Scottish Donation and Transplant Group written update: August 2023

Scotland Organ Donation

Update given by:

• Regional Manager Susan Hannah NHSBT

Deceased organ donation performance April 2022 to March 2023

Compared with last year the Donation after Brain Death (DBD) donor pathway there was an 8% decrease in eligibility with patient’s suspected neurological death (from 108 to 99). The neurological death testing rate of 86% (UK average 76%) was maintained and four more DBD donors than last year (47). The Donation after Circulatory Death (DCD) donor pathway there was a 55% increase (from 138 to 215) in eligible donors, and this resulted in seventeen more donors than last year (34). For the first time DCD donor numbers equal the number of DBD donors with total of 102 donors (highlighted below) and this 20% improvement in donor numbers from eighty-one is a return to pre-pandemic numbers.

In addition to the 102 donors there was 258 transplants, a 23% increase from last year (198).

The overall referral rate has remained the same at 97%. The DBD referral rate has seen a two-percentage point decrease from 100% to 98% and DCD a one percentage point decrease from 97% to 96%. The Specialist Nurse (SN) team presence rates remained the same at 89% and 4% lower than UK average.

With regards to the number of authorisations, we saw 12% more families approached than last year with a combined authorisation rate of 68% an improvement of 2% from last year and highest across all four UK nations. The breakdown of authorised donors had an expressed decision 54.5% versus 36.4% deemed authorisation. Expressed authorisation rates and deemed authorisation rates in Scotland for DBD were the same (93%) and highest in the UK. However, DCD expressed was 78% expressed and 63% deemed which has a 30% deemed difference between the two donation pathways. 

In Scotland, the adjusted deemed authorisation rate relative to England Wales and Northern Ireland is 70.5% the highest across the nations.

Deceased organ donation performance April – June 2023

NHSBT targets set for this fiscal year with Scotland donor numbers is 109 donors seven more than last year with breakdown of 55 DCD donors and 54 DBD donors. To achieve this our combined authorisation rate has increased 5% to 73% and DBD 1% increase to 85% and a bigger increase of 7% with DCD 65%.

During the first three months of this financial year validated data from April to June 2023 the donor eligibility has improved for both donation pathways with an overall increase of 19% (13) and a total of 25 organ donors with two under target (27) however this an increase in 8 more donors compared to same time period last year. The referral rate combined is 98% (UK 95%) and the SN team involvement rate 91% (UK average 94%) with DBD 81% and DCD 100%.

The number of potential donor families approached was forty-six with twenty-eight families authorised provides combined authorisation rate of 61% which is 6% below target (UK average 62%). A further breakdown of authorisation route has expressed opt in 95% (18), deemed authorisation 47% (7) and other 60% (3). The Practice Development Specialist (PDS) over the next three months is facilitating specific deemed approach training sessions. 

The Specialist Requestor (SR) evaluation report was submitted to the Scotland Donation Transplant Group (SDTG) and concluded this model has proven effective with a consistent group of experience staff involved in approaching families and shared learning for the wider team. 

Improvements made to the donation pathway with more flexibility of service needs and career pathway for the Specialist Nurse (SN) team and has proven pivotal in reduction of 24 hour working, Recommendation made combined monitoring of authorisation rate is referenced to the Specialist Nurse (SN) team which includes both the Specialist Requestor (SR) and the Specialist Nurse Organ Donation (SNOD) due to flexibility of roles and responsibilities.

In January 2023, the Scotland team was one of several UK donation teams to commence (16 January 2023) bereavement follow-up calls to proceeding organ donor families.

Key details: 

• Fifty-four families offered follow up call
• 46(85%) families accepted 
• Thirteen families had more than one call (five had two calls and eight had three calls)

Initial calls were made four weeks post authorisation. The Specialist Nurses noted within first two months that on occasion the funeral had not yet taken place or had very recently taken place, and this was too soon. As a result, follow up calls have changed to six weeks. 

Anecdotal feedback has been incredibly positive from families providing an opportunity to discuss donation information shared and clarification of their understanding. For some families requiring further support it has helped provide them with contact details for counselling and bereavement services.