1. Organ Donation & Transplantation in Ireland – Changing times Aileen Counihan Transplant Co-ordinator Beaumont Hospital Beaumont Hospital

2. Organ Procurement Centre Team National Service for Organ Procurement –Current Location – Beaumont Hospital Donor Coordinating Team –24hr on call service for ICUs nationally Recipient Co-ordination –24hr call for renal transplant service

3. The Donor Co-ordinator Role 24hr call to deal with all enquiries pertaining to Organ Donation 24hr call to deal with all enquiries pertaining to Organ Donation Responsible for the technical and logistical arrangements. Involved in the donation process from referral, retrieval & to the transplantation of the organs. –Care of the Donor, the Family of the Donor, the Donor Hospital staff, the Transplant Team, & Transplant recipients.

4. Recipient Co-ordinator Role Referral for Renal & Pancreas Transplant Management of Transplant waiting list Coordination of Deceased Donor Transplants Live Donor Transplant Programme

5. Kidney Transplantation Kidney transplantation is considered the best treatment option for patients in end stage renal failure Not all patients are suitable for transplant Not all patients are suitable for transplant –Only 33% of patients with kidney failure are on transplant waiting list

6. When transplant is not the best option Clinical reasons : –History of recent cancer –Major surgery –Severe cardiac problems or advanced blood vessel disease Patient choice: –decide that transplantation is not for them. –can opt to stay on dialysis.

7. Renal Transplantation Live Donor Transplant – from a family member/spouse/friend –Paired Exchange Deceased Donor Transplant – Brain Death Donor –Non Heart Beating Donor.

8. Recipient Evaluation for Transplant Recipient Evaluation for Transplant Standard workup : –Full Blood Profile –Tissue type x 2 –Virology < 3mths –Chest Xray & Abdo U/sound –Cardiac Tests, Stress ECG, Cardiac Echo –Coronary Angio ( if indicated) –Dental Clearance –Smear Test for female patients –PSA for men > 50yrs Other tests determined by age/cause of failure –Copy of all results to Transplant Office with a detailed referral letter

9. Evaluation for Transplant Some patients may require further assessment Test results may require further investigation. Patient is sent an appointment with an information booklet about transplant All patients are seen at the transplant assessment clinic in Beaumont Meet with Transplant Surgeon & Co-ordinator

10. Pre-Transplant Clinic Assess suitability for transplant Surgery explained Opportunity to ask questions, encourage patients to bring someone with them to clinic Option of Live Donation given Importance of contactability, urgency, keeping healthy & well reiterated Follow up phone call Letter to patient to inform approved for Transplant & regular blood samples for antibody screening while on the pool Letter from H&I when activated

11. Further Screening –Other tests may be required –Anaesthetic assessment –Patients to lose weight or to monitor weight –Reassurance while on the list –Patients over 2 years –Patients suspended for a prolonged period of time –Older patients

12. Waiting Time Currently 29 months. Factors influencing time on list –Patients with a high antibody level –Patient BMI –Increasing number of patients on list –Donor supply

13. Acknowledging the Donation Donor and donor family will be foremost on recipients’ mind Donor and donor family will be foremost on recipients’ mind Anonymity Maintained Anonymity Maintained –Encourage recipients to write to donor family and can be done via the Transplant Co-ordinators Information leaflet Information leaflet Attend the Annual Service of Remembrance and Thanksgiving Circle Of Life Garden in Salthill

15. Organ Donor Web Site Donor Families shared experiences Transplant Recipient success stories Gratitude of Recipients & Comfort received by Donor Families Commemorative Garden

17. Statistics Deceased Donors/Transplants in Ireland (Organ Procurement Centre)

18. Potential Live Donor Patients will be asked if they wished to consider a Live Donor Transplant Potential donors to contact the transplant co-ordinators directly Initial suitability would be discussed with them – Blood Group Compatible Arrangements made for H&I screening Information on Live donation given Only one donor can go forward to workup

19. Live Kidney Donation Donor must be fully informed and aware of risks and benefits of procedure No risk to the potential donor The decision to donate must be voluntary, no coercion or inducement The transplant must have a good chance of providing a good outcome for the recipient. Ethical Issue –Exposes an otherwise healthy person to the risks of major surgery entirely for the physical benefit of another individual

20. Living Donation Programme

21. Information for Live Donor Recipient Donor work up period 3 months approx –Medical suitability, extensive screening – Immunological screening – Independent clinical & psychological review Donor work up confidential Isolating period for recipient Recipient remains under the care of nephrology team Suspended from list, when donor deemed suitable Setting date for surgery

22. LRD and Deceased Renal Transplant activity in Ireland

25. Changing Role of Transplant Office No responsibility for Organ Procurement –Perceived conflict of interest –Independent Service Recipient Coordination –24 hour on call for renal/pancreas transplant –Liaise with Renal Unit Staff –Patient education Co-ordinate Live Donation Programme

26. Responsibility of Transplant Office Co-ordination of Renal/Pancreas Transplantation Patient in workup -Referral -Further review -Activation on list Patient on pool -Health status -Weight -Contact details -Suspension Live donation -Donor referral -Co-ordinate donor workup -Referral for PKE

27. Organ Procurement Office Donor Co-ordinators HSE Team Renal/Pancreas Transplant Centre -Referral Liver Transplant Centre -Referral Heart & Lung Transplant Centre - Referral

28. Thank You All Further information www.beaumont.ie www.beaumont.iewww.beaumont.ie www.icmed.com www.strangeboat.org www.ika.ie www.coe.int