Organ and Tissue Authority

PurposeA collaborative model involving a specialist nurse for offering organ donation to families of adult potential organ donors is associated with a higher consent rate, however some paediatric intensivists consider themselves alone best placed to discuss donation given the special relationship they forge with families. The effect of a collaborative model on consent rate in paediatric potential donors has not been studied. We therefore report the consent rate when paediatric families were offered organ donation using a collaborative model compared to an intensivist-only model, with a focus on staff-raised conversations.MethodsWe conducted a retrospective population-based cohort study using DonateLife Audit data for all donation conversations conducted in Australia with families of potential paediatric organ donors from 01/01/2016 to 31/12/2022. Demographics and details of the family donation conversations were analysed using 95% confidence intervals (CI) by the Clopper-Pearson method. Differences in consent rate between collaborative and intensivist-only models were assessed using Fisher’s Exact test. Clinical factors associated with consent in staff-raised conversations were assessed using a multivariate logistic regression model.ResultsThe consent rate to paediatric organ donation was consistently 22% higher when staff-raised conversations were conducted using a collaborative model, compared to an intensivist-only model. For the staff-raised collaborative model, consent was 4.15 times greater than that of the intensivist-only model (OR 4.15, 95% CI 2.47–7.10).ConclusionInvolving an organ donation specialist in donation conversations with families of children at end-of-life results in an increase in the incidence of consent in a similar way to that described in adult patients.

Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator. To evaluate the (i) proportion of patients discharged from ICU receiving MET review and timing of reviews; (ii) characteristics of patients who received early MET review and (iii) predictors of early MET review and associations with clinical outcomes. This is a retrospective observational study of ICU discharges over 2 years in a tertiary hospital and involves descriptive and inferential statistics, including logistic regression analysis. Of 3712 patients, 312 (8.4%) had an early MET review. Patients with cardiothoracic, cardiovascular, gastrointestinal and general surgical diagnoses, higher illness severity or who received invasive ventilation had a higher risk of early MET review. On multivariable analysis, early MET review was associated with an increased risk of ICU re-admission (odds ratio (OR) 6.76, 95% confidence interval (CI) 5.01-9.13, P < 0.001), in-hospital mortality (OR 3.62, 95% CI 2.19-5.99, P < 0.001) and discharge to a nursing home (OR 2.49, 95% CI 1.25-4.97, P = 0.01). Length of stay was longer in patients requiring early post-ICU MET review compared to those who did not (median 16 days vs. 10 days, P < 0.001). One in 12 patients received post-ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk.

Systems for quality and safety assurance in organ donation and transplantation are vital, especially those that seek to minimize donor disease transmission. Australia has developed a national vigilance and surveillance system to identify, review, and analyze actual and potential donor-derived infections and other disease transmissions. The system involves notification of incidents to the Australian Organ and Tissue Authority for review by a Vigilance and Surveillance Expert Advisory Committee (VSEAC). The VSEAC grades incidents, O makes recommendations, and issues communications both publicly and to the clinical donation and transplant sector. Annual notifications have increased since the inception of the system in 2012 until 2022. The vast majority relate to procedural aspects including donor assessment, information/data issues, and the recovery, offer, allocation, preservation and transportation of organs. Possible donor-derived disease accounted for 19% of all notifications, and those related to possible donor-derived infection only 12%. The VSEAC, as a result of reviewing these incidents, has made recommendations resulting in revisions to donor screening, organ allocation, packaging and transportation. The review of incidents has led to changes in clinical guidance for increased viral risk donor assessment, testing, and ensuing organ utilization and recipient surveillance. Guidance has also been reviewed for other infectious risks including strongyloides, human T-lymphotropic virus, and HEV. The Australian vigilance and surveillance system has enabled national retrospective reporting and evaluation of serious adverse events or reactions to identify trends and inform processes and guidelines, therefore improving the safety of donation and transplantation.

Introduction: The utilisation of donated kidneys from Hepatitis C (HCV) Ab positive/RNA-positive donors to HCV naïve recipients has been scrutinised in recent years. In Australia, a conservative approach in the acceptance of HCV positive kidneys due to transmission risk has increased the wait time and overall expenditure on patient treatment. With the development of direct-acting antivirals (DAAs), the use of HCV positive kidneys is becoming more common. The International Society of Nephrology recommends that kidneys from HCV-infected donors be considered regardless of the HCV status of potential recipients; along with confirmation of availability of DAAs within their institution. A consenting process that involves informed discussion surrounding the risks versus benefits of acceptance of a HCV positive kidney, requires accurate and timely education prior to being listed for transplant Objective: To evaluate and identify the current uptake of potential HCV positive kidneys and identify the current practices at a national level. Method: Retrospective exploratory data analysis of kidney offering and acceptance from NSW donors Results: Data is sourced from the Australian Organ and Tissue Authority (OTA) Electronic Donor Record (EDR) from 2014 to 2023. A total of 28 consented donors with an RNA NAT positive result were reviewed. 13 proceeded to actual donation and 15 were intended donors. From 2019, kidney donation to HCV naïve recipients was considered with the first successful kidney transplant taking place in 2021 Conclusion: Organ utilisation from HCV positive donors continues to be an evolving practice that requires further discussion, education and awareness from a donation and transplantation perspective.

Organ donation networks audit and report on national or regional organ donation performance, however there are inconsistencies in the metrics and definitions used, rendering comparisons difficult or inappropriate. This is despite multiple attempts exploring the possibility for convergently evolving audits so that collectives of donation networks might transparently share data and practice and then target system interventions. This paper represents a collaboration between the United Kingdom and Australian organ donation organisations which aimed to understand the intricacies of our respective auditing systems, compare the metrics and definitions they employ and ultimately assess their level of comparability. This point of view outlines the historical context underlying the development of the auditing tools, demonstrates their differences to the Critical Pathway proposed as a common tool a decade ago and presents a side-by-side comparison of donation definitions, metrics and data for the 2019 calendar year. There were significant differences in donation definition terminology, metrics and overall structure of the audits. Fitting the audits to a tiered scaffold allowed for reasonable comparisons however this required substantial effort and understanding of nuance. Direct comparison of international and inter-regional donation performance is challenging and would benefit from consistent auditing processes across organisations.