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G443 Paediatric organ donation – a uk challenge
  1. A Scales1,
  2. K Hawkins2,
  3. E Wong3
  1. Organ Donation and Transplantation, NHS Blood and Transplant, London, UK
  2. PICU, Manchester Children’s Hospital, Manchester, UK
  3. Clinical Statistics, NHS Blood and Transplant, Bristol, UK

Abstract

Introduction The overall trend of an increase in organ donation (OD) has not been replicated in the paediatric population. Individual units have wide variations in practice and raise the question of whether bespoke national strategies would contribute to the aim of increasing OD in this area.

Method The UK has 27 paediatric intensive care units (PICU) on the potential donor audit (PDA). Individual unit data was extracted from Apr15–Mar16.

Discussions were held with clinicians and specialist nursesorgan donation (SNODs) from units regarding practices.

Results 93% of children <16 years that met a referral criteria died in PICU, 92% of eligible donors were also in PICU.

Nationally neurological determination of death (NDD) was suspected in 90 cases, 59 NDD tests performed.

111 (61%) eligible donors were approached. Non identification was the reason for non approach in 16 (22%) of cases. SNODs were involved in 76 (68%) of approaches.

Consent was gained in 45 (41%) of families approached. Reasons for non consent were varied; surgery to the body was highest at 18%.

The data has shown that the neurological testing rate, approach rate, SNOD involvement and the consent rate varied from 0% to 100% across the centres.

Conclusion The data shows wide variation in unit processes, understanding the reasons for this variation is important in achieving potential for OD. Only 16 (6%) of the SNOD team have a paediatric qualification with 5 (31%) covering a PICU. Training SNODs in PICU processes plays a key role in unit relationships with OD teams.

Demands on SNODs time with priority in areas with greater potential may reduce visibility in PICUs, potentially impacting on unit relationships.

Overall data shows SNOD involvement in approach improves consent, this trend is replicated here. More research in consent for paediatrics is required to incorporate the specific needs of families in the context of these discussions.

In high performing units there is a best practice culture with open team discussion regarding OD being a regular event.

The benefits of embracing differences in practice, along with bespoke strategies to ensure OD is considered as a usual part of end of life care in paediatrics will be far reaching.

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