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The UK Potential Donor Audit
Dr Paul Murphy National Clinical Lead for Organ Donation NHS Blood and Transplant, UK
1 Swedish Inquiry into organ donation and transplantation. April 2014
UK Potential Donor Audit
• History – Established in 2003 – UK-wide audit of the potential for deceased donation
• DBD • DCD
– ICUs and Emergency Departments – Up to age of 80 years (around 30 000 deaths annually) – Data collected by transplant coordinators
• Objectives – Describe potential for deceased donation in UK
• Identify where and why the potential for donation is lost • Inform high level interventions
Potential Donor Audit
UK Potential Donor Audit
• History – Established in 2003 – UK-wide audit of the potential for deceased donation
• DBD • DCD
– ICUs and Emergency Departments – Up to age of 80 years (around 30 000 deaths annually) – Data collected by transplant coordinators
• Objectives – Describe potential for deceased donation in UK
• Identify where and why the potential for donation is lost • Inform high level interventions
– Performance management • Define actions to address ‘leakiness’
Potential Donor Audit
UK Potential Donor Audit
Key PDA domains
• Brain death – Preconditions
– Testing rate
– Confirmed
• Referral
• Family approach – Involvement of specialist nurse
• Consent
• Organ retrieval
UK Potential Donor Audit
DBD pathway 2013
Audited deaths 28966
Patient mechanically ventilated 15435
Fulfilled criteria for testing 1631
BSD tests not performed 363 1268
BSD not confirmed 25 1243
Absolute contraindication to donation 55 1188
Family not approached 88 1100
Family refusal 356 744
Retrieval did not happen 68 676
UK Potential Donor Audit
DBD pathway in UK, 2012-3 %
of p
oten
tial d
onor
s
0 10 20 30 40 50 60 70 80 90
100
Potential donors 1
Neurological death tests performed
Neurological death
confirmed Contraindications Family
approach Consent/
authorisation Donation
Figure 13.3
1 1 1
676 donors 41% conversion
22% 2% 4%
7%
32% 9%
Failure to test
Family refusal
Potential DBD donor: a patient who meets all criteria for neurological death testing
1631
UK Potential Donor Audit
0
500
1000
1500
2000
2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012
year
number
BSD possible BSD tested BSD confirmed
*
Incidence of brain-stem death in UK Audit of deaths in ICU (and ED*)
UK Potential Donor Audit
Reasons for not testing
UK Potential Donor Audit
Variation in brain-stem death testing
UK Potential Donor Audit
MC III DCD in UK 2013
Audited deaths 28966
Patient mechanically ventilated 15435
Treatment withdrawn and imminent death anticipated
6517
Absolute contraindication to donation 3403 3114
Family not approached 1298 1816
Family refusal 885 931
Retrieval did not happen 482 449
UK Potential Donor Audit
MC III DCD in UK, 2012-13 %
of p
oten
tial d
onor
s
0 10 20 30 40 50 60 70 80 90
100
Potential donors 1
Neurological death tests performed
Neurological death
confirmed Contraindications Family
approach Consent/
authorisation Donation
DCD, 449 donated (7% of potential donors, 14% of those not contraindicated)
52%
42%
49% 52%
Failure to refer
Family refusal
Potential DCD donor: a patient who had treatment withdrawn and death anticipated within 4 hours
6517
UK Potential Donor Audit
Donor hospitals Referral of potential DCD donors
Delays in decision making are recognised as an obstacle to the referral of ALL potential DCD donors.
UK Potential Donor Audit
Reasons for not referring to SN-OD
UK Potential Donor Audit
How do we use the data
• Strategic
– Annual report
– Presentations and Publications
– Strategy development
• Performance management
– Hospital reports
– ‘Club 32’
– Regional Collaborative meetings
– Performance management framework
http://www.odt.nhs.uk/uk-transplant-registry/annual-activity-report/
UK Potential Donor Audit
• Every six months, • Sent to Chief Executive
– Copied to Hospital Donation Committee
• Executive Summary (2 pages) – High level data
• Detailed report (20 pages) – Contains donor outcomes, key rates
on potential for organ donation and each of the stages where opportunities were lost
• Published on-line
Hospital Reports
UK Potential Donor Audit
Executive Summary
UK Potential Donor Audit
Executive Summary
UK Potential Donor Audit
Executive Summary
UK Potential Donor Audit
• 2-3 meetings per year – Specialist nurses – Clinical leads for donation – Hospital Donation
Committee chairs • Summary PDA data for the
region with comparative data from other teams
Regional Collaboratives
UK Potential Donor Audit
Brain-stem death testing 2013-14
79%
UK Potential Donor Audit
Referral of potential DCD donors 2013-14
70%
UK Potential Donor Audit
But………..?
Potential DBD pool Actual DBD
donors
Spain ≈ 50 32
UK 19.9 (26.1) 12.5
per million population, 2013
How can the potential for DBD vary so much?
UK Potential Donor Audit
Summary
• Important overview of donation in UK • Data collection maintains focus on donation in acute
hospitals – Resource hungry
• Greater subjective element than appreciated – Possibility of variation between regions – Performance or measurement?
• Places emphasis on conversion rather than donors pmp – Implications of variations in end of life care may be invisible
