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National Medical Director's reflection

Image of Dr Helen Opdam, the National Medical Director ​
Dr Helen Opdam, National Medical Director
As the National Medical Director of the OTA, I have never been more impressed by the collaboration, dedication and agility of Donation Agency staff and the hospital based Medical and Nursing Donation Specialists across our DonateLife network.

Optimising donation for transplantation outcomes relies on these dedicated specialists to undertake activities crucial for delivery of the national program. This is fundamental in ensuring that all potential donors are identified and that their donation preferences are respected, or that their families are given the opportunity to decide about donation on their behalf. Donation Specialists are critical to implementing best practice approaches in offering families the opportunity to donate, supporting families during the donation process, and delivering professional and community education awareness programs. Over the last 12 months they have continued to do all of this important work in a health care system that has and continues to be impacted by the COVID-19 pandemic. They have shown resilience, tenacity and tremendous initiative to continue to evolve our clinical practices, with the care and support for families at the forefront of their approach and ensuring that as many Australians as possible have access to the benefits of transplantation.

Delivery of best practice donation services

Delivering best-practice donation processes, whilst providing specialist support for families throughout the donation experience, has required collaboration from all levels of government, DonateLife Agencies, clinical units, transplant teams, transport services, pathology services, eye and tissue banks and many other stakeholders to ensure safe, quality and effective delivery of the donation and transplantation services. This has been particularly relevant in ensuring transplant teams can cross borders for retrievals to continue delivering life-saving transplants. Donor specialist interaction with donor families continues to be a crucial component to supporting donor families through the donation process. Despite the challenges this year has provided, our teams adapted and continued to provide essential support in person when possible, and via telephone and videoconferencing where necessary, to inform and support families in the process.

COVID-19 has seen many innovative practices explored and implemented, including overcoming complex logistics to coordinate the donation process, close collaboration and cooperation with transplant colleagues, tissue typing services, interstate colleagues, and other stakeholders.

Implementation of the Clinical Practice Improvement Program

A crucial element of achieving best practice donation services across our intensive care and emergency department environments is the Clinical Practice Improvement Program. In July 2020, we implemented phase four of the program, introducing best practice approaches for organ and tissue donation including those utilised in the United Kingdom, Canada, the United States and Spain. These initiatives embed the routine referral of all patients approaching end-of-life in intensive care units and emergency departments to DonateLife specialist staff to ensure appropriate and timely advice on donor potential and suitability.

We have also promoted, as best practice, the involvement of a Donation Specialist Nurse in all family donation conversations as experience and data continues to highlight the benefit of this approach with families being fully informed and supported and more saying yes to donation. In 2020, families consented to donation in 62% of cases when information about donation and support was provided by a DonateLife Donation Specialist doctor or nurse in the hospital. This dropped to 24% when there was no Donation Specialist involved.

We have also embedded the routine checking of the Australian Organ Donation Register prior to staff raising donation with families as we know that if a person is registered and their family is informed of this, nine in ten of those families will say yes to donation.

Adaptable and flexible delivery of the Professional Education Program

Improving the skill set of donation staff throughout the family donation conversation has continued to be an important focus for the OTA. As professionals who engage with families at one of the most difficult times in their lives, we have a responsibility to support families and ensure that we communicate compassionately while providing them with accurate information to assist in their consideration of organ and tissue donation. To aid in this endeavour, the OTA launched the DonateLife Coaching Program in March of 2021. This on-line program is available for Donation Specialists to enrol and participate in one-on-one coaching sessions. The program provides a unique professional development opportunity for Donation Specialists to receive real-time feedback from an experienced coach in a safe environment and is used in conjunction with the two-day core and single day practical Family Donation Conversation workshops. Sessions involve a role play of a scenario followed by a debrief with the coach and a video of the role play that the participant can review and reflect on after the coaching session. Since its launch, the program has received universally positive feedback from participants and will continue to expand its scope to meet the training requirements of Donation Specialists and needs of families.

Adaptability and flexibility of our education programs has also continued to be a priority in 2021. The Family Donation Conversation workshops were adjusted and delivered as an abridged version to ensure clinicians continue to have access to education and skills development, enabling them to deliver best practice when working with donor families and throughout the organ and tissue donation and transplantation process. The OTA has committed to increasing the availability of education resources as we navigate the virtual world imposed by COVID-19 restrictions. This has led to expanded and improved access to education resources with the creation of new video vignettes to assist in communication skills training of existing and new Donation Specialists. Podcasts continue to be created and contribute to the knowledge acquisition of DonateLife network staff, featuring invited speakers from across the sector.

Ethical guidelines for organ and tissue donation and transplantation in Australia

The OTA continues to support the National Health and Medical Research Council (NHMRC) in the updating of the Ethical guidelines for organ and tissue donation and transplantation in Australia (Ethical Guidelines). It is anticipated that the Ethical Guidelines will be considered by AHEC in late 2021 to early 2022, followed by a public consultation in 2022. This is a significant body of work which has many complexities, including consultation with many stakeholders.

Looking forward

As we look forward to 2021–22 we will continue to lead and monitor the delivery of best practice donation services, collaborate to mitigate the negative impacts of the COVID-19 pandemic and plan to optimise future growth opportunities in donation for transplantation in coming years. Our goal is to ensure that donors and their families continue to receive the best possible care and assistance and that we help as many Australians as possible to have access to life-enhancing and life-saving transplantation.

Signed by

Dr Helen Opdam

National Medical Director