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Organ donation Implementing NICE guidance December 2011 NICE clinical guideline 135.

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Presentation on theme: "Organ donation Implementing NICE guidance December 2011 NICE clinical guideline 135."— Presentation transcript:

1 Organ donation Implementing NICE guidance December 2011 NICE clinical guideline 135

2 What this presentation covers Background Aim Patient-centred care Evidence Recommendations Costs and savings Discussion NICE Pathway Find out more

3 Background 90% of the population support organ donation but actual donation rate is poor Organ donation has a major role in the management of organ failure Too few organs means long waits, costly treatment and many potentially avoidable deaths

4 Aim of the guideline To promote the identification and fulfilment of those that wish to donate organs To improve: identification and referral of potential donors approach to consent for donation consideration of donation as part of standard end-of-life care planning

5 Patient- centred care Consider peoples needs, preferences, wishes and beliefs People at the end of life should have opportunity to make informed decisions about their care Usually, parents, families and guardians should be involved in decisions about consent

6 Evidence Organ donation for transplantation is a complex area and one to which conventional clinical research methods cannot be easily applied The evidence used was mainly qualitative and does not lend itself to conventional use of GRADE assessment

7 Being prepared: actions Each hospital should have: A policy and protocol to identify potential donors and manage consent A clinical team to develop, implement and review policies A named lead consultant Multidisciplinary teams (MDTs) with the necessary skills and competencies

8 Being prepared: skills and competencies 1 All healthcare professionals Knowledge of donation after circulatory death versus donation after brainstem death Understand diagnosis of death Able to explain neurological death Understand use of clinical triggers Understand relevant processes, polices and protocols Adhere to relevant professional standards

9 Being prepared: skills and competencies 2 Consultant staff Law & medical ethics Diagnosis and confirmation of death Greater potential for transplantation of organs retrieved after brainstem death Appropriate clinical techniques Communication skills

10 The multidisciplinary team (MDT) An MDT responsible for planning the approach and discussing organ donation with those close to the patient should include: the medical and nursing staff involved in the care of the patient the specialist nurse for organ donation local faith representative(s) if relevant

11 Criteria for identification Identify all potential donors early by either: defined clinical trigger factors after catastrophic brain injury: –absence of one or more cranial nerve reflexes and –Glasgow coma scale score of 4 or less not explained by sedation or intention to withdraw life-sustaining treatment, which will, or is expected to, result in circulatory death

12 Capacity In circumstances where a patient has capacity to make their own decisions, obtain their views on, and seek consent to, organ donation

13 Assessing the patients best interests: 1 If a patient lacks capacity to make decisions about their end-of-life care, seek to establish whether organ donation would be in their best interests While assessing a patients best interests, clinically stabilise them in an appropriate critical care setting If delay is in the patients overall best interests, continue life-sustaining treatments until donation potential has been assessed

14 In assessing a patients best interests, consider the: patients known wishes and feelings patients beliefs and values views of the patients family, friends and others views of anyone named by the patient to be consulted about such decisions Assessing the patients best interests: 2

15 Seeking consent: 1 If a patient lacks the capacity to consent to organ donation seek to establish the patients prior consent by: referring to an advance statement if available establishing whether the patient has registered and recorded their consent to donate on the NHS organ donor register and exploring with those close to the patient whether the patient had expressed any views about organ donation

16 Seeking consent: 2 If the patient's prior consent has not already been ascertained, and in the absence of a person or person having been appointed as nominated representative(s), consent for organ donation should be sought from those in a qualifying relationship with the patient Where a nominated representative has been appointed and the person had not already made a decision about donation prior to their death, then consent should be sought after death from the said nominated representative(s)

17 A qualifying relationship Qualifying relationship (hierarchical order) spouse or partner (including civil or same sex partner) parent or child (in this context a child can be any age) brother or sister grandparent or grandchild niece or nephew stepfather or stepmother half-brother or half-sister friend of long standing A person in a qualifying relationship can give consent for organ donation on behalf of a patient

18 Discussion – ALL cases When approaching those close to the patient: choose a suitable setting, be professional, compassionate and caring give them time separate discussions of withdrawal of treatment and death from donation discuss with them that donation is a usual part of the end-of-life care use open-ended questions/positive language avoid negative or apologetic language

19 Discussion: checklist Action In ALL cases, before approaching those close to the patients, seek information on ALL of the following : Identify patients potential for donation in consultation with the specialist nurse for organ donation key family members and family issues cultural and religious issues that may affect donation Obtain knowledge of the patients clinical history check NHS organ donor register, advance statement, lasting power of attorney for health and welfare Clarify coronial, legal and safeguarding issues Assess whether family support is needed

20 How death is confirmed and what happens next Provide a clear explanation on : Discussions when death is anticipated Circulatory deathNeurological death What end-of-life care involves and where it will take place How death is diagnosed using neurological criteria What happens if death does not occur within a defined time period

21 Those close to the patient should be provided with the following as appropriate: Assurance that the primary focus is on the care and dignity of the patient Reassurance regarding the standard of care Rationale behind the decision to withdraw or withhold life-sustaining treatment Clear explanation and information on process possible interventions arrangements current legislation coronial requirements Consent documentation Reasons why organ donation may not take place, even if consent is granted

22 Costs and savings No individual recommendations are considered likely to have a significant impact on NHS resources on their own. The cost impact of increasing the number of organ transplantations is expected to be significant at a national level. It is anticipated that the overall impact of the guideline will increase the number of organ donors and therefore the number of transplants that are carried out.

23 Local action Does our current policy and/or procedures reflect the recommendations in this guideline? How does our current practice need to change to reflect this guideline? Are potential donors identified and referred correctly? How does this differ for children? What training do we need so that we can implement this guideline effectively? What are the possible benefits of early (triggered) referral?

24 Click here to go to NICE Pathways website

25 Find out more Visit for guideline NICE pathway quick reference guide Understanding NICE guidance costing report and template baseline assessment clinical triggers poster clinical case scenarios

26 What do you think? Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice? We value your opinion and are looking for ways to improve our tools. Please complete a short evaluation form by clicking If you are experiencing problems accessing or using this tool, please To open the links in this slide – right click over the link and choose open hyperlink. NB. Not part of presentation

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