dr paul cramp consultant anaesthetist clinical lead for ...... · dr paul cramp consultant...

National Donation Congress 2012

Dr Paul CrampConsultant Anaesthetist

Clinical Lead for Organ DonationBradford Teaching Hospitals

1. Starting point - Multi-Faith conference in 2000

2. Bradford population

3. Bradford ICU and potential donors

4. Current strategy

5. Case report


1.

20th

March 2000


Lord Hunt opened meeting11% transplants on Black or Asian patients5396 people on waiting list8.6 million on ODRLegal framework of transplantation HTA 1961

Presentations from seven different faith groupsDr Zaki Badawi Fatwa issued from Muslim Council 1995DH launched South Asian Donation Campaign in 1999

Organisational change with Spanish exampleNational Transplant ServiceMore transplant coordinators, surgeons

Current population

Bradford district 523,850 residents

Bradford has the third largest proportion of Black and Minority Ethnic people outside of London boroughs (behind Manchester and Birmingham).

Bradford has a proportion of non-white residents at 25.89%

86% of the BME population is of Asian or British Asian origin

A further 7% are of Afro-Caribbean origin

Predictions for the future


English Indices of

deprivation

42% of the District s population - or some 210,000 people - live in

the 20% of most deprived areas in the country

5% of the population (25,000 people) live in

the 1% most deprived

34% of children (40,840) are classed as living in poverty

Deprivation is ranked

32nd out of 354 districts in England


Largest Pakistani population in UKMirpur in Azad KashmirHigh levels of poverty and unemploymentReliance on workers overseasBiradeli principles or Clan system40% were born in Pakistan60% of Pakistani marriages were with spouse from country of originLiteracy rates low and language difficulties3rd generation adopting Western patterns of behaviourHigh incidence of diabetes/renal/heart disease/HepC


Ethnic groupingWhite Asian Black

Active

Suspended

Active Suspended

ActiveKidney 23 17 42 15 1 98

Pancreas

0 1 0 0 0 1Heart 1 1 1 0 0 3Lung 0 0 1 0 0 1Liver 6 3 1 10Total 30 19 47 16 1 113


Busy District General Hospital16 bed Critical Care unit about 1000 admissions per yearICNARC databaseApril 2008 to January 2012


Brainstem death tested patients and conversion rates to donation April 2008

to January 2012


Rate of Brainstem TestingWhites 3.7%Asians 8.4%

Conversion ratesWhites 64.7%Asians 12.5%


Withdraw/with-hold treatment ratesWhites 65%Asians 42%

Bradford Donation Committee developed strategy

UK Organ Donation Taskforce explicit recommendation to tackle needs of Black and Minority Ethnic groups

1.Persistent media campaign

2.Bradford Mela and other community events

3.Local community face-to-face networking approach

4.Barriers


BBC NewsITV CalendarBBC Radio 4Radio LeedsAsian ExpressYorkshire Post Yorkshire Post Health

SupplementTelegraph and ArgusKeighley NewsBCB RadioSunrise Radio


Feedback and invites into mosques/schools/community meetings to talk about Organ

Donation

Local v National

Bradford Mela

First European Mela 1988Local organisationInto heart of BME communityAttended by 100,000Attractions to engage visitorsSign-up ODRQ&A faith issuesLimited support from NHSBTDevelop network of community support

NHSBT Faith Roadshows

National organisation with some local inputSelected citiesHeadline celebritiesNHSBT resourcesCan we count on you/Prove itReal People, Real Lives, Real ActionNHSBT Mela machineSign up ODR


First European Mela 1988Local organisationInto heart of BME communityAttended by 100,000Attractions to engage visitorsSign-up ODRQ&A faith issuesLimited support from NHSBTDevelop network of community support


National organisation with some local inputSelected citiesHeadline celebritiesNHSBT machineNHSBT resourcesCan we count on youProve itReal People, Real Lives, Real ActionSign up ODRNHSBT Mela machine



British Science FestivalBiggest European science

festivalAll agesLocal debateTremendous interest and

feedback from studentsFurther invitations

Local school competitionsBradford First FestivalOpen days

Mosques and Temples

Lack of awareness of organ donation/shortage

Taboo subject with fixed religious/cultural beliefs

Literacy and language

Lack of enough ethnically appropriate and culturally sensitive team members

Access to key scholars given over 80 mosques in Bradford and 40 Imams

Some problems not with BME community


The Cultural Anatomy of Decision-Making: The Problem of Organ Donation and Ethnicity

Jessie Cooper, Department of Public Health and Policy, The University of Liverpool

Consent occurs all along organ donation trajectory

Also a product of negotiation

Prior to consent BME families viewed as preconceived problem

Refusals linked to struggle between parties

Calls into how questions are asked

Reliance on nurse/doctor to communicate death and donation to family

Presumed problematic with BME families becomes a self-fulfilling prophecy in medical practice


65 year old Muslim lady with subarachnoid haemorrhage and brainstem death confirmed

Well planned SNOD approach

Family agreed on condition liver went to cousin who was on local Transplant list all agreed with Transplant Team

Eleventh hour call to local ImamNot on ODR so not allowed


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