The National Organ Retrieval Service

Becca CurtisStatistics and Clinical Studies

NHS Blood and Transplant

BTS Congress, March 2019

Overview

• An Introduction to the National Organ Retrieval Service

• Current activity

• NORS Demand & Capacity working group

• Length of the organ donation, retrieval, and transplantation process

Introduction

The National Organ Retrieval Service (NORS)

• NHSBT commission 10 abdominal and 6 cardiothoracic surgical teams

• Retrieve organs from deceased donors in the UK

• Introduced in 2010

• Reviewed in 2015 to ensure provision of a sustainable service

• Each NORS team consists of: – Lead Surgeon and Assistant Surgeon– Scrub Practitioner– Theatre Practitioner

From April 2016 (post NORS review):

10 abdominal teams:(7 on call at any time)Birmingham or CardiffCambridgeEdinburghKing’s CollegeLeeds or ManchesterNewcastleOxford or Royal Free

Glasgow

6 cardiothoracic teams:(3 on call at any time)Birmingham GlasgowHarefield or Manchester Newcastle Papworth

●Abdominal retrieval team● Cardiothoracic retrieval team

The National Organ Retrieval Service (NORS)

Current organ retrieval activity

13111421

15851740

16371709 1756

1912

0

500

1000

1500

2000

2500

2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Don

ors

atte

nded

Donors attended

9% increase

Donors attended

Projected attendances 2018/19

13111421

15851740

16371709 1756

1912

1097

0

500

1000

1500

2000

2500

2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19(Apr-Oct)

1880

9% increase

1309 14141578 1736 1633 1702 1754 1899

421421

461

544518

564 554624

0

500

1000

1500

2000

2500

3000

2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Team attendances

Cardiothoracic

Abdominal

Total = 2523

NORS Demand & Capacity working group

NORS Demand & Capacity working group

• Formed in 2018, the working group is a subgroup of the National Retrieval Group

• Established two aims:– Review uneven activity of NORS teams – Increase capacity in abdominal retrieval to address

future demand

Uneven workload - cardiothoracic

2017/18 percentage share of donors attended 15

7

22

18

13

25

0

5

10

15

20

25

30

Birmingham Glasgow Harefield Manchester Newcastle Papworth

15

8

18

10

12

9 98

7

4

0

2

4

6

8

10

12

14

16

18

20

Number of weeks on call per annum:

52 52 52 52 37 26 26 26 26 15

2017/18 percentage share of donors attended

Uneven workload - abdominal

Full time teams

April 2010Zonal

mobilisation

April 2016Closest

available team

February 20191st and 2nd

defined sequence

April 2010Zonal

mobilisation

April 2016Closest

available team

April 2010

Zonal mobilisation

Beyond this teams still mobilised based on a closest available system.

NORS teams mobilised to attend organ donors by the ODT Hub

ScotlandNewcastleLeeds/ManBirm/CardCambridgeOxf/RFKing's

st nd

Example:

Increasing abdominal team capacity

8 teams needed instead of 7

Number of donors attended on any one day2017/18

Mean = 5.2

Number of donors attended on any one day2022/23

Mean = 6.3

1

4

7

12

17

1415

13

8

5

21

0.3 0.3 0.30

2

4

6

8

10

12

14

16

18

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Percentageof days

Number of donors attended on any one day

0

23

8 8

16

19

13

10 10

5

3

10 1

0

2

4

6

8

10

12

14

16

18

20

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Number of donors attended on any one day

30% of days >7 donors attended

• There is no need for a new abdominal team but rather an increase in time on call for existing teams

• Many options to be evaluated in order to meet the following requirements:

– Minimise uneven activity between teams– Make the option operationally and logistically deliverable – Minimise impact on travel times

Increasing abdominal capacity

Real data from recent time

period Simulate

2022/23 activity Output statistics

from each simulation

Total attendances by

team

Travel time data

Intensity of working

Simulations will be used to inform decision making regarding 8 teams on call

Next steps

The scenario to be adopted will be agreed later this year

Length and timings of the process

DBD retrieval operation timings

2013/14

2016/17

2017/18

Weekday Hour0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 TOTAL

Monday 12 9 15 10 9 17 8 8 14 4 7 3 116Tuesday 7 12 11 7 8 11 15 12 12 6 2 3 106Wednesday 10 15 12 14 18 14 10 19 10 6 9 8 145Thursday 9 12 16 6 11 19 13 6 9 6 10 5 122Friday 5 7 6 15 13 16 10 12 5 4 5 7 105Saturday 7 13 17 11 10 18 13 10 12 3 4 9 127Sunday 11 9 11 15 11 12 15 8 8 8 2 8 118

839

Weekday Hour0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 TOTAL

Monday 14 14 12 13 11 13 6 5 4 3 3 6 104Tuesday 10 16 17 12 15 12 9 5 1 5 8 6 116Wednesday 11 19 21 21 15 12 8 4 2 2 5 5 125Thursday 15 12 23 15 10 11 9 8 1 2 4 6 116Friday 11 23 21 13 12 10 2 2 2 5 1 4 106Saturday 12 16 11 19 9 7 8 2 4 6 7 5 106Sunday 12 19 22 8 12 9 11 5 3 0 3 12 116

789

Weekday Hour0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 TOTAL

Monday 9 11 22 15 7 7 20 11 11 9 8 7 137Tuesday 10 17 14 12 12 11 20 18 12 7 3 9 145Wednesday 16 14 25 13 16 13 14 17 11 8 7 13 167Thursday 11 11 16 17 19 15 12 17 4 12 5 8 147Friday 7 15 15 9 8 7 15 12 7 10 8 9 122Saturday 4 15 19 9 9 12 23 15 3 8 4 5 126Sunday 9 17 8 14 10 13 18 17 5 5 4 8 128

972

DBD process

-12 0:00 12:00 24:00 36:00

Average time interval (hh:mm)

2018/19

2017/18

2016/17

2015/16

2014/15

2013/14

2012/13

2011/12 6:07 14:12 15:00

8:00 15:05 14:48

11:07 16:51 14:19

9:35 18:02 14:22

12:04 19:46 14:02

13:50 21:41 13:42

17:10 21:49 13:08

19:45 21:14 13:30

N

(Apr-Dec)

422

459

576

608

637

695

805

393

-12:00

14:12 15:006:07

8:00 15:05 14:48

11:07

9:35

12:04

13:50

17:10

19:45

16:51

18:02

19:46

21:41

21:49

21:14

14:19

14:22

14:02

13:42

13:08

13:30

Referral to formal

approach

Approach to withdrawal of

treatment

Withdrawal of treatment to

retrieval operation start

Operation start to kidney perfused with recipient’s

blood

DCD process

-12 0:00 12:00 24:00 36:00

Average time interval (hh:mm)

2018/19

2017/18

2016/17

2015/16

2014/15

2013/14

2012/13

2011/12 3:39 10:13 0:26 11:30

3:34 11:50 0:26 11:56

4:30 13:00 0:26 11:40

4:45 14:30 0:26 11:30

5:15 16:49 0:26 11:08

5:57 17:55 0:26 11:07

7:30 18:09 0:25 10:40

12:27 19:02 0:24 10:44

N

(Apr-Dec)

249

284

345

329

401

424

491

23912:27

7:30

5:57

19:02

18:09

17:55

16:49

14:30

13:00

11:50

10:13

10:44

10:40

11:07

11:08

11:30

11:40

11:56

11:30

5:15

-12:00

Length of process

-12 0:00 12:00 24:00 36:00

Average time interval (hh:mm)

2018/19

2017/18

2016/17

2015/16

2014/15

2013/14

2012/13

2011/12 6:07 14:12 15:00

8:00 15:05 14:48

11:07 16:51 14:19

9:35 18:02 14:22

12:04 19:46 14:02

13:50 21:41 13:42

17:10 21:49 13:08

19:45 21:14 13:30

N

(Apr-Dec)

422

459

576

608

637

695

805

393

-12:00

-12 0:00 12:00 24:00 36:00

Average time interval (hh:mm)

2018/19

2017/18

2016/17

2015/16

2014/15

2013/14

2012/13

2011/12 3:39 10:13 0:26 11:30

3:34 11:50 0:26 11:56

4:30 13:00 0:26 11:40

4:45 14:30 0:26 11:30

5:15 16:49 0:26 11:08

5:57 17:55 0:26 11:07

7:30 18:09 0:25 10:40

12:27 19:02 0:24 10:44

N

(Apr-Dec)

249

284

345

329

401

424

491

239

-12:00

• Time from retrieval operation start to kidney perfusion with recipient’s blood has decreased for both the DBD and DCD process

NHSBT action plan to address this

For more information please see my poster on this topic in the exhibition hall (P179)

Summary

• Retrieval activity:– Increase in donor attendances in last 5 years– Increase expected to continue

• NORS Demand & Capacity working group:– New mobilisation sequence implemented in February 2019– Increase to 8 abdominal teams agreed, now under evaluation

• Length of the organ donation, retrieval, and transplantation process– Recent increase in time from approach to operation start is now

slowing

National Retrieval Group, working group, and NHSBT commissioning team

Acknowledgements

BTS Congress, March 2019

www.odt.nhs.uk

@NHSBT_Stats