National Medical Director's reflection
This year marked the anniversary of 10 years since the national program for organ and tissue donation in Australia began. Over this time there have been significant changes, enabling our donation system to move to a nationally coordinated world's best practice approach, as intended by the initial reform package. The success of the program is largely due to the commitment and national collaboration of so many stakeholders, of which I am privileged to be a part.
Before the reform commenced in 2009, there were various efforts made by governments and dedicated clinicians across the country to increase the rate of donation. This led to a small increase but the lack of national cohesion and limited resources meant that donation continued to be consistently low. The national organ donation rate over 2000–2008 reached an annual average of 10.2 donors per million population (dpmp). The investment by the Australian Government in 2008 for the national reform program provided the resources to make the substantial changes needed to reach the 2018 national organ donation rate of 22.2 dpmp.
A key to the success of the national program has been the establishment of a national network of DonateLife Agencies and hospital-based medical and nursing donation specialists to operate as the DonateLife Network (DLN). This network has provided dedicated resources within hospitals and in DonateLife Agencies to facilitate donation activity and ensure that all potential donors are identified. The network also facilitates a best practice approach to offering families the opportunity to donate, provides support to families after the donation, and reports on donation metrics. It also provides professional education and community awareness programs.
The DLN has grown in expertise and has led the way for the significant clinical reform that has occurred in our hospitals, enabling more people to donate and more Australians to receive transplants. The establishment of the donation specialist role has been integral to this reform through leading the embedding of best practices, being a source of information and advice for clinicians and other hospital staff, and supporting patients and their families.
In 2018–19 we extended our professional education program and focused on new ways to support donation specialists to continually enhance their skills and provide best-practice support to families at such a difficult time in their lives. For example, new small group training sessions are being conducted across the country to build on the Family Donation Conversation workshops and to expand the communication skills of donation specialists through regular scenario-based training sessions. I am looking forward to supporting the work of our education team and contributing clinicians to evolve our education program next year and provide even more opportunities for donation specialists to enhance their skills.
Essential to supporting change in hospitals has been the development of a Clinical Governance Framework and Clinical Practice Improvement Program (CPIP). The CPIP has continued to be a vehicle for driving clinical practice change and ensuring accountability in the donation sector. It has evolved over time with three different phases.
CPIP Phase 1 focused on guiding hospital teams to develop hospital plans around 12 components of best clinical practice in donation. CPIP Phase 2 incorporated group learning forums and paired donation team visits between like hospitals from different states and territories to exchange ideas and learn from each other. CPIP Phase 3, implemented in 2018–19, is focused on ensuring that all potential donors are identified through the routine referral of all intensive care unit and emergency department patients with planned end-of-life care to the DonateLife staff to advise on donation feasibility. It also embeds best practice for approaching families to offer donation.
The DonateLife Audit has been a key tool for providing information to guide best practice and has been extended to capture the key performance metrics of CPIP Phase 3. The OTA Data and Analytics team have evolved a range of useful reports and analyses enabling regular performance reporting and feedback at hospital, state/territory and national levels. This has facilitated an evidence-based approach to how and where to focus further attention and resources to optimise practice and outcomes.
We continued to focus our attention on DonateLife hospital performance and data. The participation of a donation specialist in family donation conversations is a key hospital-level performance indicator under the CPIP. In 2018 we worked to enhance the reporting of clinical process metrics identified under CPIP Phase 3, including referral of all patients with planned end of life in intensive care units and emergency departments. We will report the first year of data in 2019.
Over the past 10 years, the importance of the donation and transplantation sectors working together to maximise the access of Australians to transplantation has become increasingly apparent. Early on, donation and transplantation activity were largely dependent on improving donor identification and consent rates. In recent years, the importance of transplant unit and retrieval resourcing and capacity, along with optimal practices and systems to support the best use of all available organs for transplantation, has become more relevant.
The collaboration between the donation and transplantation sectors has grown through many initiatives. These include the development of clinical and ethical practice guidelines as well as professional education forums (including a combined two-day conference in March 2019). The collaborative development of a new organ allocation platform, OrganMatch, will provide important opportunities in the future to enhance allocation and decision-making.
Our donation and transplantation systems have matured over the past decade and will continue to evolve. However, our ongoing focus and priority will be to ensure best clinical practice and care of donors and their families, and a mutual goal of helping as many Australians as possible to access the benefits of transplantation.
Dr Helen Opdam
National Medical Director