Medical Director Bulletin
Monthly communication from the ODT Medical Director
June & July 2023
A message from Professor Derek Manas, OTDT Medical Director
Hello again from me and the clinical team.
Summer is upon us and so far, so good.
As you all know, the NHS will soon have been in existence for 75 years and even though it remains an important part of the fabric of our nation, its going through some challenging times both financially and from a workforce resilience point of view. I would like to pay tribute to all our staff who worked tirelessly to maintain the donation and retrieval services through the recent strikes and the transplanting teams who continued to deliver the lifesaving service for our patients. It is a testament to the brilliant teamwork and camaraderie we have in OTDT and within the wider transplant community. Here's hoping we get an agreement soon.
The OTDT clinical team continue to deliver on many fronts and at a recent clinical team meeting with our lay members a comment was made about ‘the positive energy’ displayed and how encouraging it was to be at a meeting where ‘COVID was now firmly in the rear-view mirror’ and we were once again looking ahead.
The Headlines:
SCORE:
In the last bulletin I spoke about the National Organ Retrieval Services (NORS) Review which has led onto the Sustainability and Certainty in organ retrieval (SCORE) program. This is an exciting program looking at refreshing the retrieval service and improving efficiencies across the board. It’s a long-term project led by Karen Quinn and her team and John Richardson and his team, based on the engagement and feedback we got from the community and will cover improvements in certainty of retrieval timings and sustainability of the work force. There are several webinars you can join to hear about the program – so please take the time to log in and hear about the plans. See more detailed information below.
Histopathology:
Some more good news. As many of you are aware, obtaining histopathology for lesions found during organ retrieval has been challenging due to lack of pathology out of hours. We have been working tirelessly in the background to secure funding for a national service based on a digital platform. We have finally got confirmation from NHS England that monies have been approved to develop the service. This will be commissioned through NHS England and will take 18 months to 2 years to come fruition, but it will finally become a reality. This is thanks to the amazing work done by Meena Saroy, Emma Billingham and Desley Neil. We also have an interim plan based on the use of the current digital scanners used for the PITHIA study which we hope to put in place by the end of the year.
NOUC:
The National Organ Utilisation Conference (NOUC) was held in London at the end of May. Those of you who were there will agree it was a great success, with some excellent presentations most notably Henry Marsh and Adnan Sharif. Well done to Chris Callaghan and the team (Jessica Jones, Helen McManus & Agimol Pradeep) for putting on such a great meeting. See a more detailed update further down.
Lung Summit Report:
The Lung Summit report is now published. Thanks to Jas Parmar, Diana Garcia-Saez, and Vicky Gerovasili we now have a report and some recommendations to try and influence change and support our clinical colleagues in making those changes. Having said that, since the summit we have seen an improvement in lung transplant numbers and that may be because of socialising the problems faced by many clinical colleagues as well as the ‘rear view mirror’ view of COVID – that had a devastating impact on lung transplantation. Whatever the reason – it's fantastic to see, so well done all.
HHV8:
Many of you would have seen a communication from Ines and I about the addition of Human Herpes Virus 8 (HHV-8) antibodies to routine deceased organ donor screening. This commenced on 30th May 2023, in line with SaBTO recommendations and the SaBTO virology subcommittee recommendations are accessible via the www.gov.uk site. Screening will apply to all potential deceased donors characterised in the UK and this will be performed post-donation. OTDT will communicate results to transplant centres through the existing routes. In addition, positive donor results will be systematically communicated by OTDT to relevant transplant centres, so that the significance of findings can be discussed and a suitable follow up plan for recipients can be agreed with the responsible clinician. And just to add my thanks to Ines Ushiro-Limb, Meena Saroy and Emma Billingham whose hard work got this over the line.
OUG:
Work has now begun on plans to move forward with implementing the recommendations. Thanks to my AMD team for the recent ‘brain storming’ event to look at a way forward. Of the 6 themes in the report – Placing the patient at the heart of the service, improving the operational infrastructure to maximise transplant potential, and supporting innovation were felt to be the areas we could start with – especially working in collaboration with NHS England and you – the clinical community. Some work streams will be established and some of you may be asked to join one and help develop the implementation plans going forward.
Changes to the COVID Treatment Service:
I know that there are still many vulnerable patients out there that are concerned about accessing treatments for COVID. Information about the changes in service provision have been difficult to find, and thanks to Robbie Burns (co-chair of the Cardiothoracic patient group) and Rommel Ravanan we have some information for patients if they require it. Between December 2021 and June 2023, a national digital system was in place that helped identify highest risk patients who had reported a positive COVID test. This enabled automatic referrals to COVID Medicine Delivery Units (CMDUs) who would then contact patients to arrange an assessment for treatments. NICE has given its final recommendations on some of the COVID-19 treatments that should be offered by the NHS. Providing access to these treatments is now the responsibility of local NHS organisations, called Integrated Care Boards (ICBs), who will be looking at alternative ways to support eligible patients and provide treatments if required. Patients are being sent a letter/email in June 2023 to update them about this change. This informs them that they will no longer be proactively contacted and will instead need to contact their local NHS services if they test positive, which could include their GP practice, NHS 111 or hospital specialist. More information can be found on the link below.
Letter to patients: Important information about treatments for Covid
Research & Development (R+D) Steering Committee:
From November RINTAG will be replaced by the OTDT R+D Steering committee to be chaired by Professor Lorna Marson (AMD for R+D) and Sapna Marwaha (Lay Member). Thank you to Gavin Pettigrew for his term as chair of RINTAG which will become the operational sub-committee of the steering group that Gavin will continue to chair with Emma Lawson. Further information will be forthcoming closer to the time.
Quote for the month:
Lets look to the future. The past is your lesson, the present is your gift, the future is your motivation.
Yours sincerely,
Professor Derek Manas
Medical Director – OTDT
NHS Blood Transplant
Updates from across the OTDT Teams:
NHSBT Organ Donation Management Team On-Call Contact Details:
Any questions or concerns transplant colleagues have regarding proceeding donors/cases can be directed in the first instance to NHSBTs Organ Donation Management Team On call. They will then be able to liaise with the staff directly involved and escalate to NHSBT Directors on Call if required. They can be directly contacted 24hrs a day via a pager 07623512222.
Message from Dr Dan Harvey, National Lead for Innovation & Research in Organ Donation:
SIGNET Trial Update – 650 donors recruited!
Over 650 donors have now been randomized to SIGNET, this means we’ve now hit 25% of our target of 2600 donors which is an incredible achievement to celebrate! We couldn’t do this without our donor families and the specialist nurses for organ donation. On our calls with the hospital research teams, they continue to sing the praises of the specialist nurses, thank you for all of your hard work.
We still have a few more hospitals to open to SIGNET but we have more than 130 hospitals open; we could only do this because of the unique infrastructure we have in the UK for organ donation and transplantation. Remember, we believe this is the largest donor intervention study being done anywhere in the world.
Thank you to everyone who joined the shared practice sessions in April, we had some great feedback and we’re always keen to hear any suggestions or examples of good practice you may have.
Message from Jackie Brander, Head of Service Delivery - Organ Donation & Nursing:
Ad-hoc Tissue Requests of Blood Vessels and Rectus Fascia from Deceased Organ Donors
We have been working with internal and external stakeholders to further strengthen our process for Recipient Coordinators, Hub Operations and SNODs when a request is made for ad-hoc vessels or Rectus Fascia from a deceased organ donor.
The revised SOP5685 Ad-hoc Tissue Requests of Blood Vessels and Rectus Fascia from Deceased Organ Donors which became effective on Wednesday 19th April 2023 can be found here:
Policies and guidance - ODT Clinical - NHS Blood and Transplant
Message from Liz Armstrong, Head of Transplant Development:
Places are still available for the 2023 NHSBT Clinical and R&D Conference (2 and 3 October at the ICC in Birmingham). Attendance at the conference is free (with delegates’ accommodation and transport being department-/self-funded). If you haven't already signed up, registration is still open but for a limited time; you can sign up via the online registration form.
The theme of the conference will be 'Tackling health inequalities', with talks, presentations and posters from across NHSBT’s therapeutic areas. Attendees will include senior researchers, Executive Team members and colleagues from across NHSBT, as well as patients and charity representatives.
Sessions will include:
- Key challenges in delivering operational strategies, and reflecting on achievements in tackling health inequalities
- NIHR Blood and Transplant Research Unit updates
- Patient-focused studies and patient stories/journeys
- Joint innovation and horizon scanning
Message from Laura Stamp, Lead Nurse Recipient Coordinator:
The annual Recipient and Living Donor Coordinator Induction Course will be held in Bristol at our Stoke Gifford site (Fox Den Road, Stoke Gifford, Avon, Bristol BS34 8RR), on Thursday 5th and Friday 6th October 2023. There are 30 places in total, and we hope to accommodate as new Recipient and Living Donor Coordinators as possible.
We have received a huge amount of interest in this course, and it is therefore oversubscribed. We are in the process of triaging the expressions of interest to ensure the places are allocated to those who will gain the most benefit, i.e. those who have been in post less than 18 months. Places will be confirmed within the next week.
Message from Jessica Jones, Organ Utilisation Programme lead - Clinical Leadership and Engagement:
Friday 19th May 2023 saw over 150 transplant physicians, surgeons, associated professionals and NHSBT staff come together at our third National Organ Utilisation Conference, held at the Waterloo Campus of King’s College London. It was fantastic to have the opportunity to meet in person, and there was plenty of networking over coffee between the sessions!
The day kicked off with best-selling author of ‘Do No Harm’ and retired neurosurgeon, Mr Henry Marsh. Mr Marsh’s irreverent talk sparked some laughter, as he spoke about his experience of risk and the importance of teamwork and good leadership.
- Mr Henry Marsh delivering keynote speech at NOUC ‘23
Dr Adnan Sharif, Consultant Nephrologist, Transplant Physician and Kidney CLU from Queen Elizabeth Hospital Birmingham, stimulated debate by speaking about risk psychology and how it relates to organ utilisation. A statistical update, provided by Sue Madden from NHSBT, gave an excellent background to the day.
- Dr Adnan Sharif: delivery of the keynote speech at NOUC ’23
The afternoon saw wide-ranging discussions on the implementation of the Organ Utilisation Group (OUG) report, with two insightful patient representatives bringing vital perspective to the debate. Updates from the National Clinical Leads for Utilisation rounded off a great day.
Thank you to everyone who attended, and to those who gave up their time to help with facilitation on the day.
To see slides from the day, please visit the conference Sway page.
Message from Lisa Burnapp, Associate Medical Director - Living Donation & Transplantation:
Travel for Transplantation:
This is a hot topic at the moment given the recent high-profile case and, understandably it has heightened concern within clinical and patient communities. NHSBT is working with the Human Tissue Authority (HTA) as the regulator and other agencies to consider any additional safeguards that could be put in place to ensure safe and legitimate living donation is not compromised and to support clinicians and patients under their care with updated guidance. In the meantime, any matters of concern related to travel to transplantation, within the UK or outside the UK, please contact the HTA at transplants@hta.gov.uk
Living Donor Liver Transplantation:
A paper has been submitted to NHS England and shared with Commissioners in Scotland to request funding for a Proctor Team to support the UK roll-out of adult-to-adult living donor liver transplantation (A-A LDLT). The 3- year plan has been endorsed by the clinical community and development of the programme is supported by patients. Establishing this programme will offer more opportunity and choice for patients who are waiting for a liver transplant and it has become more time critical given the increase in waiting lists and new indications for liver transplantation. The work of the LDLT Project Board continues to provide the educational resources and operational details to underpin the programme pending funding decisions. We are grateful to colleagues who contribute to workstreams and the Board.
Enhanced Recovery After Surgery (ERAS) in Transplantation:
NHSBT is leading on a programme which aims to provide a repository of on-line best practice guidance and resources for centres who wish to start an ERAS programme. With an initial focus on kidney and liver, workstream leads will draw from existing experience in different centres to provide the final portfolio of materials. We are grateful for their enthusiasm and support to deliver this project.
Living Donor Transformation-Living Path:
The first release of LivingPath to underpin registration in the UK Living Kidney Sharing Scheme went live for the April matching run and development of the remainder of the programme continues at pace to deliver it as soon as possible and to ensure minimum disruption to quarterly matching runs. Thank you to all clinical and histocompatibility and immunogenetics colleagues who have provided expert input and for your patience as we roll-out this really exciting development in living donation. Watch this space for further updates.
UK Living Donor Network:
With thanks to Co-Chairs Colin Geddes and John Stoves, NHSBT hosted the 5th Annual Meeting of the UK Living Kidney Donation (LKD) Network at the Hilton Hotel in Leeds on 10th May. The meeting was over-subscribed but approximately 130 delegates enjoyed a face to face meeting, covering a range of topics and focus sessions. The enjoyment and value from meeting in person was evident from the evaluation and it was a pleasure to welcome some of the recently appointed Renal Network Transplant Leads to the meeting.
Meeting materials and latest Newsletter will be available w/c 26th June 2023 using this link.
Please contact lisa.burnapp@nhsbt.nhs.uk for further information about any of the above.
Message from Laura Ellis-Morgan, Head of Clinical Informatics (OTDT):
Dear Recipient Teams,
As you may be aware, the Electronic Offering System (EOS) replacement web based application, TransplantPath is under development with a projected 'Go-Live' in Winter 2023/2024. In readiness, we are now embarking on wide scale Business Change planning. In order to facilitate the transition within your teams we please need your support in identifying potential TransplantPath users.
Please disseminate this User Identification MSForm around suitable users for completion: Microsoft Forms
The TransplantPath team are also looking to enlist two digital champions within each recipient team to become active stakeholders in the planning and local delivery.
You can indicate your interest through the User Identification Form above.
This is an exciting time for the Organ Donation and Transplantation community and I would like to take this opportunity to thank all those involved during discovery and planning phases.
For enquiries or to join the monthly engagement meetings please email Transplantpathteam@nhsbt.nhs.uk
Laura Ellis-Morgan
Head of Clinical Informatics OTDT.
Message from Jasvinder Ubhi, OTDT Portfolio Co-ordinator:
NHSBT has undertaken detailed reviews of the donation and retrieval pathway to identify the key issues over recent years. In January of this year a stakeholder engagement day was held with NORS colleagues to further explore the areas of concern, and to identify potential opportunities for change to ensure a robust and sustainable service for donors and recipients in the future.
More recently, the scope and vision have been developed and a new Programme set up. The Sustainability and Certainty in Organ Retrieval (SCORE) Programme has identified five key pillars:
- increase the certainty of donor potential
- achieve financial sustainability
- develop a future model for NORS delivery
- commission a sustainable framework for perfusion technology
- enable a sustainable NORS workforce and community of practice
To support the changes required seven Workstreams have been aligned to the pillars, each with clear aims and objectives:
Donation: - Increase the certainty of donor potential
NORS Service Model: - Increase pathway efficiency and certainty of retrieval
Support Services: - Review support services and contracts to ensure operational alignment
NORS Workforce: - Support Trust Boards to attract develop and retain an expert NORS workforce
Stakeholder Engagement: - Define and manage the communications and stakeholder engagement plans
Business Case: - Deliver a business case including strategic, economic, financial and management appraisal
Commissioning: - Ensure that the NORS contract is fit for purpose in light of approved
SCORE recommendations.
Each workstream will be composed of a wide range of subject matter experts and stakeholders with responsibility to support the design and planning of the agreed outputs, for delivery within the timescales.
The governance for leadership and oversight of the Programme will sit with the SCORE Programme Board with key roles as follows:
Senior Responsible Officer: – Anthony Clarkson
Director of Organ and Tissue Donation and Transplantation
Programme Director: – Karen Quinn
Assistant Director, UK Commissioning & Service Development
Debbie Macklam (Head of Service Development) and John Richardson (Assistant Director Organ Donation) will oversee the programme as Accountable Executives and Jonathan Green (Programme Manager) will provide Programme Management.
Professor Derek Manas (Medical Director) and Karen Quinn (Assistant Director – UK Commissioning & Service Development) have recently held a series of webinars to provide the organ donation, retrieval, and transplantation communities an opportunity to hear how the SCORE programme will take this vision forward.
You can watch the SCORE webinar recording here
If you have any queries or would like to get in touch with us, please contact us via the following email address: SCORE@nhsbt.nhs.uk
Cautionary Tales- Sharing learning from Events across the Organ Donation & Transplant Pathway. ODT Clinical Governance Team Newsletter, Issue 31, May 2023:
The attached newsletter has been provided by: Jeanette Foley, Deputy Chief Nurse OTDT, for information: