Detailed Full Report
Actual and Potential Organ Donors
1 April 2012 - 31 March 2013
LondonOrgan Donation Services Team
Table of Contents1. Donor outcomes1.1 Donors outcomes
2. Key rates on potential for organ donation2.1 Key rates2.2 Key numbers, rates and comparison with national target
3. Stages where opportunities are lost3.1 Overview of lost opportunities3.2 Neurological death testing3.3 Referral to SN-OD3.4 Contraindications3.5 Family approach3.6 Proportion of approaches involving a SN-OD3.7 Consent3.8 Reasons why solid organ donation did not occur
4. PDA data by Trust4.1 Key numbers and rates by Trust
AppendicesA.1 Radar charts of key ratesA.2 DefinitionsA.3 Data descriptionA.4 Table and figure description
Further Information
· Appendix A.2 contains definitions of terms and abbreviations used throughout this report· The latest Organ Donation and Transplantation Activity Report is available at· http://www.organdonation.nhs.uk/ukt/statistics/transplant_activity_report/· The latest PDA Annual Report is available at http://www.organdonation.nhs.uk/ukt/statistics/potential_donor_audit/· Please refer any queries or requests for further information to your local Specialist Nurse - Organ Donation (SN-OD)
Source
NHS Blood and Transplant: UK Transplant Registry (UKTR), Potential Donor Audit (PDA) and Referral Record.Issued July 2013 based on data reported at 6 June 2013.
3
1. Donor OutcomesA summary of the number of donors, patients transplanted, average number of organs
donated per donor and organs donated, obtained from the UK Transplant Registry
1.1 Donor outcomes
Between 1 April 2012 and 31 March 2013, the London Organ Donation Services Team (ODST) had 152 deceased solidorgan donors, resulting in 388 patients receiving a transplant. 509 organs were donated but 72 were not transplanted.Additional information is shown in Tables 1.1.1 and 1.1.2, along with comparison data for 2011/12. If you would likefurther information, please contact your local Specialist Nurse - Organ Donation (SN-OD).
Table 1.1.1 Donors, patients transplanted and organs per donor,Table 1.1.1 1 April 2012 - 31 March 2013 (1 April 2011 - 31 March 2012 for comparison)
Number ofNumber of
patientsAverage number of organs
donated per donorDonor type donors transplanted Team UK
DBD 93 (87) 282 (267) 3.8 (4.0) 3.9 (4.0) -DCD 59 (45) 106 (87) 2.7 (2.8) 2.6 (2.6) -
Table 1.1.2 Organs transplanted by type,Table 1.1.2 1 April 2012 - 31 March 2013 (1 April 2011 - 31 March 2012 for comparison)
Number of organs transplanted by typeDonor type Kidney Pancreas Liver Heart Lung
DBD 168 (136) 25 (33) 77 (79) 17 (23) 26 (41) -DCD 98 (66) 6 (10) 12 (21) 8 (4) -
Data in this section have been obtained from the UK Transplant Registry. Section 2 onwards reports on data obtainedfrom the national Potential Donor Audit (PDA).
4
2. Key Rates onPotential for Organ Donation
A summary of the key rates on the potential for organ donation, obtained from thenational Potential Donor Audit (PDA)
2.1 Key rates
Four bar charts are displayed in Figure 2.1.1 showing specific percentage measures of potential donation activity in2012/13 for the London ODST compared with national data for the UK, and compared with 2011/12 activity. Thisinformation is displayed in an alternative format as radar charts in Appendix A.1.
Figure 2.1.1 Key rates on the potential for organ donation,Figure 2.1.1 1 April 2012 - 31 March 2013 (1 April 2011 - 31 March 2012 for comparison)
5
2.2 Key numbers, rates and comparison with national targets
The percentages shown in Figure 2.1.1 are also shown in Table 2.2.1 along with the number of patients at each stage. Anational comparison and a time period comparison are again provided. A comparison against national DBD and DCDtargets has been applied by highlighting the key rates for your Team as red, amber or green. See Appendix A.4 forranges used. Note that caution should be applied when interpreting percentages based on small numbers.
Table 2.2.1 Key numbers, rates and comparison with national targets,Table 2.2.1 1 April 2012 - 31 March 2013 (1 April 2011 - 31 March 2012 for comparison)
DBD DCD
2012/13 2011/12 2012/13 2011/12
Team UK Team UK Team UK Team UK
Patients meeting organ donation referral criteria1 260 1,631 258 1,661 594 6,960 692 6,902
Referred to SN-OD 251 1,493 245 1,507 427 4,344 397 3,628
Referral rate % G 97% 92% 95% 91% G 72% 62% 57% 53%
Neurological death tested 212 1,268 187 1,233
Testing rate % G 82% 78% 72% 74%
Eligible donors2 199 1,188 180 1,169 303 3,114 332 2,933
Family approached 175 1,100 171 1,090 189 1,816 190 1,598
Approach rate % R 88% 93% 95% 93% G 62% 58% 57% 54%
Family approached and SN-OD involved 160 868 148 775 161 1,212 141 925
% of approaches where SN-OD involved G 91% 79% 87% 71% G 85% 67% 74% 58%
Consent given 100 744 93 694 98 931 78 794
Consent rate % R 57% 68% 54% 64% R 52% 51% 41% 50%
Expected consents based on ethnic mix 106 91 89 83
Expected consent rate based on ethnic mix % 61% 54% 48% 45%
Actual donors from each pathway 88 676 83 636 51 449 37 390
% of consented donors that became actual donors 88% 91% 89% 92% 52% 48% 47% 49%
Colour key - comparison with national targets R Red A Amber G Green
1 DBD - A patient with suspected neurological death1 DCD - A patient in whom imminent death is anticipated, ie a patient receiving assisted ventilation, a clinical decision to withdraw treatment has1 DCD - been made and death is anticipated within 4 hours
2 DBD - Death confirmed by neurological tests and no absolute contraindications to solid organ donation2 DCD - Imminent death anticipated and treatment withdrawn with no absolute contraindications to solid organ donation
Note that from 1 April 2012 to 31 March 2013 there were 7 eligible DBD donors and 11 eligible DCD donors whose familyconsented to donation who are not included in this section because they were either over 75 years of age or did not die ina unit participating in the PDA.
6
3. Stages WhereOpportunities were Lost
Stages at which potential donors lost the opportunity to become actual donors
3.1 Overview of lost opportunities
Of the 260 potential DBD donors with suspected neurological death, 88 proceeded to donation and 172 did not proceed.Of the 303 eligible DCD donors, 51 proceeded to donation and 252 did not proceed.
Figure 3.1.1 gives an overview of the various stages where opportunities were lost. There are four charts showing DBDand DCD stages separately for the London ODST and the UK, all of which contain a comparison with 2011/12. Thenumber of potential donors is shown on the vertical axis for each chart and at each 'step' the proportion of potentialdonors lost at that stage is displayed. Caution should be applied when interpreting percentages based on small numbers.Further information is available for individual Trusts in Tables 4.1.1 and 4.1.2 in Section 4.
Figure 3.1.1 Stages at which potential donors lost the opportunity to become actual donors,Figure 3.1.1 1 April 2012 - 31 March 2013 (1 April 2011 - 31 March 2012 for comparison)
7
3.2 Neurological death testing
A funnel plot of neurological death testing rates is displayed in Figure 3.2.1. The national target for 2012/13 of 78% is alsoshown on the funnel plot, for information, but the goal is to ensure that neurological death tests are performed whereverpossible. For information about how to interpret the funnel plots, please see Appendix A.4.
Figure 3.2.1 Funnel plot of neurological death testing rates, 1 April 2012 - 31 March 2013
DBD
Table 3.2.1 shows the reasons why neurological death tests were not performed, if applicable, for your Team.
Table 3.2.1 Reasons given for neurological death tests not being performed,Table 3.2.1 1 April 2012 - 31 March 2013
N %
Family declined donation 3 6.3Family pressure not to test 1 2.1Treatment withdrawn 2 4.2Cardiac arrest despite resuscitation 6 12.5Patient haemodynamically unstable 14 29.2Continuing effects of sedatives 4 8.3Biochemical/endocrine abnormality 8 16.7Brain stem reflexes returned 1 2.1Inability to test all reflexes 1 2.1Neonates - Less than 2 months post term 2 4.2Clinical reason/Clinicians decision 4 8.3Medical contraindication to donation 2 4.2
Total 48 100.0
If 'other', please contact your local SN-OD for more information, if required.
8
3.3 Referral to Specialist Nurse - Organ Donation (SN-OD)
Funnel plots of DBD and DCD referral rates are displayed in Figure 3.3.1. The 2012/13 national targets of 91% and 52%for DBD and DCD, respectively, are also shown on the funnel plots, for information. Every patient who meets the referralcriteria should be identified and referred to the SN-OD, as per NHS Blood and Transplant (NHSBT) Best PracticeGuidance on timely identification and referral of potential organ donors1.
Figure 3.3.1 Funnel plots of referral rates, 1 April 2012 - 31 March 2013
DBD DCD
Table 3.3.1 shows the reasons why patients were not referred to a SN-OD, if applicable, for your Team.
Table 3.3.1 Reasons given why patient not referred, 1 April 2012 - 31 March 2013
DBD DCDN % N %
Not identified as a potential donor/organ donation not considered 3 33.3 45 26.9Family declined donation prior to neurological testing 1 11.1 - -Family declined donation after neurological testing 1 11.1 - -Family declined donation following decision to withdraw treatment - - 4 2.4Reluctance to approach family - - 1 0.6Medical contraindications 1 11.1 82 49.1Thought to be medically unsuitable 1 11.1 24 14.4Pressure on ICU beds - - 1 0.6Other 2 22.2 10 6.0
Total 9 100.0 167 100.0
If 'other' or 'medical contraindications', please contact your local SN-OD for more information, if required.
9
Early referral to the SN-OD is important to enable the opportunity for donation to be maximised. Early referral triggersshould be in place to ensure all donors are identified to the SN-OD to allow the family the option of organ donation. Forpatients who were referred, Table 3.3.2 shows the timing of the first contact with the SN-OD by the clinical staff. Allpatients meeting the referral criteria should be referred as early as possible to enable attendance of the SN-OD to assesssuitability for donation and ensure that a planned approach for consent to the family is made in line with NHSBT BestPractice Guidance on approaching the families of potential organ donors2.
Table 3.3.2 Timing of first contact with a SN-OD by clinical staff, for patients who were referred,Table 3.3.2 1 April 2012 - 31 March 2013
DBD DCDN % N %
Before sedation stopped 22 8.8 29 6.8No sedation or after sedation stopped, decision made to carry outBSD tests, before 1st set of tests
179 71.3 15 3.5
After 1st set and before 2nd set of BSD tests 6 2.4 1 0.2After neurological death confirmation 8 3.2 - 0.0Clinical decision to withdraw life-sustaining treatment has beenmade, before treatment withdrawn
33 13.1 367 85.9
After treatment withdrawn 1 0.4 14 3.3Absence of one or more cranial nerve reflexes and GCS of 4 orless not explained by sedation
2 0.8 1 0.2
Total 251 100.0 427 100.0
NB, 31 patients with suspected neurological death also went on to meet the referral criteria for DCDdonation, and are therefore included twice.
1 NHS Blood and Transplant, 2012. Timely Identification and Referral of Potential Organ Donors - A Strategy forImplementation of Best Practice [online]. Available at: <http://www.odt.nhs.uk/pdf/timely-identification-and-referral-potential-donors.pdf> [accessed 13 May 2013]
2 NHS Blood and Transplant, 2013. Approaching the Families of Potential Organ Donors – Best Practice Guidance[online]. Available at: <http://www.odt.nhs.uk/pdf/family_approach_best_practice_guide.pdf> [accessed 13 May 2013]
10
3.4 Contraindications
Table 3.4.1 shows the primary absolute medical contraindications to solid organ donation, if applicable, for potential DBDdonors confirmed dead by neurological death tests and potential DCD donors in your Team.
Table 3.4.1 Primary absolute medical contraindications to solid organ donation,Table 3.4.1 1 April 2012 - 31 March 2013
DBD DCD
Known HIV positive 2 5Any malignancy within the past 12 months, excluding brain tumour 6 108Multi-organ failure 2 130Active untreated tuberculosis 2 6
Total 12 249
11
3.5 Family approach
Funnel plots of DBD and DCD family approach rates are displayed in Figure 3.5.1. The 2012/13 national targets of 93.5%and 61.5% for DBD and DCD, respectively, are also shown on the plots, for information. All families of eligible donorsshould be formally approached for a decision about organ donation.
Figure 3.5.1 Funnel plots of approach rates, 1 April 2012 - 31 March 2013
DBD DCD
Table 3.5.1 shows the reasons why patients were not formally approached for a decision about organ donation, ifapplicable, for your Team.
Table 3.5.1 Reasons given why family not formally approached, 1 April 2012 - 31 March 2013
DBD DCDN % N %
Family stated that they would not consent/authorise before theywere formally approached
1 4.2 2 1.8
Family untraceable 4 16.7 13 11.4Coroner/Procurator Fiscal refused permission 8 33.3 10 8.8Patient's general medical condition 3 12.5 21 18.4Other medical reason 1 4.2 8 7.0Other 7 29.2 53 46.5Not identified as a potential donor / organ donation notconsidered
- - 7 6.1
Total 24 100.0 114 100.0
If 'other', please contact your local SN-OD for more information, if required.
12
3.6 Proportion of approaches involving a SN-OD
In the UK, in 2012/13, when a SN-OD was not involved in the approach to the family for a decision about organ donation,DBD and DCD consent rates were 52% and 31%, respectively, compared with DBD and DCD consent rates of 72% and61%, respectively, when a SN-OD was involved. NHSBT Best Practice Guidance on approaching the families of potentialorgan donors2 reinforces that every approach to those close to the patient should be planned with the multidisciplinaryteam (MDT), should involve the SN-OD and should be clearly planned taking into account the known wishes of thepatient. The Organ Donor Register (ODR) should be checked in all cases of potential donation and this information mustbe discussed with the family as it represents the eligible donor's legal consent to donation.
Funnel plots of DBD and DCD SN-OD involvement rates are displayed in Figure 3.6.1. The 2012/13 national targets of75% and 60% for DBD and DCD, respectively, are also shown, for information. A SN-OD should be actively involved inthe formal approach to the family and an approach plan made and followed.
Figure 3.6.1 Funnel plots of SN-OD involvement rates, 1 April 2012 - 31 March 2013
DBD DCD
13
3.7 Consent
Funnel plots of DBD and DCD consent rates are displayed in Figure 3.7.1. The 2012/13 national targets of 67% and 55%for DBD and DCD, respectively, are also shown, for information.
Figure 3.7.1 Funnel plot of consent rates, 1 April 2012 - 31 March 2013
DBD DCD
Table 3.7.1 shows the reasons why families did not give consent, if applicable, for your Team.
Table 3.7.1 Reasons given why family did not give consent, 1 April 2012 - 31 March 2013
DBD DCDN % N %
Patient had stated in the past that they did not wish to be a donor 12 16.0 16 17.6Family were not sure whether the patient would have agreed todonation
5 6.7 12 13.2
Family did not believe in donation 5 6.7 3 3.3Family felt it was against their religious/cultural beliefs 17 22.7 7 7.7Family were divided over the decision - - 7 7.7Family felt the patient had suffered enough 6 8.0 6 6.6Family did not want surgery to the body 12 16.0 4 4.4Family wanted to stay with the patient after death 2 2.7 2 2.2Family had difficulty understanding/accepting neurological testing 1 1.3 - -Family felt the length of time for donation process was too long 2 2.7 11 12.1Family felt the body needs to be buried whole (unrelated toreligious or cultural reasons)
4 5.3 8 8.8
Family concerned that organs may not be transplanted 1 1.3 1 1.1Families concerned about organ allocation - - 1 1.1Strong refusal - probing not appropriate 4 5.3 6 6.6Other 4 5.3 7 7.7
Total 75 100.0 91 100.0
If 'other', please contact your local SN-OD for more information, if required.
14
3.8 Reasons why solid organ donation did not occur
Table 3.8.1 shows the reasons why solid organ donation did not occur, if applicable, for your Team.
Table 3.8.1 Reasons why solid organ donation did not occur, 1 April 2012 - 31 March 2013
DBD DCDN % N %
Family changed mind 1 8.3 2 4.3Coroner/ Procurator Fiscal refusal 6 50.0 2 4.3Organs deemed medically unsuitable by recipient centres 2 16.7 19 40.4Organs deemed medically unsuitable on surgical inspection - - 1 2.1Prolonged time to asystole - - 19 40.4Cardiac arrest 2 16.7 1 2.1General instability - - 1 2.1Positive virology - - 2 4.3Other 1 8.3 - -
Total 12 100.0 47 100.0
If 'other', please contact your local SN-OD for more information, if required.
15
4. PDA data by TrustA summary of key numbers and rates from the PDA by Trust
4.1 Key numbers and rates by Trust
Tables 4.1.1 and 4.1.2 show the key numbers and rates for patients who met the DBD and/or DCD referral criteria,respectively. Caution should be applied when interpreting percentages based on small numbers.
Table 4.1.1 Patients who met the DBD referral criteria - key numbers and rates,Table 4.1.1 1 April 2012 - 31 March 2013 (1 April 2011 - 31 March 2012 for comparison)
Number ofpatientswhere
neurologicaldeath wassuspected
Numberof patientsthat were
tested
Neurologicaldeath
testing rate(%)
Number ofpatientswhere
neurologicaldeath wassuspectedthat werereferred to
SN-OD
DBDreferralrate (%)
Number ofpatients
confirmeddead by
neurologicaltesting
Numberof eligible
DBD
Number ofeligible
DBD whosefamily wereapproached
DBDapproachrate (%)
Number offamilies
consentingdonation
DBDconsentrate (%)
Numberof actualDBD andDCD from
eligibleDBD
%of DBD
app. inv.SN-OD
1 April 2012 to 31 March 2013
Barking, Havering and Redbridge University Hospitals NHS Trust
31 25 81 29 94 24 23 22 96 13 59 11 100
Barnet and Chase Farm Hospitals NHS Trust
7 4 57 7 100 4 4 4 100 2 50 2 100
Barts Health NHS Trust
41 35 85 41 100 35 35 30 86 14 47 12 97
Chelsea and Westminster Hospital NHS Foundation Trust
3 1 33 3 100 1 1 1 100 1 100 1 100
Ealing Hospital NHS Trust
2 1 50 2 100 1 1 1 100 0 0 0 100
Great Ormond Street Hospital For Children NHS Trust
5 3 60 4 80 3 2 2 100 1 50 0 50
Guy's and St Thomas' NHS Foundation Trust
8 8 100 8 100 8 6 6 100 4 67 4 50
Homerton University Hospital NHS Foundation Trust
4 3 75 4 100 3 3 3 100 0 0 0 100
Imperial College Healthcare NHS Trust
31 24 77 26 84 24 20 13 65 5 38 5 92
King's College Hospital NHS Foundation Trust
56 46 82 56 100 46 44 41 93 25 61 22 95
Lewisham Healthcare NHS Trust
1 0 0 0 0 0 0 0 - 0 - 0 -
North Middlesex University Hospital NHS Trust
3 3 100 3 100 3 3 3 100 2 67 1 100
North West London Hospitals NHS Trust
8 6 75 8 100 6 6 6 100 6 100 6 67
Royal Free London NHS Foundation Trust
14 11 79 14 100 11 9 7 78 4 57 4 100
Royal National Orthopaedic Hospital NHS Trust
0 0 - 0 - 0 0 0 - 0 - 0 -
The Hillingdon Hospitals NHS Foundation Trust
5 5 100 5 100 5 5 5 100 3 60 2 80
The Whittington Hospital NHS Trust
16
Number ofpatientswhere
neurologicaldeath wassuspected
Numberof patientsthat were
tested
Neurologicaldeath
testing rate(%)
Number ofpatientswhere
neurologicaldeath wassuspectedthat werereferred to
SN-OD
DBDreferralrate (%)
Number ofpatients
confirmeddead by
neurologicaltesting
Numberof eligible
DBD
Number ofeligible
DBD whosefamily wereapproached
DBDapproachrate (%)
Number offamilies
consentingdonation
DBDconsentrate (%)
Numberof actualDBD andDCD from
eligibleDBD
%of DBD
app. inv.SN-OD
3 3 100 3 100 3 3 1 33 0 0 0 0
University College London Hospitals NHS Foundation Trust
32 30 94 32 100 30 30 26 87 16 62 15 92
West Middlesex University Hospital NHS Trust
6 4 67 6 100 4 4 4 100 4 100 3 75
1 April 2011 to 31 March 2012 (for comparison purposes)
Barking, Havering and Redbridge University Hospitals NHS Trust
27 18 67 27 100 18 17 16 94 8 50 7 100
Barnet and Chase Farm Hospitals NHS Trust
11 6 55 8 73 6 6 6 100 1 17 1 100
Barts Health NHS Trust
49 39 80 47 96 39 37 36 97 21 58 19 92
Chelsea and Westminster Hospital NHS Foundation Trust
1 1 100 1 100 1 1 1 100 1 100 1 100
Ealing Hospital NHS Trust
2 2 100 2 100 2 2 2 100 0 0 0 100
Great Ormond Street Hospital For Children NHS Trust
6 2 33 4 67 2 2 2 100 2 100 2 100
Guy's and St Thomas' NHS Foundation Trust
11 6 55 9 82 6 6 6 100 5 83 5 17
Homerton University Hospital NHS Foundation Trust
0 0 - 0 - 0 0 0 - 0 - 0 -
Imperial College Healthcare NHS Trust
33 26 79 30 91 26 25 24 96 14 58 13 79
King's College Hospital NHS Foundation Trust
36 19 53 35 97 19 19 18 95 11 61 9 94
Lewisham Healthcare NHS Trust
2 1 50 2 100 1 1 1 100 0 0 0 100
North Middlesex University Hospital NHS Trust
5 5 100 5 100 5 4 4 100 2 50 2 100
North West London Hospitals NHS Trust
10 7 70 10 100 7 7 7 100 3 43 3 71
Royal Free London NHS Foundation Trust
17 11 65 17 100 11 10 9 90 4 44 4 100
Royal National Orthopaedic Hospital NHS Trust
1 1 100 1 100 1 1 1 100 1 100 1 100
The Hillingdon Hospitals NHS Foundation Trust
7 6 86 7 100 6 6 5 83 4 80 3 60
The Whittington Hospital NHS Trust
3 3 100 3 100 3 3 3 100 2 67 2 100
University College London Hospitals NHS Foundation Trust
33 31 94 33 100 31 30 28 93 13 46 10 82
West Middlesex University Hospital NHS Trust
4 3 75 4 100 3 3 2 67 1 50 1 100
17
Table 4.1.2 Patients who met the DCD referral criteria - key numbers and rates,Table 4.1.2 1 April 2012 - 31 March 2013 (1 April 2011 - 31 March 2012 for comparison)
Number ofpatients for
whom imminentdeath wasanticipated
Number ofpatients for
whom imminentdeath was
anticipated thatwere referred to
SN-OD
DCDreferral rate
(%)
Number ofpatients for
whomtreatment
waswithdrawn
Number ofeligibleDCD
Number ofeligible
DCD whosefamily wereapproached
DCDapproachrate (%)
Number offamilies
consentingdonation
DCDconsentrate (%)
Number ofactual DCDfrom eligible
DCD
%of DCDapp. inv.SN-OD
1 April 2012 to 31 March 2013
Barking, Havering and Redbridge University Hospitals NHS Trust
83 66 80 81 45 36 80 18 50 10 89
Barnet and Chase Farm Hospitals NHS Trust
16 6 38 14 12 5 42 4 80 4 80
Barts Health NHS Trust
58 46 79 55 34 24 71 11 46 8 100
Chelsea and Westminster Hospital NHS Foundation Trust
7 7 100 5 3 2 67 2 100 1 100
Ealing Hospital NHS Trust
7 4 57 5 5 1 20 1 100 1 100
Great Ormond Street Hospital For Children NHS Trust
22 15 68 22 12 10 83 2 20 1 70
Guy's and St Thomas' NHS Foundation Trust
66 48 73 60 18 14 78 8 57 2 43
Homerton University Hospital NHS Foundation Trust
11 10 91 10 3 3 100 0 0 0 67
Imperial College Healthcare NHS Trust
72 38 53 64 37 21 57 13 62 6 86
King's College Hospital NHS Foundation Trust
76 68 89 72 54 41 76 22 54 11 95
Lewisham Healthcare NHS Trust
18 7 39 16 5 2 40 1 50 0 100
North Middlesex University Hospital NHS Trust
8 5 63 7 6 4 67 2 50 1 100
North West London Hospitals NHS Trust
35 28 80 30 21 8 38 4 50 1 88
Royal Free London NHS Foundation Trust
48 37 77 46 17 2 12 2 100 1 100
Royal National Orthopaedic Hospital NHS Trust
0 0 - 0 0 0 - 0 - 0 -
The Hillingdon Hospitals NHS Foundation Trust
7 7 100 6 3 2 67 1 50 1 0
The Whittington Hospital NHS Trust
4 3 75 4 2 1 50 1 100 1 100
University College London Hospitals NHS Foundation Trust
41 24 59 40 21 11 52 6 55 2 82
West Middlesex University Hospital NHS Trust
15 8 53 15 5 2 40 0 0 0 50
1 April 2011 to 31 March 2012 (for comparison purposes)
Barking, Havering and Redbridge University Hospitals NHS Trust
56 40 71 51 33 19 58 10 53 8 89
Barnet and Chase Farm Hospitals NHS Trust
17 5 29 16 12 4 33 2 50 0 100
Barts Health NHS Trust
96 65 68 81 38 32 84 7 22 6 81
Chelsea and Westminster Hospital NHS Foundation Trust
18
Number ofpatients for
whom imminentdeath wasanticipated
Number ofpatients for
whom imminentdeath was
anticipated thatwere referred to
SN-OD
DCDreferral rate
(%)
Number ofpatients for
whomtreatment
waswithdrawn
Number ofeligibleDCD
Number ofeligible
DCD whosefamily wereapproached
DCDapproachrate (%)
Number offamilies
consentingdonation
DCDconsentrate (%)
Number ofactual DCDfrom eligible
DCD
%of DCDapp. inv.SN-OD
6 2 33 5 2 0 0 0 - 0 -
Ealing Hospital NHS Trust
5 1 20 4 2 1 50 0 0 0 100
Great Ormond Street Hospital For Children NHS Trust
26 11 42 25 13 5 38 2 40 2 80
Guy's and St Thomas' NHS Foundation Trust
86 58 67 83 42 27 64 14 52 6 33
Homerton University Hospital NHS Foundation Trust
16 9 56 15 5 2 40 1 50 0 100
Imperial College Healthcare NHS Trust
63 28 44 54 36 16 44 8 50 3 69
King's College Hospital NHS Foundation Trust
95 64 67 91 56 42 75 18 43 4 88
Lewisham Healthcare NHS Trust
16 7 44 13 6 2 33 1 50 1 100
North Middlesex University Hospital NHS Trust
7 4 57 7 4 3 75 0 0 0 100
North West London Hospitals NHS Trust
27 14 52 21 14 6 43 1 17 1 50
Royal Free London NHS Foundation Trust
78 38 49 74 31 9 29 4 44 1 78
Royal National Orthopaedic Hospital NHS Trust
0 0 - 0 0 0 - 0 - 0 -
The Hillingdon Hospitals NHS Foundation Trust
13 13 100 13 6 4 67 3 75 0 75
The Whittington Hospital NHS Trust
9 1 11 9 4 0 0 0 - 0 -
University College London Hospitals NHS Foundation Trust
58 31 53 55 23 16 70 7 44 5 69
West Middlesex University Hospital NHS Trust
18 6 33 18 5 2 40 0 0 0 50
It is acknowledged that the PDA does not capture all activity. In total there were 198 patients referred in 2012/13 who arenot included in Section 2 onwards because they were either over 75 years of age or did not die in a unit participating inthe PDA. 12 of these are included in Section 1 because they became a solid organ donor.
19
Appendices
Appendix A.1 Radar charts of key rates
Figure A.1.1 shows the same information as the bar charts in Section 2 for 2012/13 but in an alternative format. Thenational average rates are displayed on the radar charts along with the rates achieved by your Team.
Figure A.1.1 DBD and DCD key rates, 1 April 2012 - 31 March 2013
DBD DCD
20
Appendix A.2 Definitions
POTENTIAL DONOR AUDIT / REFERRAL RECORDData excluded Cardiothoracic ICUs, wards and patients aged over 75 years are excluded.
Donors after brain death (DBD)Suspected Neurological Death A patient who meets all of the following criteria: Apnoea, coma from known
aetiology and unresponsive, ventilated, fixed pupils.
Potential DBD donor A patient who meets all four criteria for neurological death testing (iesuspected neurological death, as defined above)
DBD referral criteria A patient with suspected neurological death
Discussed with Specialist Nurse – OrganDonation
A patient with suspected neurological death discussed with the SpecialistNurse – Organ Donation (SN-OD)
Neurological death tested Neurological death tests were performed
Eligible DBD donor A patient confirmed dead by neurological death tests, with no absolutemedical contraindications to solid organ donation
Absolute contraindications An absolute contraindication is defined as any of:
a) Known or suspected CJD
b) known HIV positive
c) any malignancy within the past 12 months (excluding brain tumour)
d) multi-organ failure (Demonstrable failure of two or more vital organsystems and associated complications. Failure defined as requirement oforgan support)
e) active untreated tuberculosis
Family approached forconsent / authorisation
Family of eligible DBD asked to make a decision on donation
Family consented / authorised Family consented to / authorised donation
Actual donors: DBD Neurological death confirmed patients who became actual DBD as reportedthrough the PDA
Actual donors: DCD Neurological death confirmed patients who became actual DCD as reportedthrough the PDA
Neurological death testing rate Percentage of patients for whom neurological death was suspected whowere tested
Referral rate Percentage of patients for whom neurological death was suspected whowere discussed with the SN-OD
Approach rate Percentage of eligible DBD families approached for consent /authorisationfor donation
Consent / authorisation rate Percentage of families approached about donation that consentedto / authorised donation
Expected consent / authorisation rate Consent / authorisation rate adjusted for ethnicity case mix (white or BAME(Black, Asian and Minority Ethnic)), based on those patients whose familywere approached for consent /authorisation and patient ethnicity was known
SN-OD involvement rate Percentage of family approaches where a SN-OD was involved
SN-OD consent / authorisation rate Percentage of families approached about donation by a SN-OD thatconsented to / authorised donation
21
Donors after circulatory death (DCD)Imminent death anticipated A patient, not confirmed dead using neurological criteria, receiving assisted
ventilation, a clinical decision to withdraw treatment has been made anddeath is anticipated within 4 hours
DCD referral criteria A patient in whom imminent death is anticipated (as defined above)
Discussed with Specialist Nurse – OrganDonation
Patients for whom imminent death was anticipated who were discussed withthe SN-OD
Potential DCD donor A patient who had treatment withdrawn and death was anticipated withinfour hours
Eligible DCD donor A patient who had treatment withdrawn and death was anticipated withinfour hours, with no absolute medical contraindications to solid organdonation
Absolute contraindications An absolute contraindication is defined as any of:
a) Known or suspected CJD
b) known HIV positive
c) any malignancy within the past 12 months (excluding brain tumour)
d) multi-organ failure (Demonstrable failure of two or more vital organsystems and associated complications. Failure defined as requirement oforgan support)
e) active untreated tuberculosis
Family approached forconsent / authorisation
Family of eligible DCD asked to make a decision on donation
Family consented / authorised Family consented to / authorised donation
Actual DCD DCD patients who became actual DCD as reported through the PDA
Referral rate Percentage of patients for whom imminent death was anticipated who werediscussed with the SN-OD
Approach rate Percentage of eligible DCD families approached for consent /authorisationfor donation
Consent / authorisation rate Percentage of families approached about donation that consentedto / authorised donation
Expected consent / authorisation rate Consent / authorisation rate adjusted for ethnicity case mix (white or BAME(Black, Asian and Minority Ethnic)), based on those patients whose familywere approached for consent /authorisation and patient ethnicity was known
SN-OD involvement rate Percentage of family approaches where a SN-OD was involved
SN-OD consent / authorisation rate Percentage of families approached about donation by a SN-OD thatconsented to / authorised donation
UK Transplant Registry (UKTR)Donor type Type of donor: Donation after brain death (DBD) or donation after circulatory
death (DCD)
Number of actual donors Total number of donors reported to the UKTR
Number of patients transplanted Total number of patients transplanted from these donors
Organs per donor Number of organs donated divided by number of donors. The maximumnumber of solid organs that can be donated are 7 for a DBD and 6 for aDCD.
Number of organs transplanted Total number of organs transplanted by organ type
22
Appendix A.3 Data description
This report provides a summary of data relating to potential and actual organ donors as recorded by NHS Blood andTransplant via the Potential Donor Audit (PDA), the accompanying Referral Record and the UK Transplant Registry forthe London ODST. The report covers the time period 1 April 2012 to 31 March 2013 and data from 1 April 2011 to 31March 2012 are also provided in certain sections for comparison purposes.
As part of the PDA, patients aged over 75 years of age and those who died in a cardiothoracic ICU or ward are notaudited nationally in 2012/13 and are therefore excluded from the majority of this report. In addition, some informationfrom this time period may be outstanding due to late reporting and difficulties obtaining patient notes. Donations notcaptured by the PDA will still be included in the data supplied from the accompanying Referral Record or from the UKTransplant Registry, as appropriate.
Some percentages in this report were calculated using small numbers and should therefore be interpreted with caution.
Please refer any queries or requests for further information to your local Specialist Nurse - Organ Donation(SN-OD)
23
Appendix A.4 Table and figure description
Each table and figure displayed throughout the report is described below to aid interpretation.
1.1 Donor outcomesTable 1.1.1 The number of actual donors, the resulting number of patients transplanted and the average number of
organs donated per donor have been obtained from the UK Transplant Registry for your Team. Resultshave been displayed separately for donors after brain death (DBD) and donors after circulatory death(DCD).
Table 1.1.2 The number of organs transplanted by type from donors within your Team has been obtained from the UKTransplant Registry. Further information can be obtained from your local Specialist Nurse – OrganDonation (SN-OD), specifically regarding organs that were not transplanted. Results have been displayedseparately for DBD and DCD.
2.1 Key ratesFigure 2.1.1 Four bar charts are displayed showing specific percentage measures of potential donation activity for your
Team compared with national data for the UK, and compared with an equivalent time period from theprevious financial year, using data from the Potential Donor Audit (PDA). The DBD charts show thepercentage of patients tested for neurological death (ND), and all four charts also show the referral rates,approach rates, proportion of approaches involving a SN-OD and observed consent/authorisation rates.Appendix A.2 gives a fuller explanation of terms used.
The percentages are displayed above each bar. Note that caution should be applied when interpretingpercentages based on small numbers.
2.2 Key numbers, rates and comparison with national targetsTable 2.2.1 A summary of DBD and DCD data and key rates have been obtained from the PDA. A national
comparison and a time period comparison are provided. Note that caution should be applied wheninterpreting percentages based on small numbers. Appendix A.2 gives a fuller explanation of terms used.
A comparison against national targets has been displayed by highlighting the key rates as red, amber orgreen. Ranges for comparison against national targets:
Green: >=98% of target
Amber: >=95% to <98% of target
Red: <95% of target
Targets specific to the financial year have been used and are displayed throughout Section 3.
3.1 Overview of lost opportunitiesFigure 3.1.1 The stages at which potential donors lose the opportunity to become actual donors have been obtained
from the PDA. There are four charts showing the DBD and DCD stages separately for your Team and theUK, all of which contain a comparison against an equivalent period from the previous financial year.
The number of potential donors is shown on the vertical axis for each chart and at each ‘step’ theproportion of potential donors lost at that stage is displayed. Caution should be applied when interpretingpercentages based on small numbers.
3.2 Neurological death testingFigure 3.2.1 A funnel plot of the neurological death testing rate is displayed using data obtained from the PDA. Each
Trust/Board is represented on the plot as a blue dot, although one dot may represent more than oneTrust/Board. Your Team's Trusts/Boards are shown on the plot as large orange crosses. The nationaltarget is shown on the plot as a pink horizontal dotted line. The national rate is shown on the plot as ablack horizontal dashed line, together with 95% and 99.8% confidence limits for this rate. These limits forma ‘funnel’, with the 95% limits shown as a solid line and the 99.8% limits shown as a dashed line. Graphsobtained in this way are known as funnel plots.
If a Trust/Board lies within the 95% limits, then that Trust/Board has a rate that is statistically consistentwith the national rate. If a Trust/Board lies outside the 95% confidence limits, this serves as an alert thatthe Trust/Board may have a rate that is significantly different from the national rate. When a Trust/Boardlies above the green upper 99.8% limit, this indicates a rate that is significantly higher than the nationalrate, while a Trust/Board that lies below the red lower limit has a rate that is significantly lower than thenational rate. It is important to note that differences in patient mix have not been accounted for in theseplots.
The funnel plots can also be used to identify the maximum rates currently being achieved byTrusts/Boards with similar donor potential.
Table 3.2.1 The reasons given for neurological death tests not being performed have been obtained from the PDA, ifapplicable.
24
3.3 Referral to Specialist Nurse - Organ DonationFigure 3.3.1 Funnel plots of DBD and DCD referral rates are displayed using data obtained from the PDA. See
description for Figure 3.2.1 above.
Table 3.3.1 The reasons for not referring the patient to the SN-OD have been obtained from the PDA, if applicable.
Table 3.3.2 For patients who were referred, the timings of the first contact with the SN-OD by clinical staff have beenobtained from the PDA.
3.4 ContraindicationsTable 3.4.1 The primary absolute medical contraindications to solid organ donation have been obtained from the PDA,
if applicable.
3.5 Family approachFigure 3.5.1 Funnel plots of DBD and DCD approach rates are displayed using data obtained from the PDA. See
description for Figure 3.2.1 above.
Table 3.5.1 The reasons why families were not formally approached for a decision about solid organ donation havebeen obtained from the PDA, if applicable.
3.6 Proportion of approaches involving a SN-ODFigure 3.6.1 Funnel plots of DBD and DCD SN-OD involvement rates are displayed using data obtained from the PDA.
See description for Figure 3.2.1 above.
3.7 ConsentFigure 3.7.1 Funnel plots of DBD and DCD consent/authorisation rates are displayed using data obtained from the
PDA. See description for Figure 3.2.1 above.
Table 3.7.1 The reasons why families did not give consent/authorisation for solid organ donation have been obtainedfrom the PDA, if applicable.
3.8 Reasons why solid organ donation did not occurTable 3.8.1 The reasons why solid organ donation did not occur have been obtained from the PDA, if applicable.
4.1 Key numbers and rates by Trust/BoardTable 4.1.1 DBD key numbers and rates by Trust/Board have been obtained from the PDA. Data for the current time
period are included, along with an equivalent comparison period from the previous year.
If the Trusts/Boards are not equivalent for the two time periods, this is due to Trust/Board changes, and/orthere were no patients for whom neurological death was suspected or imminent death was anticipated inone of the time periods.
Caution should be applied when interpreting percentages based on small numbers.
Table 4.1.2 DCD key numbers and rates by Trust/Board have been obtained from the PDA. See description for Table4.1.1 above.
Appendix A.1 Radar charts of key ratesFigure A.1.1 Radar charts have been used to display the DBD and DCD key rates from the PDA. This is an alternative
way of displaying the information in Figure 2.2.1. The blue shaded area represents your Team, and thenational rates are superimposed as a solid purple line for comparison. The fuller the blue shaded area thebetter. Note that 0% and ‘not applicable (N/A)’ rates appear the same. The rates have therefore beendisplayed on the spokes of the radar charts.