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
2 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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.
4 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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
Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 5 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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
6 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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)
Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 7 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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%
Total NSW HospitalsTSR
Royal North ShoreRoyal Prince Alfred
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)
8 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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
2
13
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%
Total NSW HospitalsTSR
Royal North ShoreRoyal Prince Alfred
ONMLKJI
HGFEDCBA
Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 9 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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.
10 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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
Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 11 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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.
12 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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
Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 13 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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%
20%
10%
0
RPA Organ Donation Rates Trajectory
Actual Donation Rate (%)Forecast Donation Rate (%)
Actual Consent Rate (%)Forecast Consent Rate (%)
14 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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wel
com
ing
– te
a &
coffe
e fa
ciliti
es, T
V, lo
unge
GM
RPA
/ Dire
ctor
of
Eng
inee
ring
$15,
000
Wai
ting
room
reno
vatio
ns
com
plet
ed a
s per
sta
ted
requ
irem
ents
Appendix
Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 15 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
Organ Donation for Transplantation PlanO
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
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
16 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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
Organ Donation for Transplantation Plan
Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 17 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
Organ Donation for Transplantation PlanO
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
Organ Donation for Transplantation Plan
18 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
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
Organ Donation for Transplantation Plan
Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017 19 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
Organ Donation for Transplantation PlanO
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
Organ Donation for Transplantation Plan
20 Sydney Local Health District Organ Donation for Transplantation Plan 2014-2017
Organ Donation for Transplantation PlanO
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
Organ Donation for Transplantation Plan
June 2014