South Central Regional Collaborative Stretch Goal

The Purpose The purpose of the Regional Collaborative is to work toward The Taking Organ Transplantation to 2020 Strategy (TOT2020) that seeks to make the UK a world leader in organ donation and transplantation. International evidence shows that regional collaboratives start strong and were the drivers of much change, however they become less effective over time.

Our Stretch Goal Early Identification/Notification of patients where end of life care decisions are likely to be made in the next 24 hours to the SNOD. Reasons why - Timely SNOD presence on the unit – no one waiting - Normalising organ donation conversation as part of end of life care, regardless of the potential for donation. - Improved consent rates - Improved resource allocation

Trends in South Central DCD rates 1 April 2010 to 30 September 2015, data as at 8 October 2015

Congratulations SOUTH CENTRAL

South Central DCD referral rate 1 April 2014 to 31 March 2015, data as at 8 April 2015 LAST TIME

South Central DCD referral rate 1 April 2015 to 30 September 2015, data as at 8 October 2015 This TIME

Challenge SOUTH CENTRAL

DCD referral rate 1 April 2015 to 30 September 2015, data as at 8 October 2015 # 11

South Central DCD referral rate 1 April 2015 to 30 September 2015, data as at 8 October 2015

DCD SN-OD involved 1 April 2015 to 30 September 2015, data as at 8 October 2015

South Central DCD SN-OD involved 1 April 2015 to 30 September 2015, data as at 8 October 2015

Survey Monkey Results Sent to all Consultants and Senior Nurses in ICU’s and ED KEY FINDINGS: Is there anything that would prevent you from notifying the SNOD team before formally discussing withdrawal of treatment with the family? -27% believe the patient to be medically contraindicated -15% did not consider organ donation as a possibility

Recent and Future Changes DCD assessment - To identify an evidence base for exclusion criteria applicable to DCD donation -Applied following the current absolute contraindications -Aims to improve the process of referral and assessment -Allows for reallocation of resources to target potential donors that would be more likely to donate. -Commencing December DCD Triage -Informal enquiries to 2 centre's

Survey Monkey (2) Is there anything that would prevent you from notifying the SNOD team before formally discussing withdrawal of treatment with the family? 12% not in the patients best interests 11% Believe the family to be too upset “son died 3 days ago and no one at hospital approached the family regarding organ donation. they'd like some advice and someone to speak to regarding it”

81. If a patient is close to death and their views cannot be determined, you should be prepared to explore with those close to them whether they had expressed any views about organ or tissue donation, if donation is likely to be a possibility. 82. You should follow any national procedures for identifying potential organ donors and, in appropriate cases, for notifying the local transplant coordinator. You must take account of the requirements in relevant legislation and in any supporting codes of practice, in any discussions that you have with the patient or those close to them. You should make clear that any decision about whether the patient would be a suitable candidate for donation would be made by the transplant coordinator or team, and not by you and the team providing treatment. 1/3 of DCD referrals, family raised subject of donation prior to approach. GMC End of Life care: Organ Donation

New Organ Donor Register Ascertain what a individual’s wishes are in relation to organ donation. NB: can now register: A decision to be a donor A decision not to be a donor A decision to appoint/nominate a representative to make a decision about organ donation after the person’s death

Moving forward... The next 6 months Team Managers holding on call pager Mon – Fri, 9:00am – 5:00pm Implementation DCD assessment (December 2015) Ongoing DCD screening calls by embedded and on call SNOD’s Ongoing review of hospital’s preferred identification method Early notification – review – timely mobilisation – SNOD available on unit SNOD presence in BBN

We welcome your thoughts, comments and suggestions.