Organ Donation and Transplantation

Strategic Performance Update

Sally Johnson

26 March 2015

Overview

• Performance against ODT strategic targets

• Overview of planned initiatives and timescales

• Updates on actions and progress against each outcome

Taking Organ Transplantation to 2020: Outcomes

1. Action by society and individuals will mean that the UK’s organ donation record is amongst the best in the world and people donate when and if they can.

2. Action by NHS hospitals and staff will mean that the NHS routinely provides excellent care in support of organ donation and every effort is made to ensure that each donor can give as many organs as possible.

3. Action by NHS hospitals and staff will mean that more organs are usable and surgeons are better supported to transplant organs safely into the most appropriate recipient.

4. Action by NHSBT and Commissioners means that better support systems and processes will be in place to enable more donations and transplant operations to happen.

Taking Organ Transplantation to 2020: Outcome Measures

1. Consent Rate – 80% by 2020

2. Deceased Organ Donors per million population – 26pmp by 2020

3. Increase Organ Utilisation – 5% by 2020

4. Patients Transplanted per million population – 74 pmp by 2020

Headlines

• Activity levels recovered end 2014. Variable since with drop in potential BSD patient in January & February.

• Donor and transplant numbers below 2013/14 levels

• Latest forecast: 1,300 donors and 3,362 deceased donor transplants

• Performance against all four strategic objectives is red

Measure 1 – Consent rates

0%

20%

40%

60%

80%

100%

2010

/11

Q1

Q2

Q3

Q4

2011

/12

Q1

Q2

Q3

Q4

2012

/13

Q1

Q2

Q3

Q4

2013

/14

Q1

Q2

Q3

Q4

2014

/15

Q1

Q2

Q3

Cons

ent r

ate

Quarter

Consent rate (%) by ODR status

On ODR

Not on ODR

Overall consent rate

Stage 1 – 100% of those on ODR

Stage 2 – increase consent from those not on ODR

Measure 1 - Consent rates by Region

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Eastern London Midlands NorthWest

Northern N Ireland Scotland SouthCentral

SouthEast

SouthWales

SouthWest

Yorkshire UK

Cons

ent

rate

(%)

Consent rate (%) by ODS team, Apr 2014 - Jan 2015 (as at 9 Feb)

Overall

DBD

DCD

Overall target

DBD target

DCD target

South West = 82%

Some teams already at world class levels

Measure 1 – ODR percentage

31%30%

31%

29%

34%

27%

36% 36%

40%41%

34% 34%33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

NORTHEAST

NORTHWEST

YORKSHIREAND THEHUMBER

EAST ANDWEST

MIDLANDS

EAST OFENGLAND

LONDON SOUTHEAST

COAST

SOUTHCENTRAL

SOUTHWEST

SCOTLAND WALES NORTHERNIRELAND

UK

% p

opul

ation

on

OD

R

Former SHA

% population on ODR by former SHA, February 2015

Note: Population data are not available for the Organ Donation Services Team areas

High levels of ODR registration help

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

NORTHEAST

NORTHWEST

YORKSHIREAND THEHUMBER

EAST ANDWEST

MIDLANDS

EAST OFENGLAND

LONDON SOUTHEAST

COAST

SOUTHCENTRAL

SOUTHWEST

SCOTLAND WALES NORTHERNIRELAND

UK

Don

ors

pmp

Former SHA

Donors pmp by former SHA of donating hospital, Feb 2014 - Jan 2015

Donors pmp

2019/20 target

2014/15 target

Measure 2 – Donors pmp

#1. Spain = 35.3#2. Croatia = 33.5 = North East#3. Portugal = 27.8 = Northern Ireland

Note: Population data are not available for the Organ Donation Services Team areas

Some teams already match world class or come close

Measure 2 – Donors pmp

Note: Population data are not available for the Organ Donation Services Team areas

0

25

50

75

100

125

150

175

200

NORTHEAST

NORTHWEST

YORKSHIREAND THEHUMBER

EAST ANDWEST

MIDLANDS

EAST OFENGLAND

LONDON SOUTHEAST

COAST

SOUTHCENTRAL

SOUTHWEST

SCOTLAND WALES NORTHERNIRELAND

UK

pmp

Former SHA

Potential, eligible and actual donors pmp, by former SHA of donating hospital, Feb 2014 - Jan 2015

Potential donors pmp

Eligible donors pmp

Actual donors pmpThere is still the opportunity to do better

Measure 2 – Donor Numbers

114110

0

20

40

60

80

100

120

140

Apr

-10

May

-10

Ju

n-1

0

Ju

l-1

0

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Ja

n-1

1

Feb

-11

Mar

-11

Apr

-11

May

-11

Ju

n-1

1

Ju

l-1

1

Aug

-11

Sep

-11

Oct

-11

Nov

-11

Dec

-11

Ja

n-1

2

Feb

-12

Mar

-12

Apr

-12

May

-12

Ju

n-1

2

Ju

l-1

2

Aug

-12

Sep

-12

Oct

-12

Nov

-12

Dec

-12

Ja

n-1

3

Feb

-13

Mar

-13

Apr

-13

May

-13

Ju

n-1

3

Ju

l-1

3

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Ja

n-1

4

Feb

-14

Mar

-14

Apr

-14

May

-14

Ju

n-1

4

Ju

l-1

4

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Ja

n-1

5

Nu

mb

er

of

do

no

rs

Month

Deceased donors per month

DCDDBD2015/16 monthly target2013/14 & 2014/15 monthly average

The trend is still upwards: variation is the challenge

Measure 2 – Performance against target

200

300

400

500

600

700

800

900

1000

1100

1200

1300

Q1

2010

/11

Q2

Q3

Q4

Q1

2011

/12

Q2

Q3

Q4

Q1

2012

/13

Q2

Q3

Q4

Q1

2013

/14

Q2

Q3

Q4

Q1

2014

/15

Q2

Q3

Nu

mb

er

of

elig

ible

, c

on

se

nte

d a

nd

ac

tua

l d

on

ors

, a

nd

org

an

s t

ran

sp

lan

ted

Quarter

Eligible donorsConsented eligible donorsActual donorsOrgans transplanted

Source: UK Potential Donor Audit as at 9 February 2015. Patients aged over 75 years and cardiothoracic ICUs are excluded. Additional source: UK Transplant Registry for organs transplanted from all deceased solid organ donors

Organ Utilisation can be a challenge

1378 14881676 1736 1745

1042

1201

1242 11831319

0

500

1000

1500

2000

2500

3000

3500

2010/11 2011/12 2012/13 2013/14 Estimated 2014/15*

Num

ber o

f elig

ible

don

or fa

mili

es a

ppro

ache

dNumber of families approached and consented annually

Did not consentConsented

* Based on data to 31 Dec 2014

No of consents may increase but donors fall & still too many refusals

7248

5667

22% fall in 6 years

Active kidney transplant list

Year end

Measure 3 – Changes in donor demographics

• Proportionally fewer donors are aged 70+

• For kidneys, there appears to be less appetite to use the higher risk donors in the most recent year, while for livers there is no such trend.

• Kidney offer decline rates are higher in the last two years for extended criteria donors.

Age of deceased donors

Per

cent

age

(%)

2014/15 Based on activity to 1 March

DBD

Per

cent

age

(%)

DCD

Measure 4 – Transplant numbers

Note: Population data are not available for the Organ Donation Services Team areas

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

NORTHEAST

NORTHWEST

YORKSHIREAND THEHUMBER

EAST ANDWEST

MIDLANDS

EAST OFENGLAND

LONDON SOUTHEAST

COAST

SOUTHCENTRAL

SOUTHWEST

SCOTLAND WALES NORTHERNIRELAND

UK

Tran

spla

nts

pmp

Former SHA

Deceased donor transplants pmp by former SHA of recipient residence, Feb 2014 - Jan 2015

Transplants pmp2019/20 target2014/15 target

Allocation schemes distribute organs to different areas of the UK

Factors influencing performance

• 5% fewer DCD donors

• Proportionally fewer donors aged 70+

• For kidneys, there appears to be less appetite to use higher risk donors, while for livers there is no such trend

• Kidney offer decline rates are higher in the last two years for extended criteria donors

• ¼ of potential DCD are still not referred

• Decreased SNOD availability (change to cohort recruitment & maternity/sick leave) – impacting on staff embedding time

• Delay to the Public Behaviour Change Campaign

Tactical Actions being taken to addressdonor and transplant numbers

• All regional teams examining individual consent data and taking appropriate action

• Monthly PEER review/ Action Learning Set training being organised in 9 teams (London, Yorkshire & Midlands already done) with Practice Development Specialist team to review each consent and refusal

• Monthly RCLOD/CLOD telecons in South West and South Wales

• CQUIN launch in Oxford

• Integrated care pathway in Midlands

• Values based cohort recruitment: successfully recruited 25 WTE & exploring ability to establish ‘bank’ contracts

• Annual consent rate training for all SN-ODS

Outcome 1 – Strategic Initiatives

• Public Behaviour strategy:– Christmas campaign; Sign for Life football club campaign; extension of

government partnerships; Faith Action Plan activities eg Muslim Scholar meetings; National Transplant Week moved to September

• New ODR to be launched 2015/16• Options for donation incentives to be considered by UKDEC• Wales: extensive campaign to support decision making ahead of new

legislation• Scotland: continue marketing campaign supplemented by E-book for schools• Northern Ireland held a ‘talk to your family day’• ‘A Mother’s story’ video

Outcome 2: Strategic Initiatives

• Workforce Strategy- from April designated requester pilot in North West and Yorkshire & paper triage of potential donors starts

• ODT National Hub – business case

• Coroners project: evidence being evaluated. James Neuberger to speak at Coroners training conference

– Portfolio of evidence gathered – further evaluation required– Survey on relationships between staff and coroners about to be launched

• RCoA Guidelines for the Provision of Intensive Care Services includes specific organ donation guidance

• Organ donation established in medical training using ODT materials

• Diagnosis of death <2months under review

Outcome 3 – Strategic Initiatives

• Accredited training programme for retrieval surgeons in development: working with Royal College of Surgeons and Dutch Transplant Service

• Phase 2 of ‘Scout’ project starts in April

• Joint (with NHS England) peer review of Cardiothoracic units due to complete by April. Includes discussion of organ utilisation.

• Ante-mortem interventions workshop next week

• Funding for service development of new perfusion technologies (NRP & EVLP)

• Appointing Clinical Lead for Organ Utilisation to address variations

Outcome 4 – Initiatives

• NORS Review complete: moving into implementation phase

• New consent training programme for Specialist Nurses being rolled out.

• ODT Hub outline business case being finalised for May Board

• Project to reduce use of paper forms for transplant follow-up, working with the UK Renal Registry, underway.

• Duty Office continuing to explore new ways of working eg Case Management

• Donation Congress – March

Future challenges

• Operational Funding – resolved for 2015/16 but HDs not able to make recurrent commitment in some cases

• Development funding: funding model under discussion by ODT Sustainable Funding Group.

• Living donation tariff now promised for 2016/17: financial impact on NHSBT unclear.

• Creating a culture of continuous improvement throughout to donation and transplantation community

• Building ODT capacity to deliver key projects

Deceased donors & transplants

Target figures to 2020

2020 is still achievable!

Measure 2 – Performance against targetInternational Experience

USA

0

5

10

15

20

25

30

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Croatia

0

5

10

15

20

25

30

35

40

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

Spain

15

20

25

30

35

40

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Early initiativesTo 40pmp Initiative

• Major initiatives have had an impact• They have often been followed by an initial slump• Further initiatives, such as in Spain, have been successful

Breakthrough Collaborative