Organ Donation & Transplantation Organ Donation & Transplantation in Ireland – Changing timesin Ireland – Changing times

Aileen CounihanAileen Counihan

Transplant Co-ordinatorTransplant Co-ordinator

Beaumont HospitalBeaumont Hospital

Organ Procurement Centre TeamOrgan Procurement Centre Team

National Service for Organ Procurement National Service for Organ Procurement

– Current Location – Beaumont HospitalCurrent Location – Beaumont Hospital

Donor Coordinating TeamDonor Coordinating Team

– 24hr on call service for ICUs nationally24hr on call service for ICUs nationally

Recipient Co-ordinationRecipient Co-ordination

– 24hr call for renal transplant service24hr call for renal transplant service

The Donor Co-ordinator RoleThe Donor Co-ordinator Role

24hr call to deal with all enquiries pertaining to Organ Donation24hr call to deal with all enquiries pertaining to Organ Donation

Responsible for the technical and logistical arrangements.Responsible for the technical and logistical arrangements.

Involved in the donation process from referral, retrieval & to the Involved in the donation process from referral, retrieval & to the

transplantation of the organs.transplantation of the organs.

– Care of the Donor, the Family of the Donor, the Donor Hospital Care of the Donor, the Family of the Donor, the Donor Hospital

staff, the Transplant Team, & Transplant recipients.staff, the Transplant Team, & Transplant recipients.

Recipient Co-ordinator RoleRecipient Co-ordinator Role

Referral for Renal & Pancreas Transplant Referral for Renal & Pancreas Transplant

Management of Transplant waiting listManagement of Transplant waiting list

Coordination of Deceased Donor TransplantsCoordination of Deceased Donor Transplants

Live Donor Transplant ProgrammeLive Donor Transplant Programme

Kidney TransplantationKidney Transplantation

Kidney transplantation is considered the best treatment option for Kidney transplantation is considered the best treatment option for

patients in end stage renal failurepatients in end stage renal failure

Not all patients are suitable for transplantNot all patients are suitable for transplant

– Only 33% of patients with kidney failure are on transplant waiting Only 33% of patients with kidney failure are on transplant waiting

listlist

When transplant is not the best optionWhen transplant is not the best option

Clinical reasons :Clinical reasons :

– History of recent cancerHistory of recent cancer

– Major surgeryMajor surgery

– Severe cardiac problems or advanced blood vessel diseaseSevere cardiac problems or advanced blood vessel disease

Patient choice:Patient choice:

– decide that transplantation is not for them.decide that transplantation is not for them.

– can opt to stay on dialysis.can opt to stay on dialysis.

Renal TransplantationRenal Transplantation

Live Donor TransplantLive Donor Transplant

– from a family member/spouse/friend from a family member/spouse/friend – Paired ExchangePaired Exchange

Deceased Donor Transplant Deceased Donor Transplant

– Brain Death DonorBrain Death Donor

– Non Heart Beating DonorNon Heart Beating Donor. .

Recipient Evaluation for Transplant Recipient Evaluation for Transplant

Standard workup :Standard workup :– Full Blood ProfileFull Blood Profile– Tissue type x 2Tissue type x 2– Virology < 3mthsVirology < 3mths– Chest Xray & Abdo U/soundChest Xray & Abdo U/sound– Cardiac Tests, Stress ECG, Cardiac EchoCardiac Tests, Stress ECG, Cardiac Echo– Coronary Angio ( if indicated)Coronary Angio ( if indicated)– Dental ClearanceDental Clearance– Smear Test for female patients Smear Test for female patients – PSA for men > 50yrsPSA for men > 50yrs

Other tests determined by age/cause of failureOther tests determined by age/cause of failure– Copy of all results to Transplant Office with a detailed referral letterCopy of all results to Transplant Office with a detailed referral letter

Evaluation for TransplantEvaluation for Transplant

Some patients may require further assessment Some patients may require further assessment

Test results may require further investigation.Test results may require further investigation.

Patient is sent an appointment with an information Patient is sent an appointment with an information

booklet about transplantbooklet about transplant

All patients are seen at the transplant assessment clinic All patients are seen at the transplant assessment clinic

in Beaumontin Beaumont

Meet with Transplant Surgeon & Co-ordinatorMeet with Transplant Surgeon & Co-ordinator

Pre-Transplant ClinicPre-Transplant ClinicAssess suitability for transplantAssess suitability for transplant

Surgery explainedSurgery explained

Opportunity to ask questions , encourage patients to bring someone Opportunity to ask questions , encourage patients to bring someone

with them to clinic with them to clinic

Option of Live Donation givenOption of Live Donation given

Importance of contactability, urgency, keeping healthy & well reiteratedImportance of contactability, urgency, keeping healthy & well reiterated

Follow up phone callFollow up phone call

Letter to patient to inform approved for Transplant & regular blood Letter to patient to inform approved for Transplant & regular blood

samples for antibody screening while on the poolsamples for antibody screening while on the pool

Letter from H&I when activatedLetter from H&I when activated

Further ScreeningFurther Screening

– Other tests may be requiredOther tests may be required

– Anaesthetic assessmentAnaesthetic assessment

– Patients to lose weight or to monitor weightPatients to lose weight or to monitor weight

– Reassurance while on the listReassurance while on the list

– Patients over 2 yearsPatients over 2 years

– Patients suspended for a prolonged period of timePatients suspended for a prolonged period of time

– Older patientsOlder patients

Waiting TimeWaiting Time

Currently 29 months.Currently 29 months.

Factors influencing time on listFactors influencing time on list

– Patients with a high antibody level Patients with a high antibody level

– Patient BMIPatient BMI

– Increasing number of patients on listIncreasing number of patients on list

– Donor supplyDonor supply

Acknowledging the DonationAcknowledging the Donation

Donor and donor family will be foremost on recipients’ Donor and donor family will be foremost on recipients’ mindmind

Anonymity MaintainedAnonymity Maintained– Encourage recipients to write to donor family and can Encourage recipients to write to donor family and can

be done via the Transplant Co-ordinatorsbe done via the Transplant Co-ordinators

Information leaflet Information leaflet Attend the Annual Service of Remembrance and Attend the Annual Service of Remembrance and Thanksgiving Thanksgiving

Circle Of Life Garden in SalthillCircle Of Life Garden in Salthill

Organ Donor Web SiteOrgan Donor Web Site

Donor Families shared experiences

Transplant Recipient success stories

Gratitude of Recipients & Comfort received by Donor Families

Commemorative Garden

StatisticsStatisticsDeceased Donors/Transplants in IrelandDeceased Donors/Transplants in Ireland

(Organ Procurement Centre)(Organ Procurement Centre)

0

100

200

300

400

500

600

700

Transplants

Donors

Waiting List

Potential Live DonorPotential Live Donor

Patients will be asked if they wished to consider a Live Donor Patients will be asked if they wished to consider a Live Donor

TransplantTransplant

Potential donors to contact the transplant co-ordinators directlyPotential donors to contact the transplant co-ordinators directly

Initial suitability would be discussed with them – Initial suitability would be discussed with them – Blood Group Blood Group

CompatibleCompatible

Arrangements made for H&I screeningArrangements made for H&I screening

Information on Live donation givenInformation on Live donation given

Only one donor can go forward to workupOnly one donor can go forward to workup

Live Kidney DonationLive Kidney Donation

Donor must be fully informed and aware of risks and benefits of Donor must be fully informed and aware of risks and benefits of procedureprocedure

No risk to the potential donorNo risk to the potential donor

The decision to donate must be voluntary, no coercion or The decision to donate must be voluntary, no coercion or inducementinducement

The transplant must have a good chance of providing a good The transplant must have a good chance of providing a good outcome for the recipient.outcome for the recipient.

Ethical IssueEthical Issue– Exposes an otherwise healthy person to the risks of major Exposes an otherwise healthy person to the risks of major

surgery entirely for the physical benefit of another individualsurgery entirely for the physical benefit of another individual

Living Donation ProgrammeLiving Donation Programme

Information for Live Donor RecipientInformation for Live Donor Recipient

Donor work up period 3 months approxDonor work up period 3 months approx

– Medical suitability, extensive screeningMedical suitability, extensive screening

– Immunological screeningImmunological screening

– Independent clinical & psychological reviewIndependent clinical & psychological review

Donor work up confidentialDonor work up confidential

Isolating period for recipientIsolating period for recipient

Recipient remains under the care of nephrology teamRecipient remains under the care of nephrology team

Suspended from list, when donor deemed suitableSuspended from list, when donor deemed suitable

Setting date for surgerySetting date for surgery

LRD and Deceased Renal LRD and Deceased Renal Transplant activity in IrelandTransplant activity in Ireland

0

50

100

150

200

25072 75 78 81 84 87 90 93 96 99

2002

2005

2008

2011

Year

Kid

ney

Tra

nspl

ants

LRDDeceased

Changing Role of Transplant OfficeChanging Role of Transplant Office

No responsibility for Organ ProcurementNo responsibility for Organ Procurement– Perceived conflict of interestPerceived conflict of interest– Independent ServiceIndependent Service

Recipient Coordination Recipient Coordination – 24 hour on call for renal/pancreas transplant24 hour on call for renal/pancreas transplant– Liaise with Renal Unit StaffLiaise with Renal Unit Staff– Patient educationPatient education

Co-ordinate Live Donation ProgrammeCo-ordinate Live Donation Programme

Responsibility of Transplant Office Responsibility of Transplant Office

Organ Procurement Office Organ Procurement Office

Thank YouThank You AllAll

Further informationFurther information

www.beaumont.iewww.beaumont.ie

www.icmed.comwww.icmed.com

www.strangeboat.orgwww.strangeboat.org

www.ika.iewww.ika.ie

www.coe.intwww.coe.int