Scottish Donation and Transplant Group – written updates: March 2022

Scottish Donation and Transplant Group (SDTG): Written Updates for 31 March 2022 Meeting

Thursday 31 March 2022, 14:00-16:00

Histocompatibility and Immunogenetics Services Update

Submitted by David Turner And Ann-Margaret Little

Staffing

Glasgow H&I: Band 6: 1 fixed term maternity cover vacancy, which has been difficult to fill due to a lack of available HCPC registered scientists. Two new Band 6/7 vacancies going out to advertisement soon.

Edinburgh H&I: One senior BMS (25% of senior capacity) on long term sick leave. 1 year fixed term Band 7 acting up post and a 1 year fixed term Band 4 post are alleviating some of this pressure.

On call rotas

The one in four Consultant/Principal Clinical Scientist rota supporting deceased donor kidney, SPK, islet and cardiac transplantation in Scotland continues to work well, although are down to a 1:3 rota due to maternity leave.

The Edinburgh H&I on call rota for lab testing has been fragile due to staff having to cover long term absences, but for now is functioning.

Quality in Organ Donation (QuOD) project

UK wide study, ongoing. Samples are processed by H&I staff in H&I Edinburgh. Have still not established new route for monies from Oxford University to come to NHS Lothian (rather than the previous Edinburgh Uni) and eventually to SNBTS help fund part of a Band 6 post as previously agreed. Lorna Marson offered to try and move forward at the start of Feb 2022, but still no agreement. SNBTS have therefore missed out on funding for this for another year (2021-22).

Donor HLA typing

Both labs continue to meet the KPI for deceased donor typing.

Donor Characterisation Review

NHSBT hoping to introduce electronic reporting of deceased donor HLA typing and microbiology/virology results to ODT to avoid transcription errors. New go live date for HLA typing data is 2023. The NHSBT contract for providing deceased donor typing is with Contracts departments within SNBTS and GGC for sign off. Concerns over the insurance and indemnity clauses and SNBTS have suggested using NSS Central Legal Office to peruse the contract before sign off. Will delay beyond the NHSBT deadline of April 2022, although unsure of the repercussions of this.

Coronavirus pandemic

Both laboratories have been largely unaffected by the pandemic and continue to deliver a "normal" service.

HNA antibody testing

HNA antibodies have been implicated in small numbers of kidney transplant AMR when HLA-DSA are absent. Two cases have been identified in the last few years in Edinburgh, and one recently in Glasgow. The two H&I labs are discussing the most appropriate mechanism for introducing screening for HNA antibodies into routine practice.

Tissue Donation Update

Submitted by Dr Sharon Zahra And Mr Neil Healy, Clinical Lead And Lead Nurse, TCAT, SNBTS

Deceased Tissue Donation

Since the last report (November 21 to February 22), the number of potential tissue donor referrals has increased slightly, although the number of proceeding tissue donors has remained relatively steady. The significant deferral rate is not unexpected with deferrals being mainly due to donor past medical history.

During the first 11 months of this financial year (up to end February 2022), there were a total of 252 referrals to SNBTS, of which 31 were suitable for deceased tissue donation. Of the 31 donors, 18 were organ donors first, with the remaining 13 donating tissue only. These 31 donors donated a total of 34 heart valves and 85 tendons. There were also a further 61 eye-only donors referred to NRC (NHSBT), with SNBTS retrieving a total of 72 eyes from 36 donors.

Pancreatic Islet Programme

The COVID-19 pandemic continues to adversely impact suppliers of a number of bespoke reagents that are essential for islet cell processing, with the suppliers continuing to struggle to supply the essential reagents in a timely manner. SNBTS continues to work hard to identify suitable contingency suppliers although all suppliers appear to continue to struggle at present.

Despite this the SNBTS Islet Isolation Lab has continued to process pancreata for clinical transplantation where offered, with excellent results. To date in the first 11 months of the 2021/22 financial year (up to end of February 2022), 19 pancreata were offered to and processed by SNBTS, of which 13 (68%) yielded a successful transplantable product by SNBTS release criteria, leading to a transplant on 10 (53%) occasions. This success rate is one of the best in the world and with one month to go in the financial year, this is the highest transplant rate in the last 5 years, despite the ongoing pandemic.

Live Bone Tissue Donation

The COVID-19 pandemic continues to have a significant negative impact on elective orthopaedic surgery with patients progressing to surgery at a reduced rate and operations are not infrequently still being cancelled at short notice. This continues to have a significant negative impact on the ability to progress bone donation.

There is an additional ongoing impact of the fact that elective orthopaedic surgery has been delayed such that potential bone donors are ending up needing donated bone themselves instead of being bone donors. As a result, the rate of bone donation remains lower than required to maintain a reliable bone stock, while bone usage remains relatively increased despite the relatively low rate of orthopaedic elective operations going ahead just now.

In the first 10 months of this financial year (up to end of January 2022) the rate of bone donation (FH retrieved) vs usage is demonstrated in the table below:

	Apr-21	May-21	Jun-21	Jul-21	Aug-21	Sep-21	Oct-21	Nov-21	Dec-21	Jan-22	Total
FH Retrieved	38	54	56	49	38	41	44	50	39	30	439
Used	40	48	40	20	61	22	37	36	44	25	373

NHS Blood And Transplant

Submitted by Anthony J. Clarkson, Director Of Organ And Tissue Donation And Transplantation

From 01 April 2021 to 27^th February 2022 there have been 1281 deceased organ donors in the UK and 3131 deceased donor organ transplants. Donor numbers are a 22% increase on the same period in 20/21 but remain 13.1% down on pre-COVID levels. There are currently 6195 people in the UK on the active Organ Transplant Waiting List.

In the New Year's Honours List Professor John Forsythe, previous Chair of the SDTG, was awarded an OBE in recognition of his lifetime contribution to Organ Donation and Transplantation. Prof Forsythe has now retired from the role of Medical Director of Organ Donation and Transplantation; his successor is Professor Derek Manas.

The new NHSBT corporate strategy will officially launch on Monday 28^th March. The Strategy, 'A world where every patient receives the donation they need' sets out the 5 strategic priorities that will shape the structure and direction of the organisation into the next decade. Invitations to the launch are being shared with partners.

The Commonwealth Tribute to Life, the Memorandum of Understanding between participating Commonwealth nations was officially launched in a mixed live/virtual event in Wolverhampton on 14^th March. The event was joined by Sajid Javid Secretary of State and Health and Social Care and by both the Chair and CEO of NHSBT. Currently, 41 of the 54 Commonwealth countries have signed the Memorandum of Understanding to pledge their support to the Tribute to Life Project, which endeavours to save lives through increasing organ donation and transplantation by promoting the sharing of knowledge and expertise.

Human Tissue Authority Update

Submitted by Jessica Porter, Head Of Regulation, Human Tissue Authority (HTA)

New CEO

• We welcomed our new Chief Executive, Dr Colin Sullivan, to the organisation on 1 January 2022.

Audits of establishments

• We have developed a new way of undertaking audits for transplant centres with an HTA ODT licence. This is a blended approach; a combination of a Virtual Regulatory Asessment with a focused and targeted site visit inspection. This is subject to change as we continue to evolve and test the new approach.

Deemed Consent changes – Northern Ireland (deceased donation)

• In agreement with the Department of Health in Northern Ireland, we are currently making changes to our existing Code of Practice F part two: Deceased organ and tissue donation, to reflect the legislative change to deemed consent that is being introduced in Northern Ireland in Spring 2023.

Living Donation

• Since the last SDTG meeting in November, we have assessed 32 living organ donation cases where the transplant was due to take place in Scotland.
• Ten of these cases were for donors and recipients taking part in the National Kidney Sharing Scheme.
• Overall, there has been an increase in the number of cases submitted for the National Kidney Sharing Scheme for the upcoming matching run in April.

Living Donation Update

Submitted by Jen Lumsdaine, Living Donor Co-Ordinator, NHS Lothian

Education and Publicity

Both the multi media campaign in January and World Kidney Day generated positive living donation publicity, with resultant increased interest. A series of multi-faith webinars in association with Kidney Research UK continue throughout March. The Turas learning module for renal unit staff content is complete and piloting due to start in April 22.

REACH Transplant

The short term REACH Transplant working group has agreed the proposed allocation of REACH Transplant resources and these proposals shared with nephrology teams. Job descriptions have been submitted and awaiting banding confirmation. When available the next step will be to contact the NHS Board Chief Executives to start recruitment process.

Workforce Planning

The scoping exercise to establish current resources and produce recommendations for future staffing is complete and results being collated. The main focus has been the nurse specialist time to facilitate living donor assessment and follow up.

The number of health-check questionnaire returns to all units

Data collection for health-check questionnaire returns including all units and the number of recipients offered a kidney from a living donor by month.

In the same time period there have been 393 downloads of the living donor information pack and 223 downloads of the health-check questionnaire from the Organ Donation Scotland website

Kidney transplants Scotland 2016-2022 to date

There have been 8 altruistic donors in Scotland to date since April 21.