Jenny Warner

Regional Transplant Coordinator

I am fortunate to be one of five transplant co-ordinators (procurement), working in the largest region in the country, South Thames, densely populated with 7 million people, covering some 48 hospitals and 56 palliative care hospices (tissue donation only).

Our remit is clinical, educational, supportive and developmental, with a service philosophy to promote organ donation and facilitate the wishes of our community. Each co-ordinator is first, then, second on – call two weeks out of four, 24 hours a day.

Role of Transplant Coordinator

Our main role is the organisation of multi – organ donation. Referral to us is after the first set of brain stem death tests have been carried out, and consent is obtained (it is a moot point if the co- ordinator should be involved in obtaining consent). We are also responsible for arranging corneal, tracheal, heart valve and skin retrievals in the region. This involves collating details, assessing suitability and referring to the donating centre’s nearest tissue bank. As with multi–organ donation we follow up and thank all involved. We have an “opting in” system, where all who wish to donate are urged to express their wishes (by carrying a card, logging with the computerised register and informing their next of kin) prior to death. The family would be asked for lack of objection to carrying out the wishes of deceased. UK studies (King Fund 1984, MORI 1995) have illustrated that a change in the system would have little or no impact on donation rates, with a feeling that alteration may well kickstart that British resistance to change and actually have a detrimental effect.

The Co-ordinator attends the ICU, where an in–depth clinical and social assessment is carried out (utilising all information sources i.e significant others, health care professionals, medical notes and data). Coroner’s (medical examiner) consent having been granted, we are responsible for donor clinical management (liaising with other professionals), this is in tandem with informal teaching to staff involved. We co-ordinate with our central 24 hour support services (UKTSSA-United Kingdom Transplant Support Services Authority), with regard to organ specific transplant centres, we then contact the recipient co-ordinator (clinical) with regard to suitability. This is the procedure for each organ, with the exception of kidneys, where one is transplanted in our zone and the other is offered out to the rest of the country, after tissue typing. At present we do not pre-tissue type, unless it is for pancreatic transplantation. If we are unable to place an organ in this country (because of an unusal blood group for example), we contact Eurotransplant (similar to UKTSSA, based in the Netherlands). This provides an amusing interlude in the small hours of the morning, indulging in the banter with a transplant surgeon in Austria, for example, When we try and interpret what our clinical values mean!!!

Being an advocate of the deceased and his/her family, we also attend the organ retrieval. As a fundamentally altruistic system we rely upon hospital personnel for support and this is reciprocated by ourselves. Retrieval teams operate a zonal system (to prevent lost time with teams flying to and from Scotland, for example), and a ‘zone’ will retrieve organs for elsewhere, if they are unable to place that organ in their own zone.

Exciting Development

Tissue donated from a multi-organ donor will be banked at regional tissue specific banks. An exciting new development has been the donation of tracheas, for transplantation in babies who have long-segmental tracheal stenosis. This has been very positively received, as has the opening of a regional skin bank. We have been able to demystify many myths surrounding skin donation and, as with all donation, it has proved a great comfort to all bereaved families.

Other recent initiatives have included a Fatwa therby giving ‘permission’ for all Muslims community leaders, theologians and ethical experts. The Fatwa drew national and international publicity and has been warmly received by the Muslim Community.

I have an interest in child bereavement and how parents/carers tell a child that a family   member is brain stem dead and donated. I have been liaising with a child grief support agency, and am writing a leaflet to help answer some of the questions children ask.

Link Nurses

We are also expanding the role of “Link Nurses”. This is a named nurse in ICU, accident and emergency unit (E.R), theatres, palliative care setting and the general wards, who we liaise with in regard to teaching sessions, inform them of changes in regional/national policy, support with information and regional study days. This is then disseminated throughout his/her unit. Regional study days are planned for the specialities as a forum for a exchange of ideas and information.

NON-HERAT BEATING DONORS

Finally, we also have extended our asystolic (non-heart beating) kidney programme and after having a period with poor graft survival rates the future is very optimistic for the outcome of such donations. There are currently two such programmes running at major London teaching hospitals, in the A&E departments, which have required a huge input from our services to ensure the smooth organisation of such rapid retrievals. There is also an on-going commitment to fulfil the last wishes of those who die of a tissue–diagnosed primary brain cell carcinoma (though obviously the circumstances of the death are very different).

I believe that this is exciting times for donation and transplantation in the UK and I consider it a privilege to be a part of a service that offers my community a very positive outcome from this stage of life.

REFERENCES

MORI 1995 : 'Report of 2 years study in reason for relative's refusal of organ donation' Department of Health: London, UK. New M 1994 Solomon N.: "A question of give and Take : Improving the supply of donor organs for transplant' Kings's Fund : London. UK.