial w

ork

and

othe

r st

aff

No

chan

ge re

quire

dIC

U, E

D St

aff.

Org

an

Dona

tion

and

Tr

ansp

lant

atio

n Un

it

Prep

arat

ion

occu

rs fo

r Fa

mily

inte

rvie

ws,

ensu

ring

all i

nfor

mat

ion

abou

t the

po

ssib

le d

onor

’s pa

thol

ogy

as w

ell a

s the

bac

kgro

und

of th

e fa

mily

is o

btai

ned

prio

r to

the

inte

rvie

w

Curre

nt p

ract

ice S

igni

fican

t pr

epar

atio

n oc

curs

to

ensu

re th

at fa

mily

mem

bers

ar

e w

ell i

nfor

med

and

that

in

form

atio

n is

prov

ided

in a

m

anne

r tha

t is s

ensit

ive to

th

e fa

mily

’s ne

eds

Clar

ifica

tion

and

disc

ussio

n is

requ

ired

to e

nhan

ce ti

min

g of

fa

mily

disc

ussio

ns

Org

an

Dona

tion

and

Tr

ansp

lant

atio

n Un

it

Patie

nt/fa

mily

disc

ussio

ns

cond

ucte

d in

a ti

mel

y, se

nsiti

ve m

anne

r. Ta

rget

Co

nsen

t rat

e ac

hiev

ed




rgan

D

onat

ion

for

Tran

spla

ntat

ion

Proc

ess

Lead

ing

Prac

tice

Curr

ent S

tatu

s

at R

PAA

ctio

ns re

quire

dPo

sitio

ns

Resp

onsi

ble

Tim

e

fram

eIn

dica

tive

co

stK

PI’s

Fam

ily a

ppro

ach

The

fam

ily is

adv

ised

abou

t th

e de

ath

(Bra

in D

eath

) in

a ti

mel

y an

d se

nsiti

ve

man

ner a

nd is

then

in

trodu

ced

to th

e O

rgan

Do

natio

n Te

am

Curre

nt p

ract

ice. T

he

treat

ing

team

intro

duce

th

e do

natio

n te

am to

the

fam

ily, o

nce

the

treat

ing

team

are

sure

that

the

fam

ily u

nder

stan

ds th

e de

ath

of th

eir r

elat

ive

No

chan

ge re

quire

dIC

U St

aff.

Org

an

Dona

tion

and

Tr

ansp

lant

atio

n Un

it. N

SW O

TDS

Inte

rvie

ws

with

the

fam

ily

mem

bers

are

und

erta

ken

by s

taff

follo

win

g a

spec

ific

met

hodo

logy

(tra

inin

g +

ex

perie

nce)

Five

clin

ician

s hav

e be

en

train

ed in

Des

igna

ted

Requ

esto

rs’ m

etho

dolo

gy

The

new

Clin

ical A

cade

mic

to

revi

ew th

e m

etho

dolo

gy u

sed

Org

an

Dona

tion

and

Tr

ansp

lant

atio

n Un

it

Fam

ily m

embe

rs in

terv

iew

m

etho

dolo

gy re

view

ed

Clin

ician

s hav

e be

en

train

ed in

the

lead

ing

of

cons

ent c

onve

rsat

ions

Curre

nt p

ract

iceN

o ch

ange

requ

ired

Org

an

Dona

tion

and

Tr

ansp

lant

atio

n Un

it

Fam

ily is

pro

vide

d w

ith

supp

ort a

fter i

nter

view

re

gard

less

of w

heth

er th

ey

agre

ed to

don

atio

n or

not

Curre

nt p

ract

ice F

amily

m

embe

rs a

re w

ell

supp

orte

d

No

chan

ge re

quire

dIC

U an

d O

rgan

Do

natio

n fo

r Tr

ansp

lant

atio

n Te

am

Mec

hani

cal v

entil

atio

n is

di

scon

tinue

d w

here

bra

in

deat

h ha

s bee

n de

clare

d an

d or

gan

dona

tion

is no

t oc

curri

ng

Curre

nt p

ract

ice

Mec

hani

cal v

entil

atio

n is

ceas

ed a

s soo

n as

pos

sible

af

ter b

rain

dea

th h

as b

een

decla

red

No

chan

ge re

quire

dIC

U, E

D St

aff

Org

an re

cove

ry

Org

an re

cove

ry is

co

nsid

ered

an

emer

genc

y pr

oced

ure

with

prio

rity

in

the

oper

atin

g th

eatre

s

Curre

nt p

ract

iceN

o ch

ange

requ

ired

Thea

tre

man

agem

ent

Org

an re

cove

ry

The

reco

very

pro

cess

is

coor

dina

ted

Curre

nt p

ract

iceAd

ditio

nal r

esou

rces

will

be

requ

ired

to in

crea

se c

apac

ity

of th

e te

am a

s org

an d

onat

ion

incr

ease

s

Chie

f Exe

cutiv

e SL

HD a

nd M

oHRe

sour

ce re

quire

men

ts fo

r re

cove

ry p

roce

ss re

view

ed

and

enha

nced

as r

equi

red

to

mee

t inc

reas

ing

dem

and




rgan

D

onat

ion

for

Tran

spla

ntat

ion

Proc

ess

Lead

ing

Prac

tice

Curr

ent S

tatu

s

at R

PAA

ctio

ns re

quire

dPo

sitio

ns

Resp

onsi

ble

Tim

e

fram

eIn

dica

tive

co

stK

PI’s

Org

an re

cove

ry

As d

onat

ion

activ

ity

incr

ease

s the

hos

pita

l ha

s ade

quat

e re

sour

ces

inclu

ding

sta

ffing

and

op

erat

ing

thea

tre ti

me

Curre

ntly

RPA

is un

dert

akin

g 71

live

r tra

nspl

ants

per

yea

r an

d ap

prox

50

kidn

ey

trans

plan

ts p

er y

ear

Addi

tiona

l res

ourc

es a

re

requ

ired

to in

crea

se c

apac

ity fo

r tra

nspl

anta

tion

Chie

f Exe

cutiv

e SL

HD a

nd M

oHO

rgan

reco

very

cost

s be

twee

n $8

-15k

per

ca

se. A

n in

crea

se in

do

nor r

ate

from

6 to

10

cas

es p

er ye

ar w

ill re

quire

an

addi

tiona

l $6

0K a

nnua

lly

Num

ber o

f org

ans r

ecov

ered

/n

umbe

r of d

onor

s

Org

an a

lloca

tion

Org

an a

lloca

tion

is un

dert

aken

acc

ordi

ng

to fe

dera

l/sta

tes r

ules

Th

e pr

incip

les o

f org

an

allo

catio

n ru

les:

Equi

ty,

trans

pare

ncy,

Utili

ty,

Effic

ienc

y

Curre

nt p

ract

iceN

o ch

ange

requ

ired

(Hos

pita

l-Sta

te-

Fede

ral L

evel

)

Org

an

Tran

spla

ntat

ion

Adeq

uate

reso

urce

s ar

e pr

ovid

ed fo

r tra

nspl

anta

tion

from

all

type

s of d

onor

s (De

ceas

ed

and

livin

g)

The

curre

nt tr

ansp

lant

atio

n te

ams a

re s

tretc

hed

to

capa

city

Addi

tiona

l res

ourc

es w

ill b

e re

quire

d to

incr

ease

cap

acity

of

the

team

Chie

f Exe

cutiv

e SL

HD a

nd M

oH5

year

pr

edic

ted

grow

th a

nd

cost

s

In 2

018

the

proj

ecte

d nu

mbe

r of L

iver

trans

plan

ts 1

30 p

er

annu

m (a

vera

ge

$120

K pe

r cas

e - t

otal

$1

5.6M

)and

for

Kidn

ey Tr

ansp

lant

s 16

0 pe

r ann

um

(ave

rage

$33

K pe

r ca

se- t

otal

$5.

28M

)

Num

ber o

f tra

nspl

ants

.

Reso

urce

requ

irem

ents

for

reco

very

pro

cess

revi

ewed

an

d en

hanc

ed a

s req

uire

d to

m

eet i

ncre

asin

g de

man

d.

Addi

tiona

l res

ourc

es in

clude

: in

crea

sed

bed

base

up

to 4

0 ad

ditio

nal b

eds

incr

ease

d m

edica

l, nu

rsin

g an

d al

lied

heal

th u

p to

20F

TE

Org

an T

rans

plan

t Fe

edba

ck

Info

rmat

ion

is pr

ovid

ed

to th

e IC

U an

d ED

Sta

ff ab

out t

he o

utco

mes

of t

he

trans

plan

t per

form

ed

Curre

nt p

ract

ice b

ut li

mite

dCo

uld

be

enha

nced

and

aud

ited

Org

an

Dona

tion

and

Tr

ansp

lant

atio

n Un

it

Feed

back

pro

cess

revi

ewed

an

d en

hanc

ed a

s req

uire

d

Dono

r Fam

ily

Follo

w-u

p

Supp

ort a

nd in

form

atio

n pr

ovid

ed to

the

dono

r fa

mily

Curre

nt p

ract

ice. D

onor

fa

mili

es a

re p

rovi

ded

with

on

goin

g su

ppor

t and

at

tend

an

annu

al m

emor

ial

cere

mon

y

Coul

d be

enh

ance

d an

d au

dite

d.

Com

mun

icatio

n to

occ

ur w

ith

the

orga

n do

natio

n ne

twor

k to

max

imise

supp

ort f

or d

onor

fa

mili

es fr

om th

e ho

spita

l

Org

an

Dona

tion

and

Tr

ansp

lant

atio

n Un

it

Dono

r fam

ily fo

llow

-up

proc

ess r

evie

wed

and

en

hanc

ed a

s req

uire

d.

Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017


June 2014

Documents

New Organ Donation Plan 2014-2017 - Sydney Local Health Districtslhd.nsw.gov.au/planning/pdf/OrganDonationPlan2014_2017.pdf · 2014. 8. 13. · 2 Sydne oca ealt istrict rga onatio