Scottish Donation and Transplant Group meeting: April 2020
Minutes and papers from the meeting of the Scottish Donation and Transplant Group, held on 9 April 2020.
Attendees and apologies
- John Casey, Joint Chair and Clinical Adviser for Transplantation in Scotland
- Iain Macleod, Joint Chair and Clinical Adviser for Organ Donation in Scotland (part of meeting only)
- John Asher, Consultant Transplant & General Surgeon, NHS Greater Glasgow and Clyde
- Marc Clancy, Consultant Renal Transplant Surgeon, NHS Greater Glasgow & Clyde
- Anthony Clarkson, Director of Organ Donation and Transplantation, NHSBT
- John Forsythe, Associate Medical Director ODT, NHSBT
- Anushka Govias-Smith, Commissioning Programme Manager, National Services Division (NSD)
- Marie Gardiner, Service Manager, Renal, Transplant and Dermatology, NHS Lothian
- Susan Hannah, Regional Manager (Scotland), NHSBT
- Neil Healy, Senior Nurse for Tissue Services, SNBTS
- Alastair Innes, Consultant Respiratory Physician, NHS Lothian
- Stephen Kirkham, Patient Representative
- Ann-Margaret Little, Consultant Clinical Scientist, NHS Greater Glasgow and Clyde
- Jen Lumsdaine, Living Donor Co-Ordinator
- Heather Maxwell, Consultant Paediatric Nephrologist, NHS GGC
- Gabriel Oniscu, Consultant Transplant Surgeon, NHS Lothian
- Neal Padmanabhan, Consultant Nephrologist, NHS Greater Glasgow and Clyde
- Keith Rigg, NHSBT Board Member
- Lesley Ross, Patient Representative
- David Turner, Consultant Clinical Scientist, SNBTS
- Charles Wallis, Regional Clinical Lead for Organ Donation
- Andrew Walls, Donation Committee Regional Chair – Dumfries and Galloway
- Hester Ward, Public Health consultant, NSD
- Sam Baker, Donation Team Leader, Scottish Government (SG)
- Rachel Tatler, Donation Policy Officer, SG
- Linda White, Policy Manager, SG
Apologies:
- Richard Appleton, Scottish Intensive Care Society
- Lynne Ayton, Head of Operations, Golden Jubilee National Hospital (GJNH)
- Nawwar Al-Attar, Consultant Cardiac and Transplant Surgeon and Director, Scottish National Advanced Heart Failure Service (SNAHFS) – GJNH
- Andrew Bathgate, Consultant Hepatologist, NHS Lothian
- Roseanne McDonald, Programme Associate Director: Nursing and Quality Adviser, NSD
- Jessica Porter, Head of Regulation, Human Tissue Authority
- Liz Sadler, Interim Head of Health Protection Division
- David Walbaum, Consultant Nephrologist
- Anthony Warrens, Consultant Renal Physician, Human Tissue Authority
- Stephen Wigmore, President, British Transplantation Society
- Sharon Zahra, Clinical Lead, Tissues and Cells, SNBTS
In attendance:
- David McIlhinney, Policy Officer, SG
Items and actions
Item 1. Welcome and apologies
1. Mr John Casey chaired the meeting and welcomed members. In particular he welcomed Keith Rigg, NHSBT back to SDTG following the extension of his Non-Executive Director role and welcomed Hester Ward from NSD on behalf of Roseanne McDonald.
2. Mr Casey thanked the group for their hard work and efforts during the Covid-19 pandemic and acknowledged the letter of thanks from the Minister for Public Health, Wellbeing and Sport which had been sent to transplant units, retrieval teams and specialist nurses and clinical leads for organ donation.
Item 2. Minutes of previous meeting and matters arising – December 2019
3. The minutes were accepted as an accurate record of the previous meeting.
4. Mr Casey referred to the matter raised at the previous meeting around psychological support, which was still planned to be taken forward as part of the work on patient aftercare for the draft Scottish post-2020 plan. He advised that this work had been delayed due to the diversion of focus on Covid-19.
Item 3. Coronavirus (Covid-19)
Item 3.1. Organ Transplantation
5. The following updates were provided from the Scottish transplant units. Given that the presence of Covid-19 within hospitals increases the risks for patients of transplantation (due to the need for high levels of immunosuppression immediately post-transplant), it was acknowledged that at the time of the meeting it was only appropriate to consider transplantation for those whose transplant was urgent.
West of Scotland Transplant Unit (QEUH)
6. The transplant unit had suspended its adult renal transplantation programme, although the paediatric programme remained open for a couple of high priority patients. The next review of the adult programme was planned for 15 April and weekly thereafter. It was noted that there had been a marked decrease in the number of organ offers due to Covid-19.
Edinburgh Transplant Unit (RIE)
7. The Edinburgh Transplant Centre had suspended its deceased donor kidney transplant programme and pancreas transplantation. The Centre was continuing islet transplantation for the time being, but only for the highest priority patients needing a second islet transplant (which was currently just one patient). Liver transplantation was continuing, but only for super-urgent transplants and for those patients with liver cancer likely to soon become ineligible for transplant. The suspension of the transplantation programmes would be reviewed on a weekly basis.
Golden Jubilee National Hospital
8. The Golden Jubilee National Hospital remained open to offer transplants for their urgent patients, if suitable hearts were offered for them.
Shielding
9. Ms Baker reported that the Chief Medical Officer for Scotland (CMO) had sent a letter to people at the clinically highest risk of severe illness from Covid-19 to ask them to shield for at lest twelve weeks. This group includes all solid organ transplant recipients.
10. It was noted that 80 living donors had received the shielding letter in error. A further letter had been issued to these individuals clarifying that they did not need to shield.
11. Consideration was being given to adding further cohorts of patients to the list for shielding, particularly dialysis patients. All clinicians in Scotland had now received a letter from the CMO with instructions on how to add patients to this list if they had patients who they felt were at particularly high risk; a shielding lead is now in place in each NHS Board.
12. Members highlighted their opinion that everyone on the kidney, simultaneous pancreas/kidney (SPK) and liver waiting lists should be issued with a CMO letter asking them to shield for 12 weeks. It was noted that clinicians should contact their local NHS Board shielding lead with lists of patients that fall into these categories.
13. Transplant Units highlighted the importance of having access to Covid-19 tests for recipients before they undergo a transplant. Using these tests (potentially with CT scans) would give them more confidence in transplanting patients given the high level of risk for a patient if they underwent a transplant while infected with the virus. It was noted that there would be a rate of false negatives when testing asymptomatic patients; however testing would still provide some reassurance for transplant units and their patients.
Action: Sam Baker to enquire about testing for transplant recipients and ensure the Scottish Government or SDTG could issue clear guidance to NHS Boards on this [post-meeting note – CMO confirmed on 20 April that he is happy for patients to undergo testing pre-transplant].
Action: Sam Baker to ask Phil Curry / Lynne Ayton about their views on shielding for heart waiting list patients.
Item 3.2. NHSBT UK Covid-19 position
14. Professor John Forsythe updated the group on the NHSBT position in relation to Covid-19 and advised that frequent meetings were being held between commissioners, clinicians and Departments of Health representatives. These meetings had enabled NHSBT to make decisions on living donation, donor exclusion criteria, retrieval and transplantation in response to the evolving situation. Regular NHSBT Covid-19 bulletins were being issued to NHS colleagues across the UK.
15. At the time of this meeting it was reported that:
- Four adult kidney units were open across the UK, but none in Scotland.
- Two paediatric kidney units were open – one in Glasgow and one in Birmingham.
- Liver units across the UK were open only for urgent and super-urgent transplants.
- All cardiothoracic centres in the UK – including the Golden Jubilee National Hospital were open to heart patients.
- The Freeman Hospital in Newcastle was open for urgent lung transplantation – including for Scottish patients.
From the NHSBT transplant registry, it was confirmed that over 120 post-transplant patients were known to have been infected with Covid-19 to date. Ms Hester Ward was helping NHSBT to link Public Health Scotland’s data on patients in Scottish hospitals with the transplant registry data to improve the reporting of infections among transplant recipients. This data would help NHSBT to understand the levels of risks for different recipient groups and therefore to rebuild organ transplantation when Covid-19 had peaked.
Item 3.3. Update on Scottish Position
16. Ms Susan Hannah provided an update on the Scottish donation position. The previous year (2019-20) had seen 109 deceased donors, including 74 DBD donors, a total of 20.1 donors per million population.
17. The Specialist Requestor (SR) model had been working well so far. It had seen 30 out of 43 approaches to families since 6 January involving an SR, with an 80% authorisation rate for those approaches where the SR was involved.
18. There had been a total of 14 occasions where the family had overridden the recorded decision on the organ donor register in 2019-20. This represented the highest yearly figure so far recorded.
Item 3.4. Update on Tissue Donation
19. Mr Neil Healy gave an update on tissue donation and he highlighted the challenges ensuring appropriate PPE was available for tissue retrieval staff. The capacity of mortuaries was being monitored as there were concerns that if mortuaries were busy with Covid-19 patients this could make undertaking tissue retrieval more challenging.
20. Deceased tissue donation activities had now been paused with the exception of cornea retrieval and activities would be reviewed on a weekly basis. Three Tissue Donor Coordinators had moved to support blood donation staff given high levels of interest from people wishing to donate blood following recent advertising for donors.
Item 4. Human Tissue (Authorisation) (Scotland) Act 2019 and Post-2020 Plans
4.1 UK Strategy
21. Mr Anthony Clarkson advised that the UK strategy had been paused and work would recommence late summer. He went on to advise that it is the intention to present the final draft plan to the four UK Health Departments in September 2020; however this timescale is under review, depending on the current and evolving situation with the Covid-19 pandemic.
4.2 Scottish Post-2020 Plan and Opt out Legislation
22. Ms Baker proposed that, given the postponement of the UK strategy, the Scottish plan should also be delayed and would follow a similar timescale for publication as the UK strategy. It was suggested that the Scottish plan and timescales for publication would be the subject of a fuller discussion at the next SDTG meeting in August 2020. The group did not raise any concerns and so the revised timing plans were agreed.
23. Ms Baker went on to advise that, due to the current pressures on NHS Scotland in relation to the Covid-19 pandemic, the implementation of the Human Tissue Authorisation (Scotland) Act 2019 had been delayed to March 2021. This decision was taken in particular due to the expected difficulties in carrying out training of ICU staff in time for implementation in autumn 2020, as well as difficulties in taking forward a high-profile awareness-raising campaign on the new law at a time when the public’s attention was rightly focussed on the virus. The legislation associated with the Act was largely complete, with only one set of regulations still to go through the Scottish Parliament (those on excepted body parts). It was expected that training for implementation would resume in around September 2020.
4.3 NSD Commissioning Plan
24. Ms Ward advised that the NSD Commissioning Plan had also been postponed and the cancelled focus groups would hopefully be rescheduled later in the year. NSD currently aimed to publish their plan in December 2020.
Item 5. Written Updates
25. Mr Casey referred to the written updates information.
Item 6. AOB
6.1 Advice to patients
26. Mr Gabriel Oniscu referred to a letter that one of his transplant patients had received from a local GP about stopping their immunosuppressant medication. He raised serious concern about this inaccurate advice as it would cause detrimental effects to the patient.
27. It was confirmed that there had been no instruction from the Scottish Government to GPs about this. The Deputy Medical Director in the relevant NHS Board had been alerted to this issue and was currently investigating, but it was also confirmed that the NHS Board had not instructed GPs to send this so it was thought to be a GP practice error.
28. There was also discussion around who was best placed to make contact with transplant recipients and those on waiting lists added to the shielding list in relation to anticipatory care plans (ACPs) during the Covid-19 pandemic. It was agreed that there was need for clarity around this; Mr Clancy noted that the Glasgow transplant unit they had not had contact with some transplant recipients for many years as follow-up would be via GPs and/or Renal Units. A number of group members felt that it was not appropriate to have ACP discussions with patients who are fit and well as this would cause unnecessary alarm and distress; the group felt it was more appropriate to raise it with such patients if they were hospitalised with Covid-19 infection.
Action: Sam Baker to seek clarification on who should contact patients on the shielding list and on ACPs [post-meeting note – it was confirmed that clinicians can use their discretion in deciding whether and to what extent to raise anticipatory care planning with their patients].
29. Finally, Mr Walls asked Professor Forsythe about the experience with Covid-19 and transplantation internationally. Professor Forsythe noted that he had been having discussions with colleagues in a number of countries and they were facing similar challenges, depending on where they were in the Covid-19 hospitalisation curve. He also noted that there were no proven cases of donor to recipient transmission of the virus, but NHSBT was continuing to defer anyone with Covid-19 infection from donating as a precaution.
Date of next meeting
The next meeting would be held on 25 August 2020 in St Andrew’s House, Regent Road, Edinburgh, EH1 3DG from 10.00 – 12.00, although this may need to be reviewed depending on the Covid-19 situation.
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