Donation Collaboratives lessons for transplantation Dr Dale Gardiner

Donation Collaboratives lessons for transplantation Dr Dale Gardiner National Clinical Lead for Organ Donation Consultant in Intensive Care Medicine, Nottingham dale. gardiner@nhsbt. nhs. uk @dalecgardiner

12 Donation Collaboratives 12 Lessons SCOTLAND NORTHERN IRELAND YORKSHIRE NORTH WEST MIDLANDS EASTERN SOUTH WALES SOUTH CENTRAL SOUTH WEST SOUTH EAST 1. Lay firm foundations 2. Use data to drive best practice 3. Are a way of working 4. Create new ways of working 5. Size Matters 6. Build a community 7. Innovate 8. And then innovate some more 9. Work with government 10. Engage with each other 11. Stretch and change the world 12. Individuals can make a difference

Lay firm foundations • • • SOUTH EAST Organ donation collaboratives were established in 2011 as part of the original Taskforce implementation plan. They were in the “Don’t Let Up” Meet a minimum twice a year. SNODs, CLODs and ODC Chairs. Part of the regional structure o Regional and Team Managers o Regional CLOD Attendance is expected. South East Collaborative • Stable leadership team. • Consistently well attended and evaluated.

Use data to drive best practice April 2015 SOUTH CENTRAL DCD referral rate October 2018 Relentless focus on comparator data • Benchmark • Congratulate Every shared data slide • Challenge should tell a story. • Look for trends

Are a way of working • Donation Collaboratives are more than a twice-yearly gathering of members. • They are a way of working so that the sum is greater than the parts. YORKSHIRE Collaboratives are a vehicle for effective and transforming change in hospitals, the wider organ donation and transplantation community and the public.

Create new ways of working NORTHERN • • • Northern Referral Model Introduced 2010 Provide opportunities for pilot. Provide opportunities for national leadership. Size matters: small = nimble The aim of the Northern Referral Model was to ensure that all potential organ donors are referred to a SN-OD in a timely fashion and that in turn an expedient response is provided to the referring unit. Was the forerunner for DCD screening nationally. Northern referral 1 st to 100% DBD 1 st to 90% DCD

BIG Diverse Important Size Matters #LODSTRC London BAME Approaches vs National Approaches DCD London LONDON One third of families approached in London are from an ethnic minority. 61 One half of all the UK ethnic minority families approached for organ donation are in London. 25 Nationally 53 DBD 107 0 20 40 60 80 100 120

Build a community SNOD Triumvirate CLOD ODC Chair Teachingprofessional / ODC Chairs background Academic thematically Accountancy (nongrouped medical) NORTHERN IRELAND Public Sector 10% 5% 8% Chaplaincy 4% Industry (health care related) 14% Nursing 14% Medical (doctor) 22% Legal 5% Industry (non health care related) 18% Billy Graham Non-executive Director ODC Chair Billy was Chief Operating Officer for Northern Ireland Electricity. NI Regional Chair of Organ Donation Committees

Innovate Norkshire YORKSHIRE NORTH WEST SNODs in Uniform Specialist Requestors 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.

And then innovate some more • • MIDLANDS • • Education - simulation courses o National Deceased Donation Course (pilot site) o SNOD Simulation Training (with South East) o Local Sim Teaching Embrace opportunities o Donation Ambassadors o Specialist Requestors Midlands Deceased Donation Care Guide Promoting Organ Donation (POD) which helped facilitate the MOU with the MOHAN Foundation in India and NHSBT.

Work with government Government Human Tissue Authority Role of the family DBD Consent Quarterly Monitoring, September 2018 Wales better than England SOUTH WALES Detected 10% difference in consent rate at < 0. 05 significance Deceased Donors Jan Y T D

Engage with each other • • We are two sides of the same coin. Our patients need us working together. I’ve seen too many good ideas fail (or get stalled) because one side forgets the other. Plan together (from the beginning), work together, find greatness together. DCD hearts EASTERN The UK is the world leader and the Eastern team is the UK leader

and change the world 2016 2018 SAFER Admission policies from ED to ICU • “Organ donation saves lives: sometimes the life of the donor” • Manara, Thomas & Harding JICS 2016 • DBI consensus statement BJA 2018 • • SOUTH WEST • • It’s not enough to meet KPIs. Emerging out of our 2015 Congress o we set ourselves STRETCH goals (usually run over two years) Goals a whole region could support. The South West stretch goal o changed UK ICU.

Individuals can make a difference • • • SCOTLAND Embrace your uniqueness. Embrace your shared geography, culture and pride. It’s always Christmas at a Scottish collaborative.

Individuals can make a difference • • • Embrace your uniqueness. Embrace your shared geography, culture and pride. It’s always Christmas at a Scottish collaborative. SCOTLAND Lesley Logan One individual who came to represent a country. “It’s authorisation in Scotland not consent” “Scotland doesn’t have NHS Trusts” “Organ donation can also be green not pink. ”

12 Donation Collaboratives 12 Lessons SCOTLAND NORTHERN IRELAND YORKSHIRE NORTH WEST MIDLANDS EASTERN SOUTH WALES SOUTH CENTRAL SOUTH WEST SOUTH EAST 1. 2. 3. 4. 5. 6. 7. 8. 9. Lay firm foundations Use data to drive best practice Are a way of working Create new ways of working Size Matters Build a community Innovate And then innovate some more Work with government – South East – South Central – Yorkshire – Northern – London – N. Ireland – North West – Midlands – South Wales 10. Engage with each other – Eastern 11. Stretch and change the world – South West 12. Individuals can make a difference – Scotland