Ireland’s rate of organ donation could be increased by 25 per cent — translating to an additional 20 donors per year — through resourcing services to undertake donation after cardiac death (DCD), according to the Director of HSE Organ Donation and Transplant Ireland (ODTI).
Resourcing DCD had substantially increased donations in the UK, where it represented 40 per cent of all deceased donations, according to correspondence issued by Prof Jim Egan in October 2020.
“In the UK, an average of 2.7 transplantable organs are retrieved from DCD donors, compared to 3.6 from DBD [donation after brain death] donors. The biggest contribution of DCD is to kidney transplantation, with 39 per cent of all deceased donor kidney transplants coming from this source in 2019-2020,” Prof Egan informed Mr Ian Carter, CEO of Beaumont Hospital, Dublin, where the renal transplant programme is based.
In Ireland, a “small proportion” of donations were DCD, stated the correspondence.
Prof Egan was outlining a proposal for an intra-abdominal retrieval team, which had been considered by HSE Acute Operations and the national organ donation and transplant advisory group.
It was decided to progress a model involving advanced nurse practitioners (ANPs), with four posts agreed, outlined the letter. Current intra-abdominal retrieval practice was not well integrated and duplicated processes and manpower, resulting in “over time, breaches and a cumbersome process”, stated the proposal document.
“In the case of kidney-only retrieval, locating an experienced scrub nurse and a surgical assistant can be problematic. This is especially critical in the case of DCD donation of kidneys, where the viability of the kidneys is dependent on a time-critical surgical exposure and aortic cannulation for in situ aortic perfusion.”
As well as four ANPs in urology and transplant, the proposal included a renal transplant surgeon post. It was possible to increase access to care economically by employing ANPs in transplant and urology healthcare settings, stated the document, which noted ANP salaries were roughly 50 per cent that of senior urological trainees.
The ANPs at Beaumont would contribute to the retrieval process “as trained, experienced surgical assistants capable of assisting in in situ aortic perfusion of organs in both the DBD and DCD setting”. There was a “growing opportunity” for ANPs to “contribute to in-office procedures and outpatient clinics” in urology.
An ANP post for the liver transplant programme at St Vincent’s University Hospital, Dublin, was being sought.
Last year, there were 62 deceased and 28 living donors (to 28 December). Some 190 transplants took place (compared to 274 in 2019), including 123 kidney, 37 liver, 16 lung, nine heart and five pancreas transplants.
Minister for Health Stephen Donnelly said the pandemic had impacted hospitals’ ability to undertake transplants. He confirmed additional funding of €0.75 million in 2021 “to improve our organ donation and transplant services”.
Responding to the 2020 figures, the Irish Kidney Association (IKA) welcomed the continuance of transplantation programmes in very difficult circumstances.
The IKA paid tribute to the generosity of donors and the commitment of clinical staff working in the transplant centres.
Speaking on 4 January, CEO of the IKA Ms Carol Moore added that 2020 was “a very difficult time” for all kidney patients, who are in the ‘extremely high risk’ category for Covid-19. She urged the reprioritisation of kidney patients in the rollout of vaccines as advocated by the National Renal Office.
Ms Moore said there are approximately 590 patients in the transplant pool waiting for organ transplants and over 2,000 people receiving kidney dialysis treatment.
“The pandemic has seen an increase in the demand for dialysis as the virus can impact the functioning of the kidneys, with one in three people who end up in ICU experiencing kidney failure and requiring dialysis treatment.”