regional collaborative south central regional collaborative data 13 th november 2014 wokefield park

Regional Collaborative

South Central Regional Collaborative Data

13th November 2014

Wokefield park


Actual deceased donors- South Central team

DBD DCD

48

16

40

13

44

25

57

23

60

20

54

28

48

29

62

39

60

47

29

10

58

20

Nu

mb

er

0

10

20

30

40

50

60

70

80

90

100

110

Year

05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 Apr-Sep

14/15 projected

1 April 2005 to 30 September 2014, data as at 14 October 2014Hospitals are allocated to teams using the current team allocations, not the allocation at the time of donation


Actual deceased donors

DBD DCD

36

26

51

21

46

25

41

25 25

19

21

3

38

22

29

10

40

17

10

16

29

20

26

33

Nu

mb

er

0

10

20

30

40

50

60

Eastern London Midlands North West

Northern Northern Ireland

Scotland South Central

South East

South Wales

South West

Yorkshire

1 April 2014 to 30 September 2014, data as at 14 October 2014


Plan

• DCD• DBD• Our possible DBD not tested• DBD case presentations (Roger)


DONATION AFTER CIRCULATORY DEATH


Why less DCD?

• Chance• Not being referred? Referral % still increasing• Fewer people dying in ICU• Less withdrawal of treatment (LCP effect)• Surgeons becoming more risk averse• Informal triage filtering out patients who

previously might have become donors


South Central DCD referral rate

Ref

erra

l rat

e (%

)

0

20

40

60

80

100

Number of imminent death anticipated patients

0 10 20 30 40 50 60

1

1011

12

13

14

15

16

17

18

2

3 4

5

67

8

9

Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL



DCD referral rate

-------- National rate

8580

6972

86

7674

71 72

78 7679

Re

ferr

al r

ate

(%

)

0

20

40

60

80

100

Team



DCD SN-OD involved


79

84

58

86

6870

45

75

8783

59

86

% a

pp

roa

ch

es

wh

ere

SN

-OD

invo

lve

d

0

20

40

60

80

100

Team



DCD consent rate


54

4945

53

59

4952

40

63

43

5153

Co

ns

en

t/a

uth

ori

sa

tio

n r

ate

(%

)

0

20

40

60

80

100

Team



DCD conversion rate


1410

7 7

12

5

19

6

1114 14

17

Co

nve

rsio

n r

ate

(%

)

0

20

40

60

80

100

Team



Trends in national DCD rates%

0

20

40

60

80

100

Period

Apr 10 - Sep 10

Oct 10 - Mar 11

Apr 11 - Sep 11

Oct 11 - Mar 12

Apr 12 - Sep 12

Oct 12 - Mar 13

Apr 13 - Sep 13

Oct 13 - Mar 14

Apr 14 - Sep 14

Referral rate Approach rateSN-OD involved rate Consent/authorisation rate

4247

5055

62 63

70 7276

56

54

5760

49 48 46

53 54

61

6770

73 73

49 51 49

53

50

55 53 51



Trends in South Central DCD rates

%

0

20

40

60

80

100

Period

Apr 10 - Sep 10

Oct 10 - Mar 11

Apr 11 - Sep 11

Oct 11 - Mar 12

Apr 12 - Sep 12

Oct 12 - Mar 13

Apr 13 - Sep 13

Oct 13 - Mar 14

Apr 14 - Sep 14

Referral rate Approach rateSN-OD involved rate Consent/authorisation rate

30

3943

60

53 5561

64

71

42

50

66

55 54

4247

41

41

46

63

67

74 74

88

75 75

5047 45

46

5754

40



DCD consent/authorisation rate by ethnic group


ODS team White patients BAME patients

Family

approachedConsent/ authorisation

rate*Family


rate*Eastern 95 58 7 -London 62 50 22 45Midlands 125 50 12 25North West 96 56 4 -Northern 61 64 2 -Northern Ireland 33 48 - -Scotland 62 55 4 -South Central 56 43 6 -South East 71 62 3 -South Wales 57 44 2 -South West 64 56 2 -Yorkshire 79 54 2 -Total 861 54 66 35 * Consent/authorisation rates are not shown where the number of families approached is less than 10


DCD Summary

• Fewer people dying on ICU• Fewer families approached• More age 70 to 79 declined by

transplant surgeons• Consent rate dropped to 40%• South Central SNOD involvement

slipping?


DONATION AFTER BRAIN DEATH


Trends in national DBD rates%

0

20

40

60

80

100

Period

Apr 10 - Sep 10

Oct 10 - Mar 11

Apr 11 - Sep 11

Oct 11 - Mar 12

Apr 12 - Sep 12

Oct 12 - Mar 13

Apr 13 - Sep 13

Oct 13 - Mar 14

Apr 14 - Sep 14

Testing rate Referral rateApproach rate SN-OD involved rateConsent/authorisation rate

7173 76

7376

79 7882 80

8386

9092

91

92 9396 9592 94

9393 94

92

6669 70

7275

65

64 6364

6966 67

70 67



Trends in South Central DBD rates

%

0

20

40

60

80

100

Period

Apr 10 - Sep 10

Oct 10 - Mar 11

Apr 11 - Sep 11

Oct 11 - Mar 12

Apr 12 - Sep 12

Oct 12 - Mar 13

Apr 13 - Sep 13

Oct 13 - Mar 14

Apr 14 - Sep 14

Testing rate Referral rateApproach rate SN-OD involved rateConsent/authorisation rate

7268

76 75

67

7973 76

66

8479

8789 89 89 89 94 9496

83

97

90 89

39

62 61

80 85 86

52

81

55

67

91

7066

76 71



DBD- Neurological death testing rate


8284

77

86

94

83 84

66

78

60

84

71

ND

te

ste

d (

%)

0

20

40

60

80

100

Team



DBD- South Central Neurological death testing rate


0 0

50

65

100

67

100 100

50

100 100

33

100

6567

100

ND

te

ste

d (

%)

0

20

40

60

80

100

Hospital

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18



DBD- South Central Neurological death testing rate

ND

test

ed (%

)

0

20

40

60

80

100

Number of neurological death suspected patients

0 5 10 15 20 25 30

1

10

11

12

13

14

15

1617

18

2

3

4

5 6

7

8

9

Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL



DBD referral rate


9395 97 96 98

90

9794 95

87

98 98

Re

ferr

al r

ate

(%

)

0

20

40

60

80

100

Team



DBD approach rate


92 9296

9389

94

100

9397

94

88 90

Ap

pro

ac

h r

ate

(%

)

0

20

40

60

80

100

Team



DBD SN-OD involved


93 91

73

94 9387

55

86

95

82 84

97

% a

pp

roa

ch

es

wh

ere

SN

-OD

inv

olv

ed

0

20

40

60

80

100

Team



DBD consent rate


67

55

68

5964

77

71 71 73

59

89

74

Co

ns

en

t/a

uth

ori

sa

tio

n r

ate

(%

)

0

20

40

60

80

100

Team



DBD conversion rate


58

46

59

5055

67 6762 62

56

6964

Co

nv

ers

ion

ra

te (

%)

0

20

40

60

80

100

Team



DBD consent/authorisation rate by ethnic group


ODS team White patients BAME patients

Family


rate*Family


rate*Eastern 50 72 7 -London 54 72 45 33Midlands 67 70 10 50North West 70 61 7 -Northern 41 66 1 -Northern Ireland 31 77 - -Scotland 55 69 1 -South Central 36 78 4 -South East 55 75 7 -South Wales 16 56 - -South West 30 90 2 -Yorkshire 32 78 1 -Total 537 72 85 36 * Consent/authorisation rates are not shown where the number of families approached is less than 10


Coroner permission requested

Permission given None Partial Full

7.14%

90.82%

5.19%

16.88%

77.92%

10.20%

85.71%

5.68%

14.77%

79.55%

12.50%

16.07%

71.43%

22.73%

77.27%

10.91%

85.45%

7.55%

28.30%

64.15%

6.45%

90.32%

8.06%

88.71%

10.64%

14.89%

74.47%

%

0

10

20

30

40

50

60

70

80

90

100

Eastern London Midlands North West

Northern Northern Ireland

South Central

South East

South Wales

South West

Yorkshire



DBD summary

• 5% increase in DBD nationally but not in South Central

• Brain stem death testing rates remain red on dashboard at 66%. Blip or trend?

• Other areas of pathway remain ok


South Central Brain Stem Death Testing

• Jan to Oct 2014• 21 cases BSD? Not tested• 4/21 not referred• 3/21 never planned to test• We think 7 could/should have been

tested


Reasons

• Delay in testing due to sedation• Patient not for donation (malignancy,

advanced directive, refusal after 1st set)• Miscellaneous (individual consultant

behaviour)


BRAIN STEM DEATH? PRESENTATIONS

Dr Roger Lightfoot


Questions, discussion

1. Compared to other regions our BSD testing is lower. Problem or statistical blip?

2. Is brain stem death testing whenever possible still our aim? If not why not?

regional collaborative south central regional collaborative data 13 th november 2014 wokefield park

Documents

regional collaborative

regional collaborative

ok slide

brain death slide

circulatory death slide

time of donation slide

south central dbd rates

south central dcd rates