Organ Donation Collaboratives - Proposals to take Organ Donation Collaboratives to 2020
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Organ Donation Collaboratives
Proposals to take Organ Donation Collaboratives to 2020
To achieve the vision of world class performance in organ donation and
transplantation the organ donation collaboratives will need to build on their past
success and evolve into a structure capable of supporting the TOT2020 action plan.
Organ Donation Collaboratives should seek to enable all hospitals and the
communities they serve to maximise the gift of organ donation by serving as the
bridge between national and local initiatives. The goal remains for organ donation
collaboratives to be tenacious in identifying and delivering on the biggest
opportunities, which will allow every potential organ donor to become an actual
donor, where appropriate.
The Chair and CLOD 2014 survey revealed that the regional infrastructure and the
regional collaboratives are well regarded and supported. Key findings are in
Appendix 1.
To take Regional Collaboratives to 2020 the collaboratives must be more than a
twice-yearly gathering that coordinates the essential membership of organ donation
committee chairs, clinical leads for organ donation, and regional organ donation
services (specialist nurses, team managers and regional manager). They are a way of
working so that the sum is greater than the parts and must be a vehicle for effective
and transforming change in hospitals, the wider organ donation and transplantation
community and the public. Lessons from regional collaboratives in America are that
without ongoing support and investment, collaboratives will not maintain
momentum and will be unable to deliver the transformation in donation and
transplantation that is required in the UK. This paper outlines proposals, in line with
the TOT2020 action plan, that will evolve the Regional Collaboratives to this end.
Proposal 1
Will ensure a foundational structure for regional collaboratives, which will align
collaborative plans to national plans, ensure Regional Clinical Leads for Organ
Donation (R-CLOD) have the support and oversight to be effective in their role and
engage local Organ Donation Committee (ODC) Chairs more effectively. Work is
already well advanced in this area. Details on the proposal can be seen in Appendix
2.
Proposal 2
Will ensure best practice in organ donation at the hospital level by ensuring the
governance and oversight of local hospital organ donation teams, by minimising
variation in donor identification, family approach and donor care in hospitals, and by
delivering and supporting health care professional education in organ donation to a
world class standard. Details on the proposal can be seen in Appendix 3.
Regional Collaboratives Proposal Paper 1
DG January 2015Proposal 3
Is a proposal to establish supplementary networks or specialist groups within
specific areas of the organ donation community, namely a Level 1 Donation
Network/Group for the larger Level 1 donating hospitals and a Paediatric Donation
Network/Group in hospitals with paediatric intensive care units, which will allow
additional learning by providing opportunities to share and compare like with like.
Details on the proposal can be seen in Appendix 4.
The TOT2020 Strategy called on Regional Collaboratives to be the focal point for
translating much of the strategy into action and to increasingly involve clinicians
from the transplant service, to enable them to develop local solutions to the
interface between donation and transplantation. In the TOT2020 action plan there is
an opportunity for organ donation collaboratives to either support or deliver 21 of
the 30 specific actions (see Appendix 5).
This scope requires from the collaboratives actions beyond proposals 1-3 to allow:
1. True collaboration that will drive innovation in donation and transplantation.
2. Synergistically enhance the capacity of donation services within each region.
3. Engagement with the transplant community within the regional
collaboratives.
4. Empower the collaboratives to support a revolution in public behaviour in
relation to organ donation.
Examples of such collaboration to date are: the King s extended DCD programme (1
and 3), the Northern Screening Model (2 and 3), the North West Cluster Working
Pattern (2) and Nottingham s Hospital Simulation Day (1) and Community Awareness
Campaign (4).
Proposal 4
To develop a culture which will support and encourage innovation a core group of
members from each collaborative need to be given the knowledge and skills to lead
this development. This is the least developed proposal but an options paper to
develop the proposal further is outlined in Appendix 6.
Proposal 5
Is an infrastructure proposal to engage the transplant community within the regional
collaboratives to drive innovation in donation and transplantation. Details on the
proposal can be seen in Appendix 7.
Proposal 6
Is a proposal to fully engage the Regional Collaboratives in the Behaviour Change
Strategy. An important strand of the Behaviour Change Strategy is for the national
marketing team to support the Organ Donation Committees and Trust
communications departments to develop and implement their own local campaigns.
Regional Collaboratives will be an essential link and driver between these
national/local actions. Details on the proposal can be seen in Appendix 8.
Regional Collaboratives Proposal Paper 2
DG January 2015Appendix 1
Key findings regarding Regional Collaboratives from the Chair and CLOD 2014 Survey
Question Chairs CLODs Scale
How important do you see the 3.72 4.08 Average between
regional collaboratives? (n=72) (n=123) 1: not very important
5: essential
How effective do you find your 3.14 3.6 Average between
regional collaborative in (n=72) (n=123) 1: not very effective
empowering you to do your 5: essential
role well?
Apart from Regional n=73 n=127 N/A
Collaboratives and National 79% No 61% No
Events, do you meet with 21% Yes 39% Yes
other Chairs in your local area?
What influence do you feel 2.43 3.21 Average between
you have with NHSBT Regional (n=77) (n=129) 1: Very little influence
Collaboratives? 5: Very strong influence
What influence do you feel 2.51 3.34 Average between
you have with NHSBT Regional (n=77) (n=128) 1: Very little influence
CLOD? 5: Very strong influence
What influence do you feel 2.47 3.02 Average between
you have with NHSBT Regional (n=77) (n=128) 1: Very little influence
Manager? 5: Very strong influence
What influence do you feel 2.06 2.20 Average between
you have with national (n=77) (n=128) 1: Very little influence
NHSBT? 5: Very strong influence
Regional Collaboratives Proposal Paper 3
DG January 2015Appendix 2
Proposal 1: Ensure a foundational structure for regional collaboratives
Additional Timeframe
ACTION Lead/s Measurable
resources to achieve
1. Each regional collaborative RM / NIL Achieved Annual Report.
will meet a minimum of twice R-CLOD
per year.
2. Each regional collaborative RM NIL 2015-16 Greater
will appoint an ODC Chair Lead attendance
from the existing or former and
ODC Chairs to co-lead the engagement
regional collaborative with the from ODC
Regional Manager (RM) and Chairs.
Regional Clinical Lead for
Organ Donation (R-CLOD).
3. ODC Chairs will be expected RM NIL 2015-16 KPI: ODC Chair
to attend each appropriate attendance is
Regional Collaborative event. 60% at each
regional
collaborative.
4. The RM, R-CLOD and ODC ODT NIL 2015-16 Collaborative
Chair Lead will contribute to Performance plans in
the development of a and Business alignment with
collaborative annual plan for Manager national plans.
their region that will also detail
relevant KPIs.
5. CLODs will be expected to R-CLOD NIL 2014-15 KPI: CLOD
attend each appropriate attendance is
Regional Collaborative event 75% at each
(see Proposal 2 for CLOD regional
Governance). collaborative.
R-CLOD Governance
6. Every R-CLOD will have a 1:1 Deputy N- NIL 2015-16 Job plan
meeting with the Deputy N- CLOD achieved
CLOD every year to agree job annually.
plan.
7. All R-CLODs will be on a Deputy N- NIL 2015-16 3 Year term.
three-year contract renewable CLOD
for one further term (subject
to satisfactory annual reviews).
It is intended that the position
will be re-advertised at the
completion of a second term.
8. The Deputy N-CLOD will Deputy N- NIL 2014-15 KPI: R-CLOD
regularly communicate with CLOD attendance is
the R-CLODs as a group. 75% at these
meetings.
Regional Collaboratives Proposal Paper 4
DG January 2015Appendix 3
Proposal 2: Ensuring best practice in organ donation
Ensure the effectiveness of local hospital organ donation teams
Organ Donation Committees
Additional Timeframe
ACTION Lead/s Measurable
resources to achieve
1. Every donation committee RM NIL 2015/16 Ensures the
will be led by a Chair who is model of
not an intensive care or Organ
emergency medicine health Donation
professional. Committees as
outlined by the
taskforce is
implemented.
Annual
regional report
2. Donation committees will RM NIL 2015/16 Ensures
meet a minimum of four times donation
per year. committees
are established
and meeting.
KPI:
100%
achieved.
3. Every ODC will monitor their RM NIL 2014/15 Ensures ODC
hospitals performance every are working
three months and develop toward
action plans for areas of poor improving
performance. donation in
their
hospital/s.
Annual
regional report
4. Every ODC will write an RM / NIL 2014/15 Ensures ODC
annual plan which includes R-CLOD have set and
action points and these action are working
points are reviewed for toward clear
progress. objectives.
Annual
regional report
5. Each local organ donation RM / NIL 2015/16 Ensures ODC
committee will be attended at R-CLOD has input from
least once per year by either the regional
the Regional CLOD (R-CLOD), team.
Regional Manager or Team KPI: 100%
Manager. achieved.
Regional Collaboratives Proposal Paper 5
DG January 2015CLOD Governance
Additional Timeframe
ACTION Lead/s Measurable
resources to achieve
6. The R-CLOD or RM will RM / NIL 2014-15 Ensures CLOD
represent NHSBT on the R-CLOD is aware of
interview panel of any new their NHSBT
CLOD appointment. responsibilities
Action
achieved.
7. All CLODs and ODC Chairs Deputy £30,000 2015/16 KPI: 100%
will have attended a N-CLOD Year 1 achieved.
formalised induction reducing
programme within 12 months to £15,000
of appointment. per year
8. Every CLOD will have a 1:1 R-CLOD NIL 2014-15 Job plan
meeting with the R-CLOD every achieved
year to agree job plan in annually.
accordance to agreed national KPI: 100%
CLOD standards. achieved.
9. CLODs will attend a R-CLOD NIL 2014-15 Job plan.
minimum of 75% of organ
donation collaborative events
every two years (ie 3 out of
four).
10. All CLODs will be on a R-CLOD NIL 2015-16 3 Year term.
three-year contract renewable
for one further term (subject
to satisfactory annual reviews).
It is intended that the position
will be re-advertised at the
completion of a second term.
11. CLODs in Level 1 donating R-CLOD NIL 2015-16 Job plan.
hospitals and/ or hospitals with
PICUs, are expected to attend
relevant education or
performance meetings.
12. A review of the CLOD role Deputy NIL 2015-16 Review
and the distribution of CLODs N-CLOD achieved.
should be carried out which
will feed into CLOD
governance.
13. CLODs will sign off their 6- R-CLOD NIL 2015-16 KPI: 100% sign
monthly PDA report. off.
14. CLODs will ensure their R-CLOD NIL 2015-16 KPI: 100% sign
hospital has an up-to-date off.
organ donation policy which is
appropriately approved by the
relevant internal hospital
governance structures.
Regional Collaboratives Proposal Paper 6
DG January 2015Minimise variation in donor identification, family approach and donor care
Additional Timeframe
ACTION Lead/s Measurable
resources to achieve
15. Collaboratives should RM / NIL 2015-16 KPI: 100% sign
continue their focus on R-CLOD off.
improving key donation
performance indicators.
16. Collaboratives should R-CLOD NIL 2015-16 100%
ensure that local hospital achieved.
organ donation guidance and
policies are in accordance to
national guidance and policies.
Deliver and support health care professional education in organ donation
Additional Timeframe
ACTION Lead/s Measurable
resources to achieve
17. NHSBT will establish an Deputy N- Admin. 2015-16 Approved SMT
education fund to support CLOD September
health professional education 2014
nationally, as advised by the
National Organ Donation
Committee education
subcommittee.
18. NHSBT will invest in the Deputy N- From the 2015-16 R-CLODs more
development needs of R- CLOD Education effective in
CLODs particularly in Fund their role.
management, leading change,
media and IT.
19. The IT support will be Deputy N- £12,000 2015/16 Equipment
improved to allow Organ CLOD single cost. purchase.
Donation Collaboratives to Increased use
share their data, education of
materials and projects with a www.odt.nhs.u
wider audience. k
20. The Collaboratives will Deputy N- £30,000 2015-16 ICM trainees
work with the NODC Education CLOD Year 1 have received
sub-committee to support the increasing training.
goal that all ICM trainees have to £40,000 KPI:
received nationally endorsed per year 25% Year 1
training in deceased donation from the 50% Year 2
before Completion of Education 75% Year 3
Certificate of Training (CCT). Fund. 95% Year 4+
Regional Collaboratives Proposal Paper 7
DG January 2015Appendix 4
Proposal 3: A supplementary structure for organ donation collaboratives
Additional Timeframe
ACTION Lead/s Measurable
resources to achieve
1. NHSBT will establish a Deputy N- £5000 2015-16 KPI: Improving
network of the largest CLOD donation key
donating hospitals. performance
indicators in
Level 1
hospitals.
This
information
should be
shared at each
regional
collaborative.
2. The R-CLOD for each region R-CLOD NIL 2015-16 KPI: 100%
will visit each Level 1 hospital achieved.
annually.
3. A national Paediatric CLOD Deputy N- New 1-2PA 2015-16 KPI: Improving
should be appointed. CLOD position paediatric
donation and
transplant.
4. Hospitals with a paediatric National £3000 per 2015-16 KPI: Improving
intensive care unit should form Paediatric year from paediatric
a Paediatric Donation CLOD the donation and
Network/Group and meet at Education transplant.
least annually. Membership Fund
will be reviewed 2 yearly and This
will include CLODs, SN-ODs and information
ODC Chairs from those should be
hospitals and paediatric shared at each
transplant surgical regional
representation for each organ collaborative.
group.
Regional Collaboratives Proposal Paper 8
DG January 2015Appendix 5
The role Organ Donation Collaboratives can have in supporting the
TOT2020 Action Plan
Taking Organ Transplantation to 2020
Aim to match world class performance in organ donation and transplantation
Outcome 1: Action by society and individuals will mean that the UKs organ
donation record is amongst the best in the world and people donate when and if
they can.
Develop national strategies to promote a shift in behaviour and increase
consent.
Ensure that it is easy to pledge support for organ donation and once a pledge
has been given, honour the individual s wish.
Increase Black, Asian and Minority Ethnic community awareness of the need to
donate,, to benefit their own communities and provide better support for
people in these communities to donate, and
Learn from the experience of legislative change in Wales and elsewhere.
Specific Actions Colour code for the
collaboratives:
Delivery role
Supportive role
No major role
Develop national strategies to promote a shift in behaviour Regional
and increase consent and test progress with regular public Collaboratives
surveys.
The relevant Government Health Departments should explore Regional
with Education Departments the possibility of incorporating Collaboratives
donation and transplantation issues into schools curricula.
All Governments should provide regular reports to All UK Governments
Parliament/Assembly on progress in their nation and Health
Ministers should have a duty to promote organ donation and
transplantation effectively leading to a significant
improvement in public attitudes and consent for organ
donation.
There should be national debates to test public attitudes to Regional
radical actions to increase the number of organ donors. For Collaboratives
example, whether those on the Organ Donor Register should
receive higher priority if they need to be placed on the
transplant waiting list.
Ensure that the introduction of a system of deemed consent to South Wales and
organ and tissue donation in Wales as described by the North West
Human Transplantation (Wales) Bill is as successful as Collaboratives
Regional Collaboratives Proposal Paper 9
DG January 2015possible and learn from this experience.
Develop a community volunteer scheme to support Regional
trust/health board donation committees to promote the Collaboratives
benefits of donation in local communities, particularly
amongst groups with little tradition of organ donation.
Following the experience in the USA, ensure everyone who Regional
has made a decision to donate during their life has their Collaboratives
wishes honoured, if they die in circumstances where donation Level 1 Donation
is possible Network
Outcome 2: Action by NHS hospitals and staff will mean that the NHS routinely
provides excellent care in support of organ donation and every effort is made to
ensure that each donor can give as many organs as possible.
Increase the number of people who are able to donate following brain
death.
Increase the number of people who are able to donate following
circulatory death and learn from the Scottish pilot on donation after failed
resuscitation.
Provide hospital staff with the support, training, resources and
information they need to provide and excellent organ donation service,
and
Ensure every donor s care, prior to retrieval, boosts organ quality.
End of Life Care standards should promote BSD testing as the Regional
preferred method of diagnosing death, where this can be Collaboratives
achieved and is in the best interests of the patient. Level 1 Donation
Network
End of Life Care practices should be reviewed to establish Level 1 Donation
whether they might be adjusted so as to promote donation Network
after brain death.
Establish a National Referral Service to improve support to Regional
hospitals. Collaboratives
Level 1 Donation
Network
Scope the potential for donation following unexpected cardiac Scottish Collaborative
arrest in the UK, learning from the pilot programme in Level 1 Donation
Scotland. Network
Families of potential donors will only be approached by Regional
someone who is both specifically trained and competent in Collaboratives
the role, training packages and accreditation will be provided Level 1 Donation
to those who wish to develop this competence. Network
Work collaboratively to reduce instances of objection to organ Regional
donation from the coroner and procurator fiscal service and Collaboratives
the police. Level 1 Donation
Network
Regional Collaboratives Proposal Paper 10
DG January 2015Publish hospital data to include: brain stem death testing Level 1 Donation
rates, donor referral rates, family approach rates, Specialist Network
Nurse involvement and other key measures. NHSBT
Outcome 3: Action by NHS hospitals and staff will mean that more organs are
usable and surgeons are better supported to transplant organs safely into the
most appropriate recipient.
Increase the number of organs that are retrieved from both DBD and DCD
donors.
Increase the number of organs that can be transplanted safely, providing
surgeons with the information and guidance to make decisions about
organ suitability, and
Improve transplant recipient survival by improving understanding of the
donor organ/recipient compatibility.
Improve donor management for potential cardiothoracic Regional
donors, providing a 24/7 service to assist if pilot schemes Collaboratives
prove effective. Level 1 Donation
Network
Review what pre-mortem interventions could legally and UKDEC
ethically be undertaken to maximise the potential for organ NHSBT
donation (such as the administration of heparin, elective
ventilation etc.).
Evaluate new techniques and technologies for the NHSBT
preservation of retrieved organs with a view to their use in
the UK.
Develop a system of peer review that is underpinned by a set Regional
of agreed standards for retrieval/transplant centres. Collaboratives
Level 1 Donation
Network
Provide guidance on levels of acceptable risk in relation to NHSBT
offered organs, particularly from extended criteria donors,
relevant to the individual recipient s needs and wishes.
Publish centre-specific risk-adjusted patient survival from Regional
listing as well as from transplantation. Collaboratives
Ensure clinicians are aware of and follow, best practice to NHSBT
increase patient and graft survival.
Outcome 4: Action by NHSBT and Commissioners means that better support
systems and processes will be in place to enable more donations and transplant
operations to happen.
Support Regional Collaboratives to lead local improvement in organ
donation, retrieval and transplant practice and promote organ donation.
Review and improve the workforce, IT, systems and processes which
operate throughout the donation and transplant pathway, and
Build a sustainable training and development programme to support
organ donation and retrieval.
Regional Collaboratives Proposal Paper 11
DG January 2015Develop a workforce strategy for the organ donation service Regional
which will tailor the service to the needs of individual Collaboratives
hospitals and seek to provide a workforce that is focused on Level 1 Donation
supporting the potentially conflicting demands of providing a Network
service to the donor family, donor management and donor co-
ordination. This may be configured in one or more roles as
the needs of the service dictate.
Subject to variations in Government policy, agree a formal Level 1 Donation
contract for organ donation with hospitals specifying how Network
hospitals and the NHSBT donation service work together to
achieve excellence
Regional Collaboratives to lead local improvement in organ Regional
donation, retrieval and transplant practices and in local Collaboratives
promotion of donation and transplantation. Level 1 Donation
Network
Ensure that transplant centres have the capacity and surgical Commissioners
expertise and other clinical skills to meet the demands for
transplantation as donor numbers increase.
Develop training programmes to sustain and increase Regional
clinicians organ donation understanding and expertise. Collaboratives
Optimise the processes, timescales, resources and supporting Regional
IT at every stage of the pathway from donor identification to Collaboratives
long-term survival. Level 1 Donation
Network
Review the current processes for donor characterisation NHSBT
(especially for microbiology and tissue typing).
Develop and implement a training and accreditation NHSBT
programme for all retrieval surgeons and extend this to
supporting post-mortem technologies when these are
introduced.
Investigate the feasibility and implications for the provision of NHSBT
a 24/7 provision of expert histopathology advice.
Regional Collaboratives Proposal Paper 12
DG January 2015Appendix 6
Options Paper for Proposal 4
To date, Regional Collaboratives act more as a regional information sharing and
regional coordination mechanism. More will be required from collaboratives to
achieve the 2020 strategy:
1. True collaboration that will drive innovation in donation and transplantation.
2. Synergism of regional efforts to enhance the capacity of donation services
within each region.
Proposal 4
To develop a culture which will support and encourage innovation a core group of
members from each collaborative need to be given the knowledge and skills to
lead this development.
Proposal 4 is designed to meet these new needs in a cost effective manner and in
the quickest time frame and assumes Option 2 is the preferred option.
Option 1 - Do nothing
Collaboratives will evolve slowly but are unlikely to achieve true collaborative effort
and innovation.
Option 2 Internal leadership
It is unlikely that the Regional Collaborative leadership structure of Regional
Manager / R-CLOD will be sufficient to achieve required changes to the regional
collaboratives without external support and guidance. This option presupposes
external support to build on the capabilities of the current leadership.
Key actions:
1. Gain expertise in leading collaboratives (Current proposal is to send two
representatives to the USA to learn from their OPO collaborative structure).
2. Learning from #1 and the ACCORD project develop the actions required to
cause this cultural shift within the regional collaboratives.
3. Seek advice from others in the NHS who are experts in change / PDSA
innovations.
4. Develop a change strategy for the Regional Collaboratives.
5. Identify a core group from each or some of the regional collaboratives who at
the March 2015 Congress will be given the necessary knowledge and skills to
lead this change. This will require an investment in their training beyond the
Congress over at least a two-year period and would involve utilising #3.
6. Stage the roll out to some pilot regional collaboratives first.
7. The setting of overarching 2-year goals for each regional collaborative is likely
to be a key platform for this initiative.
8. All these actions must be supported by a project lead position.
Option 2 External leadership
Employ an external change expert or team to deliver the necessary changes in the
collaboratives. Some of the actions in Option 2 will still be relevant but this option
presupposes external delivery onto the regional collaborative leadership and
structure
Regional Collaboratives Proposal Paper 13
DG January 2015Appendix 7
Proposal 5: Support the transplant community
Additional Timeframe
ACTION Lead/s Measurable
resources to achieve
1. Each collaborative should RM / NIL 2015-16 Improvement
develop actions to facilitate a R-CLOD / in organ
closer and effective NORS lead donation,
relationship with the retrieval and
transplanting hospitals in their transplant
region and from each NORS practices and
team that routinely recovers processes.
organs from their region. A key Develop the
role will be to review any action plan.
clinical issues.
2. Transplant key performance RM / NIL 2015-16 Improvement
indicators should be shared at R-CLOD in organ
each collaborative event. donation,
retrieval and
transplant
practices and
processes.
3. A transplant recipient Recipient NIL 2015-16 Improvement
coordinator representative coordinator in organ
should join each collaborative. lead donation,
retrieval and
transplant
practices and
processes.
KPI: 75%
attendance at
regional
collaborative
events.
Regional Collaboratives Proposal Paper 14
DG January 2015Appendix 8
Proposal 6: Support the community promotion of organ donation
Additional Timeframe
ACTION Lead/s Measurable
resources to achieve
1. Annual promotion goals RM Negotiated Phased A rise in organ
should be agreed for each funds from regionally donation
regional collaborative. the Organ starting consent,
Donation from registration on
Consent 2015-16 the ODR.
Strategy Demographic
of new
registrants on
the ODR.
2. There should be an assigned NHSBT Funds Phased A rise in organ
representative from NHSBT marketing from regionally donation
marketing / communications and Organ starting consent,
team to each regional communic- Donation from registration on
collaborative. Attendance at ations team Consent 2015-16 the ODR.
each regional collaborative Strategy Demographic
event would be expected. of new
registrants on
the ODR.
Regional Collaboratives Proposal Paper 15
DG January 2015You can also read
