1. Title of presentation Implementing DCD Barriers and solutions VPNG 51 st State Conference 30 th July 2015 Nicky Stitt Donation Specialist Nursing Coordinator Monash Health

2. The Australian Organ and Tissue Authority established on 1 January 2009 (Australian Organ and Tissue Donation and Transplantation Authority Act 2008) An independent statutory authority Established to provide national leadership and to drive the National Reform Package The Authority

3. Key Objectives Increase capacity in hospitals Raise awareness of pathways and donation processes Provide staff with skills to support donor families Increase donation rates Raise awareness in the Australian community Encourage family discussion Identify potential donors, raise donation and support families to make an informed decision

4. Deceased organ donors 2009-2014

5. Donation Pathways Donation after Brain Death (DBD) – ANZICS Statement on Death and Organ Donation 1 Donation after Circulatory Death (DCD) –National Protocol for Donation after Cardiac Death 2 –ANZICS Statement on Death and Organ Donation

6. What is DCD?  Donation of organs from patients declared dead by cardio-pulmonary criteria  Prior to the introduction of brain death into law in the early 80’s, all organ transplants from deceased donors came from non-heart beating donors (NHBD)  Internationally now referred to as Donation after Circulatory Death- (DCD)

7. DCD history  Abandoned since adoption of brain death criteria  Organs from brain dead donors had better survival rates  Dissatisfaction with the process  Refocus on DCD  Public demand  Shortage of organs  Improved surgical and preservation techniques

8. Benefits of DCD  More organs are available for transplantation  Allows families to consider donation in scenarios where  Patients thought unlikely to progress to brain death  Families not accepting of brain death diagnosis  Families of brain dead patient who wish to be with loved one when heart stops  Fulfils patient’s wishes  Meets community expectations

9. ANZOD data: www.anzdata.org.au/anzod DCD versus BD donors

10.  Largest public health service in Victoria  Advanced neuro/cardiac services  Renal pancreas Transplant centre

11.  AOTA release national protocol for DCD  Provided Guidelines only  Decentralised health in Victoria  Individual hospitals to create own CPG

12. BRICK WALL

14. Minimum requirements for a facility to implement DCD  Institutional commitment to DCD  Clinical leadership, accountability & governance  Internal policy/procedure approved by hospital executive – notification to Donatelife Victoria  Relevant expertise  ICU & OR  access to supportive & diagnostic services  Multidisciplinary education campaign of key stakeholders

15. Development of DCD Program Guideline DCD program working party –ICU, Anaesthetics, theatre, perfusionists, medical administration/executive, legal, ethics, allied health –Develop internal guidelines –Review outcomes and lessons learnt

16. Strategic Priorities  Hospital engagement  Building relationships  Establishing policies  Education saturation  Normalising donation Getting our message out there…

17. Strategic Priorities Engagement of key staff Development of policies & procedures Education Education Education!

18. Mission Impossible Reached!! We have Implemented DCD We have a team approach to any DCD case We have a team approach to any DCD Case We Continue with engagement and education

19. Deceased donors by donation pathway 2009-2014

20. Success.

21. Before transplantation After transplantation

22. Thank You