Scottish Donation and Transplant Group written update: December 2024

NHS Blood and Transplant (NHSBT) 

Update given by:

• Anthony Clarkson, Director of Organ and Tissue Donation and Transplantation

Performance

We are seeing a continued down-trend in organ donation. The are two factors impacting this. The first one being that the number of potential and eligible donors remains lower than pre-pandemic levels. There are no reasons for this showing in our data, so we are undertaking further work to understand what is driving this. The second factor is the consent/authorisation rate which remains one of the key challenges and opportunities. The national consent / authorisation rate is currently sitting at around 60% compared to a rate of around 70% pre-pandemic.

Activity in Living Donation is also below projected levels; however we expect the shortfall to be offset by increased activity from the UK Living Kidney Sharing Scheme in July and October.

There is positive news in ocular donation, with November having the largest increase in month this year.

Marketing

Our Annual Report on Ethnicity Differences in Organ Donation and Transplantation has been published and received considerable media engagement upon launch.

UK opt-in registrations are on target for this year, and currently sit approximately 7% higher than they did at this point last year. However, it still remains below historical rates and work is focusing on increasing partner feeds to the NHS Organ Donor Register (ODR).

Key metrics from our latest UK public survey report show public support for organ donation remains high despite a continuing long-term decline, with fewer people strongly supporting or committing to donate. Awareness of the ODR has dropped to 84% from 91% in 2017. Altruistic motives, such as saving lives, remain key drivers, while barriers include avoiding thoughts of death, lack of knowledge, and distrust in the NHS. The main reasons for not registering are procrastination, not wanting to think about death, and insufficient information. Although 80% of adults believe it’s important to discuss their donation decisions with loved ones, actual conversations have slightly decreased.

NHSBT leadership

We have now appointed a new Director of Communications and Engagement, Antony Tiernan, who joins the Executive Team. Antony is an award-winning Director of Communications who served over 20 years in the NHS, including at Guy’s and St Thomas’ NHS Foundation Trust and London Ambulance Service. Antony also served as a Director of Communications at NHS England, leading on a range of major initiatives, including the NHS’s 70th and 75th anniversaries in 2018 and 2023, respectively. He most recently led communications for the London Fire Brigade and is a Trustee of the national charity, NHS Charities Together.

Sustainability and Certainty in Organ Retrieval (SCORE): redesigning organ retrieval in the UK

In the UK, organ donation, retrieval and transplantation operate under the auspices of NHSBT who commission the National Organ Retrieval Service (NORS). This model supports three cardiothoracic and eight abdominal retrieval teams to be available each day. In recent years, the sustainability of this retrieval service and the relative success of transplant outcomes have required focus, leading to a proposed structural change to the way these services are delivered. The Sustainability and Certainty in Organ Retrieval (SCORE) programme has been established to redesign the delivery model for organ retrieval.

UK organ donation trends have moved in the last decade where organ retrieval was predominantly a night time activity is now conducted most frequently in core business hours, having an impact on donating hospitals operating lists, increased number of delays, and pressure in the NORS teams which have seen an increased fragility within the service.  There has been a marked increase in the number of occasions teams have been unable to cover the on-call rota, and ongoing recruitment and retention challenges. Consequently, organ transplant surgery and organ offering, spanning all organ groups, are now primarily performed out-of-hours, posing avoidable risks due to limited access to support in complex cases, surgeons operating outside of optimal windows and late declines due to changes in members of the multidisciplinary team.

The SCORE programme aims to rectify this imbalance by creating a predictable Planned Arrival Window (PAW) outside of normal working hours, for the NORS team to arrive at the donor hospital and carry out the retrieval operation. Although this will extend the donation process overall, the NORS service, transplanting hospitals, organ allocation, recipients and logistical support teams will have structure planning time to deliver this complex service more efficiently, giving certainty to all.

We believe that these system-wide changes will yield direct benefits by creating a sustainable NORS service for the future, utilise support services (For example, transport) more efficiently and, with transplantation conducted at the optimal time in the day, better outcomes.

SCORE has been a standing agenda item at the Transplant Commissioners Meeting and Karen Quinn, SCORE Programme Director, will attend the April Scottish Donation and Transplant Group (STDG) meeting to give a full progress update.