Donation and transplantation plan for Scotland 2013-2020

Our national plan setting out key recommendations around organ and tissue donation and transplantation to improve Scotland's performance.

Annex B Organ Donation Task Force Reommendations

Recommendation Progress In Scotland
1. A UK-wide Organ Donation Organisation should be established. NHSBT undertook an internal reorganisation in order to form the Organ Donation and Transplantation Directorate with a remit coordinating organ donation and transplantation across the UK. It operates in Scotland under an income generating agreement with Scottish Government.
2. The establishment of the Organ Donation Organisation should be the responsibility of NHS Blood and Transplant.
3. Urgent attention is required to resolve outstanding legal, ethical and professional issues in order to ensure that all clinicians are supported and are able to work within a clear and unambiguous framework of good practice. Additionally, an independent UK-wide Donation Ethics Group should be established. The Scottish Transplant Group established an ethics sub-group which works closely with the UK Donation Ethics Committee, to give consideration to complex ethical and legal issues. In 2010 it published guidance on legal issues relevant to donation following cardiac death and provided updated advice in 2012.
4. All parts of the NHS must embrace organ donation as a usual, not an unusual, event. Local policies, constructed around national guidelines, should be put in place. Discussions about donation should be part of all end-of-life care, when appropriate. Each Trust should have an identified Clinical Donation Champion and a Trust Donation Committee to help achieve this. The Scottish Government gave strong support for implementation of the Taskforce recommendations, not least by including a reference to them in the Better Health, Better Care Action Plan. Organ Donation Committees have been established in all mainland NHS Boards with links established to the Island Boards and Clinical Leads for Organ Donation have been appointed in all NHS Boards.
5. Minimum notification criteria for potential organ donors should be introduced on a UK-wide basis. These criteria should be reviewed after 12 months in the light of evidence of their effect, and the comparative impact of more detailed criteria should also be assessed. A Professional Development Programme centred on best evidence was delivered to support Clinical Leads and Committee Chairs. The master class covering Authorisation took account of this recommendation which has proved challenging in Scotland. In Spring 2013 NHSBT produced a Strategy for Identification and Referral of potential donors, endorsed by the Scottish Transplant Group. This is currently being revisited within the Scottish Collaborative network. Whilst the referral rate of potential donors has increased over the five years this remains an area in progress particularly in regard to donation after circulatory death where Scotland's performance remains poor in comparison to the UK average.
6. Donation activity in all Trusts should be monitored. Rates of potential donor identification, referral, approach to family and consent to donation should be reported. The Trust Donation Committee should report to the Trust Board through the Clinical Governance process and the Medical Director, and the reports should be part of the assessment of Trusts through the relevant healthcare regulator. Benchmark data from other Trusts should be made available for comparison. Regular information is available, via NHSBT. The potential donor audit (PDA) allows us to monitor a range of measures and data on donation and transplantation. NHSBT provides biannual reports for each NHS Board.
7. Brainstem death testing should be carried out in all patients where brainstem death is a likely diagnosis even if organ donation is an unlikely outcome. The diagnosis of death by neurological criteria is not undertaken in all patients where brainstem death is likely. In Scotland this occurs around 73% of the time. The UK average is 79%. We continue to monitor this complex area of clinical practice.
8. Financial disincentives to Trusts facilitating donation should be removed through the development and introduction of appropriate reimbursement. Not applicable to Scotland (there never were disincentives in Scotland).
9. The current network of donor transplant co-ordinators should be expanded and strengthened through central employment by a UK-wide Organ Donation Organisation. Additional co-ordinators, embedded within critical care areas, should be employed to ensure a comprehensive highly skilled, specialised and robust service. There should be a close and defined collaboration between donor co-ordinators, clinical staff and Trust Donation Champions. Electronic on-line donor registration and organ offering systems should be developed. All Specialist Nurses for Organ Donation were TUPE transferred to NHSBT employment and a regional Scottish Headquarters established in central Scotland. An additional seven Specialist Nurses for Organ Donation were appointed and fully embedded in critical care areas. Electronic on-line donor registration and organ offering systems fully implemented.
10. A UK-wide network of dedicated Organ Retrieval Teams should be established to ensure timely, high quality organ removal from all heart beating and non-heart beating donors. The Organ Donation Organisation should be responsible for commissioning the retrieval teams and for audit and performance management. This recommendation is modelled on the practice in Scotland of a single national retrieval team and therefore, did not apply to Scotland. Commissioning of the Scottish organ retrieval team transferred from National Services Division to NHSBT.
11. All clinical staff likely to be involved in the treatment of potential organ donors should receive mandatory training in the principles of donation. There should also be regular update training. A professional development programme for CL-ODs, SN-ODs and Donation Committee Chairs established by NHSBT. In addition, the Scottish Government, working in partnership with NHSBT, has developed an ongoing advanced clinical communications course for clinical staff likely to be involved in breaking bad news to the families of potential organ donors.
12. Appropriate ways should be identified of personally and publicly recognising individual organ donors, where desired. These may include national memorials, local initiatives and personal follow-up to donor families. In Scotland there has for some time been a national memorial for organ donors (the Love seat in Kelvingrove Museum), and we are currently in the process of establishing a new memorial, to be located in the Royal Botanic Garden, Edinburgh.
13. There is an urgent requirement to identify and implement the most effective methods through which organ donation and the 'gift of life' can be promoted to the general public, and specifically to the Black and Minority Ethnic population. Research should be commissioned through Department of Health Research and Development funding. The Scottish Government has consistently run high-profile public awareness campaigns to raise awareness of organ donation, to encourage people to join the NHS Organ Donor Register and to make their loved ones aware of their wishes. Tailored awareness-raising and information giving activity is undertaken with BAME communities through high-profile multicultural events throughout Scotland. We recognise, due to changing demographics within the Scottish population, additional ethnic minority groups may need to be engaged with in the future.
14. The Department of Health and the Ministry of Justice should develop formal guidelines for coroners concerning organ donation. Not relevant to Scotland, although we have done a lot of work with the Crown Office and Procurators Fiscal to ensure that there are no unnecessary donation refusals. This is an ongoing task. The Scottish Transplant Group supports a regularly reviewed agreement with the Crown Office and Procurator Fiscal service outlining respective responsibilities. The guidance is again under review to take account of the COPFS support in establishing the Category II programme pilot in Edinburgh.


Email: Pamela Niven

Back to top