london organ donation services team - odt...

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.

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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).

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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)

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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.

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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)

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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.

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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.

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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]

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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

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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


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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

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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


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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


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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(%)


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

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neurologicaldeath wassuspected

Numberof patientsthat were

tested

Neurologicaldeath

testing rate(%)


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)


27 18 67 27 100 18 17 16 94 8 50 7 100


11 6 55 8 73 6 6 6 100 1 17 1 100


49 39 80 47 96 39 37 36 97 21 58 19 92


1 1 100 1 100 1 1 1 100 1 100 1 100


2 2 100 2 100 2 2 2 100 0 0 0 100


6 2 33 4 67 2 2 2 100 2 100 2 100


11 6 55 9 82 6 6 6 100 5 83 5 17


0 0 - 0 - 0 0 0 - 0 - 0 -


33 26 79 30 91 26 25 24 96 14 58 13 79


36 19 53 35 97 19 19 18 95 11 61 9 94


2 1 50 2 100 1 1 1 100 0 0 0 100


5 5 100 5 100 5 4 4 100 2 50 2 100


10 7 70 10 100 7 7 7 100 3 43 3 71


17 11 65 17 100 11 10 9 90 4 44 4 100


1 1 100 1 100 1 1 1 100 1 100 1 100


7 6 86 7 100 6 6 5 83 4 80 3 60


3 3 100 3 100 3 3 3 100 2 67 2 100


33 31 94 33 100 31 30 28 93 13 46 10 82


4 3 75 4 100 3 3 2 67 1 50 1 100

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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


whom imminentdeath was

anticipated thatwere referred to

SN-OD

DCDreferral rate

(%)


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


83 66 80 81 45 36 80 18 50 10 89


16 6 38 14 12 5 42 4 80 4 80


58 46 79 55 34 24 71 11 46 8 100


7 7 100 5 3 2 67 2 100 1 100


7 4 57 5 5 1 20 1 100 1 100


22 15 68 22 12 10 83 2 20 1 70


66 48 73 60 18 14 78 8 57 2 43


11 10 91 10 3 3 100 0 0 0 67


72 38 53 64 37 21 57 13 62 6 86


76 68 89 72 54 41 76 22 54 11 95


18 7 39 16 5 2 40 1 50 0 100


8 5 63 7 6 4 67 2 50 1 100


35 28 80 30 21 8 38 4 50 1 88


48 37 77 46 17 2 12 2 100 1 100


0 0 - 0 0 0 - 0 - 0 -


7 7 100 6 3 2 67 1 50 1 0


4 3 75 4 2 1 50 1 100 1 100


41 24 59 40 21 11 52 6 55 2 82


15 8 53 15 5 2 40 0 0 0 50

1 April 2011 to 31 March 2012 (for comparison purposes)


56 40 71 51 33 19 58 10 53 8 89


17 5 29 16 12 4 33 2 50 0 100


96 65 68 81 38 32 84 7 22 6 81


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whom imminentdeath wasanticipated


whom imminentdeath was

anticipated thatwere referred to

SN-OD

DCDreferral rate

(%)


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 -


5 1 20 4 2 1 50 0 0 0 100


26 11 42 25 13 5 38 2 40 2 80


86 58 67 83 42 27 64 14 52 6 33


16 9 56 15 5 2 40 1 50 0 100


63 28 44 54 36 16 44 8 50 3 69


95 64 67 91 56 42 75 18 43 4 88


16 7 44 13 6 2 33 1 50 1 100


7 4 57 7 4 3 75 0 0 0 100


27 14 52 21 14 6 43 1 17 1 50


78 38 49 74 31 9 29 4 44 1 78


0 0 - 0 0 0 - 0 - 0 -


13 13 100 13 6 4 67 3 75 0 75


9 1 11 9 4 0 0 0 - 0 -


58 31 53 55 23 16 70 7 44 5 69


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.

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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

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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

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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

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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)

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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.

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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.

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