Several key initiatives were undertaken in 2018–19 to enhance donation and transplantation systems and processes.
4.1 Use data to inform clinical best practice for donation and transplantation
Further work was undertaken to enhance the performance measurement and reporting framework through the development of performance dashboards. These visual dashboards present key donation metrics to DonateLife Network and hospital staff, and state and territory health departments, to inform and drive best practice.
An essential part of improving donation and transplantation processes is the collection, analysis and application of data. In collaboration with state and territory health representatives and key sector data custodians, an overarching Data Governance Framework has been developed. This framework provides agreement on the governance of data to ensure compliance with relevant state and territory legislation.
The framework also creates a foundation for establishing a national de-identified dataset spanning the donation and transplantation sector, including wait-listing, registration, organ donation, organ matching and allocation, and transplantation data. This data will be used to further inform the national program.
Analysis of current organ donation potential in each state and territory and likely growth trajectories informed the review of the Australian donation, retrieval and transplantation system. The modelling work undertaken in 2018–19 informed the decision by the Australian Health Ministers Advisory Council to retain 25 dpmp as the national donation target for 2019.
4.2 Improve utilisation of retrieved organs
Australia continues to develop improved allocation and matching systems and processes, as well as clinical guidance and standards, to maximise the utility and function of donated organs. In addition, there have been medical advances that improve organ function following retrieval, such as preservation fluids and machine technologies.
In 2018–19 we worked in partnership with clinical stakeholders to improve the utilisation of retrieved organs. These projects are described below.
In April 2019 the OTA, in collaboration with the Australian Red Cross Blood Service, successfully delivered a bespoke organ matching system to replace the ageing National Organ Matching System (NOMS). The new system, known as OrganMatch, uses state-of-the-art technology that will improve reporting on wait-listing as well as the organ offer, allocation and acceptance process for transplantation. OrganMatch will support all existing programs, including the deceased organ donor program, living donor kidney transplants, and the Australian and New Zealand Paired Kidney Exchange Program.
OrganMatch has the capability to be more adaptive and responsive to the changing needs of the donation and transplantation sector. The governance structure for OrganMatch will provide a robust process for the changes recommended by the clinical sector to occur, ensuring adequate consultation, collaboration and communication.
Above: The OrganMatch team demonstrated the application at the conference Connecting donation and transplantation: a decade of growth and collaboration
In 2019–20 the OrganMatch project team will deliver a staged rollout of two key system enhancements – the OrganMatch Clinical Portal and the OrganMatch Simulation Module.
Revision of the Transplantation Society of Australia and New Zealand clinical guidelines
The Transplantation Society of Australia and New Zealand (TSANZ) Clinical guidelines for organ transplantation from deceased donors continue to be an important guide for the donation and transplantation sector, with ongoing review to ensure currency of clinical practice.
In 2018–19 we provided funding to support TSANZ in reviewing and updating the infectious disease assessment recommendations in Chapter 2, Organ donor eligibility. The updated guideline was published in June 2019 and can be accessed at www.tsanz.com.au/organallocationguidelines/index.asp.
In June 2019 we provided funding to support TSANZ to further maintain the currency of the guidelines through development of a standardised process for periodic review of the guidelines and focused work to review two identified priority areas:
- donor assessment for risk of malignancy transmission
- recipient consenting processes.
New techniques and technologies
We continued to support research into new techniques and technologies for the preservation and utilisation of retrieved organs, such as machine perfusion.
Machine perfusion has the ability to overcome challenges that Australia faces, such as geographical distance, and allows for organs to be tested and/or preconditioned before transplantation. This is likely to lead to fewer organs being declined or discarded due to distance and poor quality.
We provided support for TSANZ to establish a working group with the specific task of exploring machine perfusion in the Australian setting with consideration of the benefits and challenges. Advice from the working group is expected by 30 June 2020 and will inform future actions in this area.
4.3 Enhance the safety of organ donation and transplantation
The Vigilance and Surveillance Expert Advisory Committee (VSEAC) has completed its first year as the committee responsible for monitoring and reporting on the performance of the Australian vigilance and surveillance system.
This year has seen the continued evolution of the review process by the VSEAC to ensure robust analysis of submitted adverse notifications. This retrospective review of adverse occurrences continues to work in parallel with the clinical incident management systems of each jurisdiction which remain responsible for the clinical management and investigation of the incident. The number of adverse occurrence notifications made to the VSEAC continues to increase each year. This shows a greater commitment by the donation and transplantation sector to transparency and shared learnings in a national context to help improve the safety of donation and transplantation.
The VSEAC is currently finalising the inaugural Australian vigilance and surveillance in organ donation for transplantation annual report for publication in early 2019–20.
To further enhance shared learnings in the donation and transplantation sector, the VSEAC has agreed to develop a tiered feedback process depending on the severity of the adverse occurrence. Those deemed low impact will be included in the annual report and any moderate to high impact adverse occurrences will be included in a quarterly communique sent to the donation and transplantation sector. Rare and unlikely occasions where an adverse occurrence requires urgent notification will be communicated immediately to the donation and transplantation sector through a pre-determined communication pathway. We will be working with the VSEAC in early 2019–20 to confirm these processes.
Professor Jeremy Chapman AC
In May 2019 we celebrated the prestigious career of Professor Chapman as he announced his retirement from his clinical position. He changed the lives of thousands through his work in organ donation and transplantation in Australia and internationally.
Professor Chapman began his career and involvement with organ donation in Westmead Hospital over 30 years ago and was drawn to kidney transplantation as a means to save and change lives. Foremost a renal physician and transplant surgeon, Professor Chapman went on to become a Board member of the Western Sydney Local Health District and Westmead Medical Research Foundation, Chairman of the Australian Bone Marrow Donor Registry, and Advisory Member of the WHO Expert Advisory Panel on Human Cell Tissue and Organ Transplantation, among other prominent roles. He chaired the National Clinical Taskforce on Organ and Tissue Donation which informed the national reform program.
He is an outstanding leader and mentor, and throughout his career showed great dedication to the field and, importantly, to his patients. Professor Chapman was awarded the Medal of the Order of Australia in 2003 for establishing the Australian Bone Marrow Donor Registry. He was then appointed as a Companion of the Order of Australia for eminent service to medicine and for his work in organ donation and transplantation in 2015.
We have no doubt that the organ donation and transplantation sectors worldwide would be the poorer if not for the efforts of Professor Chapman.
We are very grateful that Professor Chapman will continue to chair the OTA’s Vigilance and Surveillance Expert Advisory Committee.
Professor Lindsay Grayson AM
In June 2019 Professor Grayson received a Member of the Order of Australia (AM) for significant service to medicine in the field of infectious diseases. His work as President of the Australasian Society for Infectious Diseases and Chair of the Interscience Conference on Antimicrobial Agents and Chemotherapy Program Committee for the American Society for Microbiology has had a great impact on organ and tissue donation. He is currently Director of the Department of Infectious Diseases and Microbiology at Austin Health Victoria, and he brings this expertise to our Vigilance and Surveillance Expert Advisory Committee.
We are privileged to work with Professor Grayson and value his expertise in the analysis of serious adverse events that are reported through the national vigilance and surveillance system.
4.4 Improve the efficiency of donation and transplantation
The DonateLife Network provides organ and tissue donation services across Australia. As donation activity increases, the system needs to continually adapt and change to ensure the best possible donation and transplantation outcomes.
Reviewing the entire system
In April 2018 Australian Health Ministers agreed to the Commonwealth Government’s proposal to undertake a review of the organ donation, retrieval and transplantation system, in collaboration with the states and territories. The aim of the review is to identify areas within our health system which could compromise future growth and sustainability of donation and transplantation. This review followed increasing evidence that the growth in organ donation activity was placing significant pressure on the demand for downstream services, including retrieval, tissue typing and transplantation services.
The Commonwealth Department of Health engaged Ernst & Young to undertake the Review of the Australian organ donation, retrieval and transplantation system, which began in May 2018. The review comprised an extensive consultation process with over 230 key stakeholders who included Australian Government and jurisdictional government officials, training colleges and peak bodies, clinicians, transplant recipients and donor families.
In 2018–19 we worked closely with the Department of Health and Ernst & Young to inform the review and provide data to demonstrate the complexities of the system and highlight the pressures experienced by the sector. We also worked with key stakeholders to document elements of the end-to-end system. The elements comprise initial assessment and wait-listing management of potential recipients, deceased donation, organ allocation, offering and acceptance, retrieval, transplantation and post-transplantation.
In 2019–20 we will continue to work with the Department of Health to inform the next phase of the review. This will involve the development of a future national strategy for organ donation, retrieval and transplantation. The strategy and a plan for the future will be considered by Australian Health Ministers once finalised.
Establishing and assessing outcomes against key performance indicators
Nationally and internationally, there are different methods by which clinical practice and performance at an individual hospital level are assessed. In the Australian setting, the implementation of the Clinical Practice Improvement Program (CPIP) Phase 3 at the hospital level is imperative in driving and influencing cultural change. Hospital outcomes against the key performance indicators (KPIs) are drawn from de-identified data provided by DonateLife hospitals.
DonateLife Agencies and hospitals are given feedback on their performance against the CPIP Phase 3 KPIs through the distribution of dashboards and quarterly reports. The reports capture the key metrics for donation and transplantation activity within a state or territory. We discuss these dashboards during six-monthly progress report meetings with the DonateLife Networks and relevant state and territory health departments.
We continue to provide funding under state and territory agreements for the delivery of nationally consistent organ and tissue donation services in each jurisdiction, which includes staff in the DonateLife Agency and hospital-based donation specialists. Under new two-year funding agreements, which started on 1 July 2018, the states and territories agreed to implement CPIP Phase 3 in all DonateLife hospitals.
The outcomes of the Ernst & Young review and projected growth in donation and transplantation will inform future resource requirements for donation, retrieval and transplantation services.
Improving outcomes in the eye and tissue sector
In June 2017 the Commonwealth Department of Health released a PricewaterhouseCoopers (PwC) report, Analysis of the Australian eye and tissue sector, which had been commissioned by Australian Health Ministers. The report found that the Australian eye and tissue sector is diverse and undergoing rapid change in some areas. In the accompanying government response, Health Ministers accepted the recommendation of the report that there is a need for a national policy framework for the sector to ensure the continued availability of eyes and tissues for those Australians who need them.
To address the key issues raised in the report, the Commonwealth Department of Health:
- established a Jurisdictional Eye and Tissue Steering Committee, comprising senior health officials from all states and territories and OTA staff, to oversee the project
- engaged the National Health and Medical Research Council to develop ethical guidelines for living and deceased eye and tissue donation for transplantation.
Throughout 2018–19 we worked collaboratively with Commonwealth, state and territory governments to develop the draft National Policy Framework for the Eye and Tissue Sector.
As a member of the National Health and Medical Research Council’s Organ and Tissue Working Group, in 2018–19 we contributed to the development of the Interim ethical position on key issues relating to the Australian eye and tissue sector. This ethical position will inform the final draft of the National Policy Framework for the Eye and Tissue Sector.
The framework will be presented to Australian Health Ministers for consideration later in 2019.