Organ Donation

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Organ Donation Transplantation in Ireland
Changing times

• Aileen Counihan
• Transplant Co-ordinator
• Beaumont Hospital

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Organ Procurement Centre Team

• National Service for Organ Procurement
• Current Location Beaumont Hospital
• Donor Coordinating Team
• 24hr on call service for ICUs nationally
• Recipient Co-ordination
• 24hr call for renal transplant service

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The Donor Co-ordinator Role

• 24hr call to deal with all enquiries pertaining
  to Organ Donation
• Responsible for the technical and logistical
  arrangements.
• Involved in the donation process from referral,
  retrieval to the transplantation of the organs.
• Care of the Donor, the Family of the Donor, the
  Donor Hospital staff, the Transplant Team,
  Transplant recipients.

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Recipient Co-ordinator Role

• Referral for Renal Pancreas Transplant
• Management of Transplant waiting list
• Coordination of Deceased Donor Transplants
• Live Donor Transplant Programme

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Kidney Transplantation

• Kidney transplantation is considered the best
  treatment option for patients in end stage renal
  failure
• Not all patients are suitable for transplant
• Only 33 of patients with kidney failure are on
  transplant waiting list

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When transplant is not the best option

• Clinical reasons
• History of recent cancer
• Major surgery
• Severe cardiac problems or advanced blood vessel
  disease
• Patient choice
• decide that transplantation is not for them.
• can opt to stay on dialysis.

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Renal Transplantation

• Live Donor Transplant
• from a family member/spouse/friend
• Paired Exchange
• Deceased Donor Transplant
• Brain Death Donor
• Non Heart Beating Donor.

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Recipient Evaluation for Transplant

• Standard workup
• Full Blood Profile
• Tissue type x 2
• Virology lt 3mths
• Chest Xray Abdo U/sound
• Cardiac Tests, Stress ECG, Cardiac Echo
• Coronary Angio ( if indicated)
• Dental Clearance
• Smear Test for female patients
• PSA for men gt 50yrs
• Other tests determined by age/cause of failure
• Copy of all results to Transplant Office with a
  detailed referral letter

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Evaluation for Transplant

• Some patients may require further assessment
• Test results may require further investigation.
• Patient is sent an appointment with an
  information booklet about transplant
• All patients are seen at the transplant
  assessment clinic in Beaumont
• Meet with Transplant Surgeon Co-ordinator

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Pre-Transplant Clinic

• Assess suitability for transplant
• Surgery explained
• Opportunity to ask questions , encourage patients
  to bring someone with them to clinic
• Option of Live Donation given
• Importance of contactability, urgency, keeping
  healthy well reiterated
• Follow up phone call
• Letter to patient to inform approved for
  Transplant regular blood samples for antibody
  screening while on the pool
• Letter from HI when activated

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Further Screening

• Other tests may be required
• Anaesthetic assessment
• Patients to lose weight or to monitor weight
• Reassurance while on the list
• Patients over 2 years
• Patients suspended for a prolonged period of time
• Older patients

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Waiting Time

• Currently 29 months.
• Factors influencing time on list
• Patients with a high antibody level
• Patient BMI
• Increasing number of patients on list
• Donor supply

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Acknowledging the Donation

• Donor and donor family will be foremost on
  recipients mind
• Anonymity Maintained
• Encourage recipients to write to donor family and
  can be done via the Transplant Co-ordinators
• Information leaflet
• Attend the Annual Service of Remembrance and
  Thanksgiving
• Circle Of Life Garden in Salthill

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Organ Donor Web Site
Donor Families shared experiences Transplant
Recipient success stories Gratitude of Recipients
Comfort received by Donor Families Commemorative
Garden
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Statistics

• Deceased Donors/Transplants in Ireland
• (Organ Procurement Centre)

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Potential Live Donor

• Patients will be asked if they wished to consider
  a Live Donor Transplant
• Potential donors to contact the transplant
  co-ordinators directly
• Initial suitability would be discussed with them
  Blood Group Compatible
• Arrangements made for HI screening
• Information on Live donation given
• Only one donor can go forward to workup

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Live Kidney Donation

• Donor must be fully informed and aware of risks
  and benefits of procedure
• No risk to the potential donor
• The decision to donate must be voluntary, no
  coercion or inducement
• The transplant must have a good chance of
  providing a good outcome for the recipient.
• Ethical Issue
• Exposes an otherwise healthy person to the risks
  of major surgery entirely for the physical
  benefit of another individual

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Living Donation Programme
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Information for Live Donor Recipient

• Donor work up period 3 months approx
• Medical suitability, extensive screening
• Immunological screening
• Independent clinical psychological review
• Donor work up confidential
• Isolating period for recipient
• Recipient remains under the care of nephrology
  team
• Suspended from list, when donor deemed suitable
• Setting date for surgery

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LRD and Deceased Renal Transplant activity in
Ireland
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Changing Role of Transplant Office

• No responsibility for Organ Procurement
• Perceived conflict of interest
• Independent Service
• Recipient Coordination
• 24 hour on call for renal/pancreas transplant
• Liaise with Renal Unit Staff
• Patient education
• Co-ordinate Live Donation Programme

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Responsibility of Transplant Office
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Organ Procurement Office
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Thank You All

• Further information
• www.beaumont.ie
• www.icmed.com
• www.strangeboat.org
• www.ika.ie
• www.coe.int