Paediatric donation - Microsoft · 2017. 8. 11. · PICU through donation pathway (PDA data) 0 2 4...
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Paediatric donation 1 April 2015 to 31 March 2017
Transcript of Paediatric donation - Microsoft · 2017. 8. 11. · PICU through donation pathway (PDA data) 0 2 4...
Paediatric donation1 April 2015 to 31 March 2017
Paediatric patients
(aged 15 years or under)
2015/16 – 2016/17
Paediatric patients (age<16 years)
Audited deaths in
2016/17 YTD (n=1028)
Met referral criteria
(n=261,25%)
Eligible donor
(n=223, 85%)
Family approached
(n=109, 49%)
Consent/ authorisation
given (n=43, 39%)
Actual solid organ
donors (n=34, 79%)
Flow of paediatric patients through
donation pathway (PDA data)
Audited deaths in
2015/16 YTD (n=1151)
Met referral criteria
(n=261, 23%)
Eligible donor
(n=197, 75%)
Family approached
(n=119, 60%)
Consent/ authorisation
given (n=50, 42%)
Actual solid organ
donors (n=38, 76%)
618
515
485462
48 51
Paediatric ICU A+E Other units
Unit where patient died
0
50
100
150
200
250
300
350
400
450
500
550
600
650
700
750
800
Nu
mb
er
of
au
dit
ed
de
ath
s
1 April 2016 - 31 March 20171 April 2015 - 31 March 2016
Units of death for all audited deaths
243 239
2 416 18
Paediatric ICU A+E Other units
Unit where patient died
0
50
100
150
200
250
300
350
400
450
500
550
600
Nu
mb
er
of
pa
tie
nts
me
eti
ng
re
ferr
al c
rite
ria
1 April 2016 - 31 March 20171 April 2015 - 31 March 2016
Units of death for patients meeting referral
criteria
Units of death for eligible donors
182
205
1 114 17
Paediatric ICU A+E Other units
Unit where patient died
0
50
100
150
200
250
300
350
400
450
500
550
600
Nu
mb
er
of
elig
ible
do
no
rs
1 April 2016 - 31 March 20171 April 2015 - 31 March 2016
Paediatric patients
(aged 15 years or under)
2016/17
Unit where patient died, April 2016 – March 2017
515
239
205
101
40 32
462
4 1 0 0 0
51
18 17 8 3 2
Paediatric ICU A+E Other units
Unit where patient died
0
50
100
150
200
250
300
350
400
450
500
550
600
Nu
mb
er
of
de
ath
s
Eligible donors proceeding to organ donationEligible donors whose families consented to organ donation
Eligible donors whose families were approachedEligible donors
Meeting referral criteriaAudited deaths
0
2
4
6
8
10
12
14
16
Age (
years
)
Audited deaths
criteria
Meeting referral Eligible donors
were approached
whose families
Eligible donors
organ donation
consented to
whose families
Eligible donors
organ donation
proceeding to
Eligible donors
Age distribution, April 2016 – March 2017
1
10
7
1
2
11
N 1028 261 223 109 43 34
Paediatric patients who
died in a paediatric ICU
2016/17
Paediatric patients who died in a PICU
Audited deaths in
2016/17 YTD (n=515)
Audited deaths in
2015/16 YTD (n=618)
Met referral criteria
(n=243, 39%)
Eligible donor
(n=182, 75%)
Family approached
(n=111, 61 %)
Consent/ authorisation
given (n=45, 41 %)
Actual solid organ
donors (n=33, 73 %)
Met referral criteria
(n=239, 46%)
Eligible donor
(n=205, 86%)
Family approached
(n=101, 49%)
Consent/ authorisation
given (n=40, 40%)
Actual solid organ
donors (n=32, 80%)
Flow of paediatric patients who died in a
PICU through donation pathway (PDA data)
0
2
4
6
8
10
12
14
16
Age (
years
)
Audited deaths
criteria
Meeting referral Eligible donors
were approached
whose families
Eligible donors
organ donation
consented to
whose families
Eligible donors
organ donation
proceeding to
Eligible donors
Age distribution, April 2016 – March 2017
1
10
7
22
10
N 515 239 205 101 40 32
3734
30
19
5 5
136
8277
46
22
16 171412
72 2
51
109
3 3 25
1 1 1 1 1
40
5 40 0 0
66
1916
1 0 0
31
6 41 0 0
13
7
0 0 0 0
119
61
52
23
7 6
haemorrhage)
(Intracranial
CVA
damage
Hypoxic brain Trauma
failure
Respiratory Pneumonia Cardiothoracic
failure
Multi-organ Septiceamia Cancer Other
Grouped cause of death
0
50
100
150
Nu
mb
er
of
de
ath
s
Eligible donors proceeding to organ donationEligible donors whose families consented to organ donation
Eligible donors whose families were approachedEligible donors
Meeting referral criteriaAudited deaths
Grouped cause of death, April 2016 – March 2017
10
69
27
23
1210
3
2422
12
7
58
32
20
12 12
19
4
34
6
14
1719
8
13
23
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
10
20
30
40
50
60
70
80
Au
dit
ed
de
ath
sAudited deaths by hospital,
April 2016 – March 2017
National: 515 deaths
2 hospitals with 35 or
more audited deaths
3
10
6
3
2
1 1
4
5
0
1
9
7
3
0
4
1 1
5
1
4
1
4
3
0
2
1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
1
2
3
4
5
6
7
8
9
10
Ne
uro
log
ica
l d
ea
th s
us
pe
cte
d p
ati
en
tsNeurological death suspected, by hospital,
April 2016 – March 2017
National: 82 deaths where neurological
death was suspected
2
6
4
1
2
1 1 1
4
0
1
5
7
3
0
3
0
1
2
1
3
1
2 2
0
2
1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
1
2
3
4
5
6
7
8
9
10
Ne
uro
log
ica
l d
ea
th t
es
ted
pa
tie
nts
Neurological death tests performed, by hospital,
April 2016 – March 2017
National: 56 deaths where neurological
tests were performed
Reason why neurological death tests were not
performed for patients where neurological death
was suspected, April 2016 – March 2017
2, 7%
3, 11%
8, 31%
2, 8%
2, 8%
2, 8%
6, 23%
1, 4%
Family declined donation
Family pressure not to test
Patient haemodynamically unstable
Continuing effects of sedatives
Biochemical/endocrine abnormality
Inability to test all reflexes
Clinical reason/Clinicians decision
SN-OD advised that donor not suitable
National: 26 deaths where neurological death
was suspected but neurological tests were not
performed
8
3 3
4
3
1
2 2 2
5
1
5
4
2
9
2
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Age (years)
0
1
2
3
4
5
6
7
8
9
10
11
12
Ne
uro
log
ica
l d
ea
th t
es
ted
pa
tie
nts
Neurological death tests performed, by age,
April 2016 – March 2017
Median (IQR): 9 years (3, 12)
4
1211
12
8
21
1011
3 3
29
12
7
2
8
4
2
12
4
10
7
12
3
5
9
2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
Elig
ible
do
no
rsEligible donors, by hospital, April 2016 – March
2017National: 205 eligible donors
(55 eligible DBD and 150 eligible DCD)
4
12
11
12
8
2
1
10
11
3 3
29
12
7
2
8
4
2
12
4
10
7
12
3
5
9
2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
Elig
ible
do
no
rs
Family not approachedFamily approached
3
18
4
4
7
5
7
5
3
1
1
1
5
5
6
5
1
2
2
1
10
19
7
5
7
2
6
2
4
2
6
6
3
1
5
5
4
3
5
7
3 3
2
4
5
2
Eligible donors, by hospital and whether the
family were approached, April 2016 – March 2017National: Families of 101 (49%) eligible
donors were approached for organ donation
(43 eligible DBD and 58 eligible DCD)
8, 7%
3, 3%
20, 19%
28, 27%7, 7%
31, 30%
7, 7%
Family stated that they would not supportdonation before they were formally approached
Family considered too upset to approach
Coroner / Procurator Fiscal refused permission
Patient’s general medical condition
Other medical reason
Other
Not identified as a potential donor / organdonation not considered
Reason families of eligible donors were not
approached, April 2016 – March 2017
National: Families of 104 eligible donors were
not approached for organ donation
3
8
4
5 5
1 1
5
6
1
2
10
7
0 0
6
0
2
6
3
5
4
5
3 3
4
2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
1
2
3
4
5
6
7
8
9
10
11
12
Fa
milie
s o
f e
lig
ible
do
no
rs a
pp
roa
ch
ed
SNOD not involved in approachSNOD involved in approach
33
67
75
25
75
25
60
40
80
20
100 100 20
80 100
100
100
70
30
57
43
. .
100
.
100
83
17
100 60
40
25
75
80
20
67
33
100
100
100
National: SNODs involved in 72 (71%) of the
101 approaches (32 (74%) eligible DBD and
40 (69%) eligible DCD)
Proportion of approaches involving a SNOD,
by hospital, April 2016 – March 2017
3
8
4
5 5
1 1
5
6
1
2
10
7
0 0
6
0
2
6
3
5
4
5
3 3
4
2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
2
4
6
8
10
12
Fa
milie
s o
f e
lig
ible
do
no
rs a
pp
roa
ch
ed
Family did not consent/authorise organ donationFamily consented/authorised organ donation
3
5
3
3
1
5
1
4
1 1 1
4
3
3
1
2
5
5
1
6
4
2
1
1
2
4
1
2
2
3
4
1
4
1
2
1
2
2
2
2
Eligible donors whose families were approached,
by hospital and whether the family consented/
authorised organ donation, April 2016 – March 2017
National: Families of 40 (40%) eligible donors
were approached and consented/authorised
organ donation (23 eligible DBD and 17 eligible
DCD)
Reason families of eligible donors did not
consent/ authorise organ donation,
April 2016 – March 2017 National: Families of 61 eligible donors
approached did not consent to
organ donation
1, 1%
3, 5%
6, 10%
1, 2%
8, 13%
12, 20%
2, 3%
13, 21%
5, 8%
1, 2%
1, 2%
8, 13%
Family were not sure whether the patient wouldhave agreed to donation
Family did not believe in donation
Family felt it was against their religious/culturalbeliefs
Family were divided over the decision
Family felt the patient had suffered enough
Family did not want surgery to the body
Family wanted to stay with the patient after death
Family felt the length of time for donation processwas too long
Family felt the body needs to be buried whole(unrelated to religious or cultural reasons)
Family concerned that organs may not betransplanted
Strong refusal - probing not appropriate
Other
0
5
3
0
1
0
1 1
3
1
2
5
1
0 0
4
0
1
2
1
2
0
1 1 1
2 2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
1
2
3
4
5
6
7
8
Elig
ible
co
ns
en
ted
/au
tho
ris
ed
do
no
rs
Proceeding donorNon-proceeding donors
5
3
1 1 1
2
1
1 1
1 3
2
1
4
1
2
1
2
1 1 1
2
1
1
Eligible donors whose families consented/
authorised, by hospital and whether the donor proceeded
to organ donation, April 2016 – March 2017
National: 32 eligible donors whose families
consented/authorised organ donation
proceeded to organ donation
(20 eligible DBD and 12 eligible DCD)
1, 12%
2, 25%
1, 12%
2, 25%
1, 13%
1, 13%
Family changed mind
Coroner/Procurator Fiscal refusal
Organs deemed medicallyunsuitable by recipient centres
Prolonged time to asystole
Cardiac Arrest
Other
Reason eligible donors whose families
consented/authorised organ donation did not
proceed to organ donation, April 2016 – March 2017
National: 8 eligible donors whose families
consented/authorised organ
donation did not proceed to
organ donation
0
14
8
0 0 0
3
2
7
0
5
8
1
0 0
7
0
1
8
0
2
0
7
4 4
7
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Hospital
0
2
4
6
8
10
12
14
16
18
20
22
24
Nu
mb
er
of
tra
ns
pla
nts
Transplants from eligible proceeding donors,
by hospital, April 2016 – March 2017
National: 93 solid organ transplants were
performed (70 from eligible DBD and 23 from
eligible DCD)
Deceased paediatric donors
(aged 15 years or under)
2005/06 - 2016/17
Deceased paediatric donors (<16 yrs),
by donor type, 1 April 2005 to 31 March 2017
24
4
36
5
20
9
24
12
18
8
26
9
19
9
18
9
21
15
22
12
25
16
23
17
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
2016/17
Financial year
0
10
20
30
Num
ber
DCDDBD
Deceased paediatric donors (2 years old and under),
by donor type, 1 April 2010 to 31 March 2017
3
1
5
12
10
5
3
5
8
months<2
months2-6
months6-12
months12-24 <1 month.
months.1-2
months.2-6
months.6-12
months.12-24
Age
0.0
2.5
5.0
7.5
10.0
12.5
Num
ber
DCDDBD
Paediatric patients
(<18 years)
2016/17
% o
f p
ote
nti
al d
on
ors
0
10
20
30
40
50
60
70
80
90
100
Potentialdonors1
Neurologicaldeath testsperformed(DBD only)
Neurologicaldeath
confirmed(DBD only)
Contraindications Familyapproach
Consent/authorisation
Donation
1 Potential DCD donor - A patient who had treatment withdrawn and death was anticipated within four hours
1 brain stem reflexes returned, and neonates less than 2 months post term
1 Potential DBD donor - A patient who meets all four criteria for neurological death testing excluding those for which cardiac arrest occurred despite resuscitation,
1
DBD, 37 donated (33% of potential donors)DCD, 12 donated (6% of potential donors, 7% of those not contraindicated)
28% 1%
20%
35%10%
10%
61%
72%37%
Stages at which potential paediatric (<18 years)
organ donors lost the opportunity to become
actual donors , 1 April 2016 to 31 March 2017
