Title of presentationTitle of presentation

Implementing DCDBarriers and solutions

VPNG 51st State Conference 30th July 2015

Nicky StittDonation Specialist Nursing CoordinatorMonash Health

• The Australian Organ and Tissue Authority established on 1 January 2009

(Australian Organ and Tissue Donation and Transplantation Authority Act 2008)

• An independent statutory authority

• Established to provide national leadership and to drive the National Reform Package

The Authority

Key ObjectivesIncrease capacity in hospitals

• Raise awareness of pathways and donation processes• Provide staff with skills to support donor families

Increase donation rates

• Raise awareness in the Australian community• Encourage family discussion• Identify potential donors, raise donation and support

families to make an informed decision

Deceased organ donors 2009-2014

Donation Pathways

Donation after Brain Death (DBD)– ANZICS Statement on Death and Organ Donation1

Donation after Circulatory Death (DCD) – National Protocol for Donation after Cardiac Death2

– ANZICS Statement on Death and Organ Donation

What is DCD? Donation of organs from patients declared dead

by cardio-pulmonary criteria Prior to the introduction of brain death into law in

the early 80’s, all organ transplants from deceased donors came from non-heart beating donors (NHBD)

Internationally now referred to as Donation after Circulatory Death- (DCD)

DCD history

Abandoned since adoption of brain death criteria

Organs from brain dead donors had better survival rates

Dissatisfaction with the process

Refocus on DCD Public demand Shortage of organs Improved surgical and preservation techniques

Benefits of DCD

More organs are available for transplantation Allows families to consider donation in scenarios

where Patients thought unlikely to progress to brain death Families not accepting of brain death diagnosis Families of brain dead patient who wish to be with loved one when

heart stops

Fulfils patient’s wishes Meets community expectations

ANZOD data: www.anzdata.org.au/anzod

DCD versus BD donors

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

0

50

100

150

200

250

300

350 DCD donors

BD donors

De

ce

as

ed

org

an

do

no

rs

Largest public health service in Victoria

Advanced neuro/cardiac services

Renal pancreas Transplant centre

AOTA release national protocol for DCD

Provided Guidelines only

Decentralised health in Victoria

Individual hospitals to create own CPG

BRICK WALL

sarah

my sister will have a real photo of rome from her travels - i'll get one from her tomorrow - be bettter quality :)

Minimum requirements for a facility to implement DCD

Institutional commitment to DCD Clinical leadership, accountability & governance Internal policy/procedure approved by hospital

executive – notification to Donatelife Victoria Relevant expertise

ICU & OR access to supportive & diagnostic services

Multidisciplinary education campaign of key stakeholders

Development of DCD Program Guideline

• DCD program working party– ICU, Anaesthetics,

theatre, perfusionists, medical administration/executive, legal, ethics, allied health

– Develop internal guidelines

– Review outcomes and lessons learnt

Strategic Priorities

Hospital engagement Building relationships Establishing policies Education saturation Normalising donation

Getting our message out there…

Strategic Priorities

Engagement of key staff

Development of policies & procedures

Education Education Education!

Mission Impossible Reached!!

We have Implemented

DCD

We have a team approach to any DCD case

We have a team approach to

any DCD Case

We

Continue with engagement

and education

Deceased donors by donation pathway 2009-2014

Success.

Before transplantation

After transplantation

Thank You