Preface

This report has been produced by Statistics and Clinical Audit, NHS Blood and Transplant. All figures quoted in this report are as reported to NHS Blood and Transplant by 17 June 2012 for the UK Transplant Registry, maintained on behalf of the transplant community and National Health Service (NHS), or for the NHS Organ Donor Register, maintained on behalf of the UK Health Departments. The information provided in the tables and figures given in Chapters 2-10 does not always distinguish between adult and paediatric transplantation. For the most part, the data also do not distinguish between patients entitled to NHS treatment (Group 1 patients) and those who are not (Group 2 patients). It should also be noted that not all cornea donors or cornea grafts are necessarily reported to NHS Blood and Transplant. The UK definition of an organ donor is any donor from whom at least one organ has been retrieved with the intention to transplant. Organs retrieved solely for research purposes have not been counted in this Activity Report. Organ donation has been recorded to reflect the number of organs retrieved. For example, if both lungs were retrieved, two lungs are recorded even if they were both used in one transplant. Similarly, if one liver is donated, one liver is recorded even if it results in two or more transplants. The number of donors after brain death (DBD) and donors after circulatory death (DCD) by hospital are documented in Appendix I. Donation and transplant rates in this report are presented per million population (pmp): population figures used throughout this report are mid-2010 estimates based on ONS 2001 Census figures and are given in Appendix III. All charts presented in this report are available as an accompanying slide set available from www.organdonation.nhs.uk.

Acknowledgement NHS Blood and Transplant would like to thank all those in the donation and transplantation communities responsible for providing data to the UK Transplant Registry and the Potential Donor Audit, without whom this report would not be possible. Thanks also go to NHS Blood and Transplant staff responsible for data entry and accuracy and completeness of the data.

Foreword

I am delighted to be writing this foreword to the Transplant Activity Report for 2011-12 which details the continuing, overall upward trend in organ donation and transplantation. In 2007-08 the Organ Donation Taskforce (ODTF) published fourteen recommendations for increasing deceased donation and NHS Blood and Transplant took responsibility for implementing seven of these. Since then, our efforts have been concentrated on creating the infrastructure identified as crucial to improving the rates of organ donation in the UK and supporting our clinical partners in the wider NHS to change practice and make organ donation usual rather than unusual. Much of the necessary structure and systems are now established and the Clinical Leads for Organ Donation, together with their Donation Committee Chairs and Specialist Nurses have worked hard to ensure we are on target to meet the ODTF’s challenge of achieving 50% growth in donation by 2013. For the seventh year in succession, the number of organ transplants in the UK has increased. In 2011-12, 3,960 transplants were performed, 6% more than the previous year. The number of deceased organ donors is also continuing to increase year on year. There was a total of 1,088 deceased donors last year, 8% more than in the previous year. The sharp rise in donation after circulatory death (DCD) has been sustained, with a 17% increase over the past year although the increase in donation after brain death has unfortunately been much more modest at 2%. Living organ donors continue to play a vital role in transplantation and account for half of the total number of organ donors. In 2011-12 just over 36% of kidneys transplanted were from living donors. Of the 1,009 patients receiving a living donor transplant, 35 were non-directed altruistic donor transplants and 51 paired/ pooled transplants. The investment in the eye retrieval schemes are paying dividends with a further increase in donation in 2011-12, bringing the total increase in the past three years to 42%. More than 33% of organ donors also donated their corneas and this is further helping to increase the supply of corneas. We are now in the fortunate position where the CTS Manchester and Bristol eye banks currently have sufficient corneal tissue to allow Trusts to order corneas for surgical availability as and when they are needed. We are committed to continuing the development of NHSBT as the UK wide Organ Donation Organisation envisaged by the report of the first ODTF. During 2012-13 we will be working with our stakeholders to develop a new strategy for organ donation, mapping out our direction beyond 2013.

E. Sally Johnson Director of Organ Donation and Transplantation, NHS Blood and Transplant.

Contents

1 2

Summary of Donor and Transplant Activity .................................................................. 1 Overview of Organ Donation and Transplantation ....................................................... 3 2.1 Summary of activity .................................................................................................. 4 2.2 Transplant list ........................................................................................................... 6 2.3 Transplants ............................................................................................................... 7 Organ Donation Activity .................................................................................................. 8 3.1 Summary of activity .................................................................................................. 9 3.2 Organ donors.......................................................................................................... 10 3.3 Demographic characteristics .................................................................................. 13 The National Organ Retrieval Service and Usage of Organs ..................................... 15 4.1 The National Organ Retrieval Service (NORS) ...................................................... 16 4.2 Retrieval and usage of organs................................................................................ 17 Kidney Activity ............................................................................................................... 24 5.1 Overview ................................................................................................................. 25 5.2 Transplant list ......................................................................................................... 27 5.3 Donor and organ supply ......................................................................................... 30 5.4 Transplants ............................................................................................................. 31 5.5 Demographic characteristics .................................................................................. 36 Pancreas Activity ........................................................................................................... 37 6.1 Overview ................................................................................................................. 38 6.2 Transplant list ......................................................................................................... 39 6.3 Donor and organ supply ......................................................................................... 42 6.4 Transplants ............................................................................................................. 43 6.5 Demographic characteristics .................................................................................. 45 Cardiothoracic Activity .................................................................................................. 46 7.1 Overview ................................................................................................................. 47 7.2 Transplant list ......................................................................................................... 48 7.3 Donor and organ supply ......................................................................................... 53 7.4 Transplants ............................................................................................................. 55 7.5 Demographic characteristics .................................................................................. 57 Liver Activity 58 8.1 Overview ................................................................................................................. 59 8.2 Transplant list ......................................................................................................... 61 8.3 Donor and organ supply ......................................................................................... 63 8.4 Transplants ............................................................................................................. 65 8.5 Demographic characteristics .................................................................................. 67 Intestinal Activity............................................................................................................ 68 9.1 Overview ................................................................................................................. 69 9.2 Transplant list ......................................................................................................... 69 9.3 Transplants ............................................................................................................. 70

3

4

5

6

7

8

9

10 Cornea Activity ............................................................................................................... 71 10.1 Overview ................................................................................................................. 72 10.2 Donor and tissue supply ......................................................................................... 74 10.3 CTS Eye Bank activity ............................................................................................ 75 10.4 Transplants ............................................................................................................. 76 10.5 Demographic characteristics .................................................................................. 78 11 Survival Rates Following Transplantation ................................................................... 79 11.1 Kidney graft and patient survival ............................................................................ 81 11.1.1 Adult kidney recipients - donor after brain death (DBD) ............................ 81 11.1.2 Adult kidney recipients - donor after circulatory death (DCD) .................... 82 11.1.3 Adult kidney recipients - living donor ......................................................... 83 11.1.4 Paediatric kidney recipients - donor after brain death (DBD) .................... 84 11.1.5 Paediatric kidney recipients - living donor ................................................. 85 11.2 Pancreas graft and patient survival ........................................................................ 86 11.2.1 Simultaneous kidney/pancreas transplants donor after brain death (DBD) ................................................................... 86 11.2.2 Simultaneous kidney/pancreas transplants donor after circulatory death (DCD) ........................................................... 87 11.2.3 Pancreas only transplants - donor after brain death (DBD) ....................... 88 11.2.4 Pancreas only transplants - donor after circulatory death (DCD) .............. 89 11.3 Cardiothoracic patient survival ............................................................................... 90 11.3.1 Adult heart recipients ................................................................................. 90 11.3.2 Adult heart/lung block recipients ................................................................ 91 11.3.3 Adult lung recipients – donors after brain death (DBD) ............................. 92 11.3.4 Adult lung recipients – donors after circulatory death (DCD) ..................... 93 11.3.5 Paediatric heart recipients ......................................................................... 94 11.4 Liver patient survival ............................................................................................... 95 11.4.1 Adult recipients - donor after brain death (DBD) ........................................ 95 11.4.2 Adult recipients - donor after circulatory death (DCD) ............................... 96 11.4.3 Paediatric recipients - donor after brain death (DBD) ................................ 97 11.5 Intestinal patient survival ........................................................................................ 98 11.6 Cornea graft survival .............................................................................................. 99 12 NHS Organ Donor Register ......................................................................................... 100 13 National Potential Donor Audit ................................................................................... 106 13.1 Introduction ........................................................................................................... 107 13.2 Definitions ............................................................................................................. 107 13.3 Breakdown of audited deaths in ICUs and emergency departments ................... 107 13.4 Potential donors.................................................................................................... 110 13.5 Consent/authorisation rates.................................................................................. 116 13.6 Specialist Nurse - Organ Donation (SN-OD) involvement .................................... 119 13.7 Comparison with previous year ............................................................................ 121 Appendices ......................................................................................................................... 122

1

Summary of Donor and Transplant Activity

Summary of Donor and Transplant Activity

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In the financial year to 31 March 2012, compared with the previous year

there was an 8% increase in the number of deceased donors to 1,088, the largest number ever in the UK the number of donors after brain death increased by 2% to 652, while the number of donors after circulatory death increased by 17% to 436 the number of living donors increased by 1% to 1,055; living donors account for half of the total number of organ donors the number of patients whose lives were saved or improved by an organ transplant increased by 6% to 3,960 3,521 patients had their sight restored through a cornea transplant, representing a decrease of 1%

The total number of patients registered for a transplant has fallen slightly, so that:

there were 7,636 patients waiting for a transplant at the end of March 2012, with a further 2,880 temporarily suspended from transplant lists 508 patients died while on the active waiting list for their transplant and a further 819 were removed from the transplant list. The removals were mostly as a result of deteriorating health and ineligibility for transplant and many of these patients would have died shortly afterwards.

Some of the other key messages from this report are that, compared with last year, there has been:
• • • • • •

an increase of 15% in the number of pancreas transplants an increase of 12% in the total number of liver transplants an increase of 6% in the total number of cardiothoracic organ transplants an increase of 4% in the total number of kidney transplants an increase of 2% in the number of potential organ donors identified to 4094 in 2011-12 an increase in the referral rate of possible deceased donors to Specialist Nurses – Organ Donation (SNODs) from 52% to 60%

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2

Overview of Organ Donation and Transplantation

Overview of Organ Donation and Transplantation

A summary of the main features of organ donation and transplantation activity in the UK during the financial year from 1 April 2011 to 31 March 2012

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2.1

Summary of activity

As the total number of deceased donors and transplants continued to increase this year, the number of patients on the active transplant list at 31 March 2012 is 164 less than on the same date last year. This fall is unlikely to reflect a true decrease in the need for transplantation. The increase in donor and transplant numbers (1 April 2002 to 31 March 2012) and the number of patients registered on the transplant lists at 31 March each year are shown in Figure 2.1. There were 210 more deceased donor transplants in 2011-2012 than in the previous year, representing an 8% increase. The corresponding increase in the number of deceased donors was 8%.
Figure 2.1
8000 7655 7000 6698 6000 5654 5000 5673 Donors Transplants Transplant list 6142 7219 7877 7997 7800 7636

Number of deceased donors and transplants in the UK, 1 April 2002 - 31 March 2012, and patients on the active transplant lists at 31 March

Number

4000

3000 2388 2000 2396 2241 2196 2385 2381

2552

2644

2695

2905

1000

777

770

751

764

793

809

899

959

1010

1088

0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 Year 2008-2009 2009-2010 2010-2011 2011-2012

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Figure 2.2 shows the number of deceased and living donors for 2002-2012. The number of deceased organ donors in the UK fell over a number of years but following the implementation of the Organ Donation Taskforce recommendations, the numbers rose and are continuing to increase. The number of donors after brain death (DBD) has increased by 7% over the last four years, reversing the trend which had seen a 15% decrease between 2002/2003 and 2007/2008. The number of donors after circulatory death (DCD) has been increasing year-onyear in an effort to bridge the gap between the number of donors and the number of patients waiting for a transplant. In particular the number of these donors has increased by 118% since 2007/2008. Living donors remained relatively stable, 1,055 this year, representing a 1% increase on last year.
Figure 2.2
1100 1000 900 800 716 700 697 702 664 637 599 485 436 397 335 300 200 127 100 0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 Year 2008-2009 2009-2010 2010-2011 2011-2012 61 73 87 200 159 288 373 634 609 611 624 637 652 DBD donors DCD donors Living donors 858 961

Number of deceased and living donors in the UK, 1 April 2002 - 31 March 2012

1062

1046

1055

Number

600 500 400 472

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2.2

Transplant list

At 31 March 2012, 10,516 patients were registered for an organ transplant in the UK. Of these, 2,880 (27%) patients were temporarily suspended from the active national transplant list because they were unfit or otherwise unavailable for transplant. Details of numbers of patients on each of the organ transplant lists are given in Table 2.1 for 31 March 2011 and 2012. The total number fell by 164 patients (2%).
Table 2.1 Active transplant lists in the UK at 31 March 2011 and 2012 2011 Kidney & pancreas patients Kidney Kidney & pancreas Pancreas Pancreas islets Cardiothoracic patients Heart Heart/lung Lung(s) Liver patients Intestinal patients
1,2 3

2012 6669 6417 193 35 24 399 167 16 216 534 13 21 7636

% Change -4 -3 -23 -27 0 +13 +29 +23 +2 +9 -7 5 -2

6921 6599 250 48 24 354 129 13 212 491 14 20 7800

Other multi-organ patients ALL PATIENTS

Percentages not reported when fewer than 10 in either year 1 Excludes bowel only patients see Table 9.1 in Chapter 9 2 Two including kidney in 2011, three including kidney in 2012 3 Includes patients waiting for kidney and liver transplants (19 in 2011, 18 in 2012), kidney and heart transplants (1 in 2011, 2 in 2012), liver and pancreas transplants (1 in 2012)

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2.3

Transplants

There was a 6% increase in the total number of organ transplants (from deceased and living donors) last year: 3,960 transplants were performed in 2011-2012 compared with 3,741 in 2010-2011 (Table 2.2). All multi-organ transplants are identified separately as are transplants from living donors. The total number of kidney transplants increased by 4% in 2011-2012; kidney transplants from donors after circulatory death increased by 18%, while the number of living donor kidney transplants fell by 1%. The total number of cardiothoracic organ transplants rose by 6%, the number of liver transplants rose by 12% and the number of pancreas transplants (including pancreas only, kidney/pancreas and pancreas islets) increased by 15%.
Table 2.2 Transplant DBD kidney DCD kidney Living donor kidney DBD Kidney & pancreas DCD Kidney & pancreas DBD Pancreas DCD Pancreas Pancreas islets Deceased heart Domino heart Heart/lung DBD Single lung DCD Single lung DBD Double lung DCD Double lung DBD liver DCD liver Domino liver DBD liver lobe DCD liver lobe Living donor liver lobe Kidney & liver Liver & pancreas Liver, kidney & pancreas TOTAL ORGAN TRANSPLANTS Total kidney transplants 1 Total pancreas transplants Total cardiothoracic transplants 1 Total liver transplants
1

Transplants performed in the UK, 1 April 2010 - 31 March 2012 2010-2011 960 542 1021 131 25 30 11 13 131 0 3 23 0 124 22 445 99 4 119 1 21 9 7 0 3741 2688 217 303 705 2011-2012 960 639 1009 138 35 24 13 30 138 3 5 27 4 127 17 480 130 5 109 2 38 18 7 2 3960 2801 249 321 791 % Change -0 +18 -1 +5 +40 -20 +18 +131 +5 +17 +2 -23 +8 +31 -8 +81 +6 +4 +15 +6 +12

Percentage not reported when fewer than 10 in either year 1 Includes intestinal transplants, 8 in 2010-2011 (5 including liver (1 liver only), 1 including kidney) and 10 in 2011-2012 (9 including liver (2 including kidney)), excludes bowel only transplants, see Table 9.2 in Chapter 9

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3

Organ Donation Activity

Organ Donation Activity
Key messages

There has been an 8% increase in deceased donors (to 1,088) and a 1% increase in living organ donors (to 1,055) compared with last year The number of donors after brain death increased by 2% to 652 and there was a 17% increase in donors after circulatory death to 436 Donors after circulatory death provide, on average, one less organ for transplantation than donors after brain death Donor characteristics are continuing to change: donors are older, more obese, and less likely to have suffered a trauma-related death, all of which have adverse effects on transplant outcomes

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3.1

Summary of activity

There was an 8% increase in the number of deceased organ donors in 2011-2012. This was a result of 2% more donors after brain death (DBD) and 17% more donors after circulatory death (DCD). The 1,088 deceased organ donors gave 3,726 organs compared with 1,010 donors and 3,495 organs in 2010-2011. This represents a 7% increase in organs donated. This is lower than the rate of increase in the number of donors because fewer organs can be used from donors after circulatory death, which is where the greatest increase was seen. In particular DCD donors cannot provide hearts for transplant. Table 3.1 shows deceased organ donors according to the organs they donated. Nearly all deceased donors (95%) gave a kidney and of these the majority (75%) also donated at least one other organ. Only 10% of donors after brain death were single organ donors, the majority of which were liver only donors. By contrast, 57% of donors after circulatory death were single organ donors, the majority (93%) of these donating just their kidneys. Although the vast majority of living organ donors donated a kidney, there were three domino heart donors while a further 43 donated part of their liver. All living donations are approved by the Human Tissue Authority.
Table 3.1 Organ donors in the UK, 1 April 2011 - 31 March 2012, by organ types donated DBD Kidney only Kidney & cardiothoracic Kidney & liver Kidney & pancreas Kidney, cardiothoracic & liver Kidney, cardiothoracic & pancreas Kidney, liver & pancreas Kidney, cardiothoracic, liver & pancreas Cardiothoracic only Cardiothoracic & liver Cardiothoracic & pancreas Cardiothoracic, liver & pancreas Liver only Pancreas only TOTAL 27 8 208 4 48 4 145 168 3 2 1 1 32 1 652 DCD 233 4 89 18 7 3 57 8 17 436 Living donor 1009 3 43 1055 TOTAL 1269 12 297 22 55 7 202 176 6 2 1 1 92 1 2143

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3.2

Organ donors

Organ donor rates per million population (pmp) for 2011-2012 are given by country and Strategic Health Authority according to where the donor lived in Table 3.2 while the number of deceased donors are shown based on the location of the hospital in which they died in Table 3.3. Table 3.4 shows the number of deceased donors by Organ Donation Services team. Appendix 1 shows a more detailed breakdown of the number of donors from the donating hospitals. Number and rates of utilised donors are given in Chapter 4.
Table 3.2 Organ donation rates per million population (pmp), in the UK, 1 April 2011 1 31 March 2012, by country/Strategic Health Authority of donor residence N DBD (pmp) (15.7) (9.1) (9.1) (10.2) (7.1) (9.2) (11.7) (9.5) (9.6) (12.3) (11.4) (8.2) (10.4) (10.0) (37.5) (13.3) (12.3) (10.2) (20.0) (10.4) N DCD (pmp) (10.7) (6.8) (5.7) (7.1) (6.5) (6.8) (8.9) (7.5) (4.1) (5.2) (4.6) (13.1) (8.0) (7.0) (0.0) (6.7) (12.6) (5.4) (1.7) (7.0) N TOTAL (pmp) (26.4) (15.9) (14.7) (17.3) (13.6) (15.9) (20.6) (17.0) (13.7) (17.5) (15.9) (21.3) (18.5) (17.0) (37.5) (20.0) (24.9) (15.5) (21.7) (17.4) N Living (pmp) (19.5) (15.6) (12.8) (15.3) (14.7) (15.8) (16.1) (15.6) (27.5) (15.7) (14.7) (11.2) (13.7) (16.8) (25.0) (40.0) (17.9) (11.3) (31.7) (16.9)

Country/Strategic Health Authority of residence North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1

41 63 48 152 32 50 68 150 75 54 47 43 144 521 3 2 37 53 36 652

28 47 30 105 29 37 52 118 32 23 19 69 111 366 0 1 38 28 3 436

69 110 78 257 61 87 120 268 107 77 66 112 255 887 3 3 75 81 39 1088

51 108 68 227 66 86 94 246 215 69 61 59 189 877 2 6 54 59 57 1055

Includes 88 donors (35 deceased, 53 living) where the hospital postcode was used in place of an unknown donor postcode

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Table 3.2 shows variation in the number of DBD and DCD donors pmp across the UK. There were 10.4 DBD donors pmp for the UK as a whole, but across the English Strategic Health Authorities (SHA) this ranged between 7.1 and 15.7 pmp. However, the number of potential donors pmp also varies and further information can be seen in Chapter 13. It should be noted that these figures are not directly comparable, however, because certain categories of patients are excluded from the Potential Donor Audit. For DCD donors the UK rate is 7.0 pmp, ranging from 1.7 to 12.6 pmp across countries of the UK and from 4.6 to 13.1 pmp in the English SHAs. No adjustment has been made for any differences in demographics of the populations across centres or SHAs.

Table 3.3

Deceased organ donors in the UK, 1 April 2011 - 31 March 2012, by country/Strategic Health Authority of hospital of donor death DBD N 42 71 45 158 32 51 60 143 113 34 44 35 113 527 2 2 32 53 36 652 DCD N 32 52 29 113 19 40 44 103 49 20 18 66 104 369 0 1 35 28 3 436 TOTAL N 74 123 74 271 51 91 104 246 162 54 62 101 217 896 2 3 67 81 39 1088

Country of donation/ Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL

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Table 3.4 Team

Deceased organ donors in the UK, 1 April 2011 - 31 March 2012, by Organ Donation Services Team DBD N 63 106 70 77 43 36 53 48 43 29 33 51 652 DCD N 47 49 50 53 36 3 28 29 21 32 56 32 436 TOTAL N 110 155 120 130 79 39 81 77 64 61 89 83 1088

Eastern London Midlands North West Northern Northern Ireland Scotland South Central South East South Wales South West Yorkshire TOTAL

The mean number of organs retrieved per donor in 2011-2012 is given by country in Table 3.5. Overall for adult donors, an average of 4.0 organs were donated per DBD donor and 2.6 per DCD donor. For adult DBD donors, the rate ranged from 3.7 organs per donor in Scotland to 4.1 in Wales.
Table 3.5 Country DBD England Wales Scotland Northern Ireland TOTAL 4.0 4.1 3.7 3.9 4.0 Organs retrieved per donor, in the UK, 1 April 2011 - 31 March 2012, by country of donor residence Adult DCD 2.6 2.5 2.5 3.7 2.6 TOTAL 3.4 3.3 3.3 3.9 3.4 DBD 4.3 4.8 4.4 Paediatric DCD 2.8 4.0 2.9 TOTAL 3.8 4.7 3.9

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3.3

Demographic characteristics

While the number of donors overall is increasing, it is important to be aware that there have been changes over time with regard to donor characteristics (Table 3.6). In 2011-2012, 34% of deceased donors were aged 60 years or more compared with 16% in 2002-2003 (Figure 3.1). In particular the proportion of these donors aged at least 70 years has increased from 3% to 11% over the same time period. The trend is similar for both DBD and DCD donors. The proportion of clinically obese donors (Body Mass Index (BMI) of 30 or higher) has increased from 14% to 23% in deceased donors in the last 10 years (Figure 3.2) and the trend is similar for both DBD and DCD donors. In addition, the proportion of all deceased donors after a trauma death has decreased from 18% to 6% over the same time period. All of these changes may have an adverse impact on the quality of the organs and the subsequent transplant outcome for the recipient. Table 3.6 also indicates the ethnicity of deceased organ donors, highlighting that 4% of donors are from ethnic minority groups. By contrast, ethnic minority groups represent 8% of the UK population.
Table 3.6 Demographic characteristics of organ donors in the UK 1 April 2011 - 31 March 2012 DBD N Age 0-17 18-49 50-59 60-69 70+ Mean (SD) 0-19 20-29 30+ Unknown Mean (SD) Intracranial Trauma Other White Asian Black Other O A B AB 30 274 167 127 54 48 35 464 151 2 27 572 39 41 617 11 10 14 302 259 59 32 652 (%) (5) (42) (26) (19) (8) (17) (5) (71) (23) (0) (6) (88) (6) (6) (95) (2) (2) (2) (46) (40) (9) (5) (100) N 13 137 100 123 63 53 34 301 97 4 26 342 27 67 425 5 2 4 199 186 43 8 436 DCD (%) (3) (31) (23) (28) (14) (17) (8) (69) (22) (1) (6) (78) (6) (15) (97) (1) (0) (1) (46) (43) (10) (2) (100) N 43 411 267 250 117 50 69 765 248 6 27 914 66 108 1042 16 12 18 501 445 102 40 1088 TOTAL (%) (4) (38) (25) (23) (11) (17) (6) (70) (23) (1) (6) (84) (6) (10) (96) (1) (1) (2) (46) (41) (9) (4) (100)

BMI

Cause of death Ethnicity

Blood group

TOTAL

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Figure 3.1
100% 90% 80% 70% 60%

Age of deceased donors in the UK, 1 April 2002 - 31 March 2012
770 751 764 793 809 899 959 1010 1088

N= 777

3 13

2 14

3 15

3 14

3 13

3 17

5 15

8

10

11

18 27 25 22 26 24 24

20

23

25

26

Percentage

23 25

70+ 60-69 50-59 18-49 0-17

50% 40% 30% 20% 10% 0%

50

52

49

50

53 48

50 46 42 38

7

7

8

7

8

5
Year

7

4

4

4

2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012

Figure 3.2
100% 90% 80% 70% 60%

BMI of deceased donors in the UK, 1 April 2002 - 31 March 2012
726 707 724 750 771 886 942 995 1082

N= 741

14

16

16

16

18

19

20

24

20

23

Percentage

50% 40% 30% 20% 10%

30+ 20-29 0-19

78

76

76

78

74

75

72

70

72

70

8
0%

8

8

6

7
Year

6

7

5

7

6

2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012

Note that BMI cannot be determined for all deceased donors thus numbers indicated in Figure 3.2 are the numbers of donors for which BMI was available, not total numbers of donors.

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4

The National Organ Retrieval Service and Usage of Organs

The National Organ Retrieval Service and Usage of Organs
Key messages

National Organ Retrieval Service teams attended 667 DBD donors and 754 DCD donors; 2% of DBD donors and 42% of DCD donors attended did not proceed to donation 85% of deceased donor kidneys offered to transplant centres are subsequently transplanted, compared with 66% of livers, 40% of pancreases, 29% of hearts and 23% of lungs; the remaining organs are not transplanted due to lack suitability of the donor or organ for any patient on the transplant list The UK actual donor rate is 17.4 pmp, while the utilized donor rate is 16.4 pmp as 6% of organ donors result in no organs being transplanted

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4.1

The National Organ Retrieval Service (NORS)

A National Organ Retrieval Service (NORS) was introduced in the UK on 1 April 2010. The service comprises seven abdominal organ retrieval teams and six cardiothoracic organ retrieval teams. These teams are based in liver and cardiothoracic transplant centres, respectively. Each of the thirteen teams is on call 24 hours per day, seven days per week. If a team is the first on-call for a particular donor hospital, they are required to attend within an agreed timescale if at least one organ has been accepted for transplant when offered to the transplant centres in the UK. Each team has a designated area for which they are first on-call, based on the premise that the travel time to any hospital in their area should be less than three hours. There are some exceptions to this principle for remote hospitals. If a team is already retrieving when they are called to attend a donor, then a second team will be called in to retrieve, and so on. The number of donors after brain death and donors after circulatory death that were attended by each of the teams is shown in Table 4.1. The table also shows the number of proceeding (actual) organ donors and the number that did not proceed to donation. Many of the potential donors after circulatory death prove unsuitable for organ donation due to a prolonged time to death in which time the organs deteriorate. The number of donors attended per team varies according to the number of potential donors identified in each of the areas, as the areas are not of equal size. A small number of donors are attended by local kidney transplant teams. This is typically for donors after circulatory death when only the donor's kidneys have been accepted for transplant. There is no expectation that local kidney teams retrieve organs, but they are appropriately reimbursed if they are willing and able to do so.

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Table 4.1

Number of actual and non-proceeding donors per retrieval team Donors after brain death Non% nonNo. Actual proceeding proc attended 99 90 115 107 79 105 54 649 41 32 48 37 55 11 224 652 3 0 1 4 3 3 1 15 19 22 13 9 20 33 116 15 3 0 1 4 4 3 2 2 32 41 21 20 27 75 34 2 102 90 116 111 82 108 55 664 60 54 61 46 75 44 340 Donors after circulatory death Non% nonNo. Actual proceeding proc attended 110 62 63 68 45 55 29 432 0 9 4 5 4 0 22 436 79 36 51 65 31 37 15 314 0 34 8 15 4 0 61 318 42 37 45 49 41 40 34 42 79 67 75 50 73 42 189 98 114 133 76 92 44 746 0 43 12 20 8 0 83 -

Retrieval team Abdominal Birmingham/Cardiff Cambridge King's Leeds/Manchester Newcastle Royal Free/Oxford Scotland Abdominal total Cardiothoracic Birmingham Harefield Manchester Newcastle Papworth Scotland Cardiothoracic total Total donors (abdominal and/or cardiothoracic)

Note: there were 15 actual donors attended by a local team. Plymouth, Nottingham, Liverpool and St George’s each attended one of the local abdominal donors. Of the cardiothoracic donors, two were attended by Great Ormond Street Hospital and 9 were attended by an overseas retrieval team.

4.2

Retrieval and usage of organs

There were 1088 actual deceased organ donors last year, but not all organs from these donors were offered for transplantation. Table 4.2 shows the number of organs offered, retrieved and transplanted from the 652 DBD and 436 DCD donors. The number of organs from these donors that were subsequently used for research purposes is also shown. The number of organs offered for transplant excludes those where the donor did not meet the nationally agreed age criteria for suitability for donation of that specific organ. There are no age cut-offs agreed for kidney and liver donation. Each year, a number of actual organ donors result in no transplants. Donors resulting in at least one transplant are termed ‘utilised’ donors and the number of actual and utilised donors for the UK as a whole is shown in Table 4.3. The number of donors per million of population is also shown. Last year 6% of actual donors resulted in no organ transplants.

- 17 -

Figures 4.1 and 4.2 show offering, retrieval and transplantation of organs, in terms of percentages. Charts start at 100% for each organ, representing all organs from the 652 DBD and 436 DCD donors. The charts indicate the proportion of those organs following the pathway through each step to transplantation eg meeting national donor age criteria, having consent, being offered out to transplant centres, being retrieved for transplant and resulting in transplantation. For example, Figure 4.1 shows that 30% of the pancreases from the 652 DBD donors were transplanted, but that 41% of pancreases from donors within the nationally agreed age limit of 60 years were transplanted. Transplant rates of kidneys and livers are generally high, while other organs, even allowing for the agreed age limits, are less often transplanted. Reasons for organs not being offered for transplant, being offered but not accepted and retrieved and for being retrieved but not subsequently transplanted are shown in Table 4.4 for abdominal organs from DBD donors, Table 4.5 for abdominal organs from DCD donors and in Table 4.6 for cardiothoracic organs. Reasons for the medical unsuitability of a donor include infections, tumours, anatomy and disease. Non-medical reasons include donor size. Clinical unsuitability of an organ encompasses poor perfusion, prolonged ischaemia time, past history of donor and, in the case of pancreases for islets, insufficiency of viable islet yield. Reasons reported under ‘other’ include logistical and recipient related issues in addition to un-coded reasons reported of a miscellaneous nature. These tables also indicate the number of organs from UK donors that were transplanted overseas. These organs were not accepted for transplant by any UK transplant centre, but were accepted for suitable recipients identified elsewhere, usually in Europe. Other than livers fulfilling an arrangement for the transplantation of super-urgent patients in the Republic of Ireland, only hearts and lungs were exported for transplant outside the UK. Organs from outside the UK are occasionally imported for transplant. In 2011/12 these were 11 hearts (including 4 from ROI), 1 lung from ROI and 14 livers (including 10 from ROI).

- 18 -

Table 4.2

Donation and transplantation of organs from 1088 deceased donors in the UK, 1 April 2011 – 31 March 2012 Organs meeting initial suitability criteria and offered for transplant Organs used for research (from actual 4 organ donors)

Organ

Organs retrieved for transplant N % of offered 1209 604 314 136 322 823 178 86 42 2032 782 400 136 364 93 94 75 29 32 94 44 42 8 94 75 64 29 24

N

Organs transplanted % of % of retrieved offered 93 92 62 100 96 87 74 59 90 91 88 62 100 95 87 87 47 29 31 82 33 25 7 85 66 40 29 23

DBD organ donors Kidney 1298 Liver 641 1 Pancreas 419 2 Heart 476 3 Lung 994 DCD organ donors Kidney Liver 1 Pancreas 3 Lung 872 405 203 536

1127 557 195 136 308 712 132 51 38 1839 689 246 136 346

25 27 41 0 3 38 38 12 0 63 65 53 0 3

Deceased organ donors Kidney 2170 Liver 1046 1 Pancreas 622 2 Heart 476 3 Lung 1530
1 2 3 4

Excludes donors aged > 60 years Excludes donors aged > 65 years or died due to myocardial infarction Excludes donors aged > 65 years Includes one DBD and one DCD pancreas retrieved only for research

Table 4.3

Actual and utilised deceased donors in the UK, 1 April 2011 – 31 March 2012 DBD (pmp) DCD (pmp) 436 387 (7.0) (6.2) Total (pmp) 1088 1026 (17.4) (16.4)

Actual donors 1 Utilised donors
1

652 639

(10.4) (10.2)

Utilised donors defined as donors where one or more organs were retrieved and transplanted

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Figure 4.1

Donation and transplantation rates of organs from DBD organ donors in the UK, 1 April 2011 – 31 March 2012
Transplanted: % of all organs 86% 85% % of all organs meeting age criteria1 86% 85%

100 90 80 70

Percentage

60 50 40 30 20 10 0 Organs from actual DBD donors Donor age criteria met 1 Consent for organ donation Organs offered Organs retrieved for donation for transplant Organs transplanted Kidney Liver Pancreas Heart Lungs

30% 24% 21%

41% 25% 28%

1

Hearts – in addition to age criteria, donors who died due to myocardial infarction are excluded

Figure 4.2

Donation and transplantation rates of organs from DCD organ donors in the UK, 1 April 2011 – 31 March 2012
Transplanted: % of all organs 82% % of all organs meeting age criteria 82%

100 90 80 70

Percentage

60 50 40 30 20 10 0 Organs from actual DCD donors Donor age criteria met Consent for organ donation Organs offered Organs retrieved for donation for transplant Kidney Liver Pancreas Lungs

30%

30%

12% 4%
Organs transplanted

20% 6%

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Table 4.4

Reasons for non-retrieval and non-use of abdominal organs from organ donors after brain death (DBD) in the UK, 1 April 2011 – 31 March 2012 Kidney Liver 652 11 10 1 0 0 0 11 641 37 (6) Pancreas 652 23 21 1 1 173 18 20 233 419 105 (25)

All DBD organ donors Donors from whom organs not offered for donation Reasons for organs not being offered Family permission refused Permission refused by coroner Donor unsuitable – age Donor unsuitable – past history Other TOTAL DONORS WITH ORGANS NOT OFFERED Organs offered for donation Organs not retrieved (% of organs offered for donation) Reasons for non-retrieval Donor Donor unsuitable – medical Donor unsuitable – non-medical Donor age Organ Organ unsuitable – clinical Poor function Other Other TOTAL ORGANS NOT RETRIEVED Organs retrieved (% of organs offered for donation) Organs transplanted in the UK Organs transplanted overseas Organs not transplanted Reasons for organ not being transplanted Donor Donor unsuitable – medical Donor unsuitable – non-medical Donor age Organ Organ unsuitable – clinical Poor function Other Other TOTAL ORGANS NOT TRANSPLANTED (Number used for research)
1 2

652 3 3 0 0 0 0 3 1298 89 (7)

19 3 6 45 12 4 89 1209 (93) 1127 0 82

3 0 0 21 4 9 37 604 (94) 552 2 5 47

12 17 5 48 9 14 105 314 (75) 195 0 119

34 0 0 29 0 19 82 (25)

5 3 0 36 0 3 47 (27)

9 2 0 91 2 15 119 (40)

One pancreas not offered for donation due to donor age was retrieved and used for research Transplanted into super-urgent patients in the Republic of Ireland

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Table 4.5

Reasons for non-retrieval and non-use of abdominal organs from organ donors after circulatory death (DCD) in the UK, 1 April 2011 – 31 March 2012 Kidney Liver 436 31 26 5 0 0 0 31 405 227 (56) Pancreas 436 233 23 2 1 185 12 11 233 203 117 (58)

All DCD organ donors Donors from whom organs not offered for donation Reasons for organs not being offered Family permission refused Permission refused by coroner Donor unsuitable – age Donor unsuitable – past history Other TOTAL DONORS WITH ORGANS NOT OFFERED Organs offered for donation Organs not retrieved (% of organs offered for donation) Reasons for non-retrieval Donor Donor unsuitable – medical Donor unsuitable – non-medical Donor age Organ Organ unsuitable – clinical Poor function Other Other TOTAL ORGANS NOT RETRIEVED Organs retrieved (% of organs offered for donation) Organs transplanted in the UK Organs transplanted overseas Organs not transplanted Reasons for organ not being transplanted Donor Donor unsuitable – medical Donor unsuitable – non-medical Donor age Organ Organ unsuitable – clinical Poor function Other Other TOTAL ORGANS NOT TRANSPLANTED (Number used for research)
1

436 0 0 0 0 0 0 0 872 49 (6)

8 0 6 14 5 16 49 823 (94) 712 0 111

7 9 55 90 24 42 227 178 (44) 132 0 46

3 14 19 47 3 31 117 86 (42) 51 0 35

29 0 0 38 3 41 111 (38)

6 1 0 27 0 12 46 (38)

3 1 0 22 1 8 35 (11)

One pancreas not offered for donation due to donor age was retrieved and used for research

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Table 4.6

Reasons for non-retrieval and non-use of cardiothoracic organs from organ donors in the UK, 1 April 2011 – 31 March 2012 Heart (DBD) Lung (DBD) 652 155 39 13 103 0 155 994 672 (68) Lung (DCD) 436 168 47 8 113 0 168 536 494 (92)

All organ donors Donors from whom organs not offered for donation Reasons for organs not being offered Family permission refused Permission refused by coroner Donor age >65 years Donor COD of cardiac arrest or MI TOTAL DONORS WITH ORGANS NOT OFFERED Organs offered for donation Organs not retrieved (% of organs offered for donation) Reasons for non-retrieval Donor Donor unsuitable – medical Donor unsuitable – non-medical Donor age Organ Organ unsuitable – clinical Poor function Other Other TOTAL ORGANS NOT RETRIEVED Organs retrieved (% of organs offered for donation) Organs transplanted in the UK Organs transplanted overseas Organs not transplanted Reasons for organ not being transplanted Donor Donor unsuitable – medical Donor unsuitable – non-medical Organ Organ unsuitable – clinical Poor function Other Other TOTAL ORGANS NOT TRANSPLANTED (Number used for research)

652 176 55 17 103 1 176 476 340 (71)

23 44 24 76 126 47 340 136 (29) 132 4 0

43 49 30 152 314 84 672 322 (32) 288 20 14

25 112 54 108 139 56 494 42 (8) 38 0 4

0 0 0 0 0 0 (0)

1 0 0 2 11 14 (3)

0 0 0 2 2 4 (0)

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5

Kidney Activity

Kidney Activity
Key messages
• •

The number of deceased kidney donors increased by 8% to 1,031 Kidney transplants from living donors decreased by 1% to 1,009, while transplants from deceased donors increased by 7% to 1,792 51 kidney transplants were made possible by the paired living kidney donation programme Non-directed living kidney donation resulted in 35 living donor kidney transplants The number of patients registered on the kidney transplant list this year fell by 3% from 6,871 to 6,633

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5.1

Overview

The number of deceased kidney donors increased by 8% in 2011-2012 compared to 2010-2011 and the number of deceased donor kidney transplants increased by 7%. These increases are very welcome for the 6,633 patients waiting for a kidney transplant and for the third year running the number of patients on the national list for a kidney transplant has declined. This is unlikely to reflect a true decline in demand for transplantation, however, since if there was an unlimited supply of organs for transplant, many more patients with kidney failure could receive a transplant than is currently the case. A summary of activity for deceased donor kidney transplants and the transplant list at year end for the last ten years is shown in Figure 5.1. Despite the slight drop in the last three years, the number of patients registered on the active transplant list at 31 March 2012 for a kidney or kidney and pancreas transplant has risen by 32% since 2003.
Figure 5.1
8000

Deceased donor kidney programme in the UK, 1 April 2002 - 31 March 2012 Number of donors, transplants and patients on the active transplant list at 31 March

7000 6980 6000 5863 6481

7190

7183 6871 6633

Number

5000 5020 4000

5425 5074

Donors Transplants Transplant list

3000

2000 1399 1000 743 1388 734 1308 712 1326 722 1440 765 1453 789

1570 859

1657 931

1667 957

1792 1031

0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Year

Table 5.1 shows the number of deceased and living donor kidney transplants carried out in 2011-2012 at each centre. Kidney transplants from donors after circulatory death are increasingly common and in this financial year only two adult kidney transplant centres did not perform any such transplants. As yet, very few kidneys from donors after circulatory death are transplanted in paediatric patients (<18 years). Donation figures for centres in North and South Thames are not reported individually as they have shared designated areas and donor populations. Multi-organ transplants including a kidney are included in the table. The total number of deceased kidney donors rose to 1,031 in 2011-2012 from 957 in 2010-2011 and the number of transplants increased from 1,667 to 1,792. The number of kidney donors after circulatory death increased to 419 from 355 in 2010-2011 and the number of transplants from such donors increased by 19% to 674.

- 25 -

Table 5.1
Centre

Kidney donors and transplants, 1 April 2011 - 31 March 2012 (2010-2011) and transplant list at 31 March 2012 (2011) in the UK, by centre
Deceased kidney donors DBD DCD (36) (47) (18) (32) (30) (5) (34) (15) (0) (27) (14) (29) (37) (33) (82) (13) (39) (12) (12) (17) (70) (602) 3 32 29 40 27 6 16 12 0 21 6 20 32 34 31 11 14 29 12 9 35 419 (2) (24) (26) (35) (22) (10) (11) (7) (0) (21) (3) (23) (19) (26) (34) (10) (10) (19) (11) (13) (29) (355) 27 69 27 47 41 22 59 59 8 75 53 37 107 23 42 35 65 46 97 9 36 23 79 32 1118 Deceased donor transplants DBD (26) (69) (45) (53) (50) (19) (52) (53) (10) (50) (38) (33) (104) (35) (26) (48) (75) (67) (90) (2) (22) (36) (70) (27) (1100) 0 16 32 76 67 6 21 24 1 53 0 36 47 49 26 28 5 35 40 46 12 16 25 13 674 DCD (0) (9) (36) (74) (40) (10) (16) (11) (1) (51) (2) (35) (19) (49) (25) (18) (18) (20) (53) (23) (17) (12) (18) (10) (567) 52 57 42 47 39 35 24 31 21 46 36 28 77 59 43 41 56 13 50 12 17 20 113 50 1009
2

Living donor transplants (46) (55) (44) (45) (39) (34) (28) (25) (9) (38) (54) (26) (78) (53) (38) (46) (70) (26) (48) (12) (18) (19) (117) (53) (1021)

Active transplant list

Belfast Birmingham Bristol Cambridge Cardiff Coventry Edinburgh Glasgow Great Ormond Street Leeds Leicester Liverpool Manchester Newcastle 1 North Thames Royal Free Royal London WLRTC Nottingham Oxford Plymouth Portsmouth Sheffield 1 South Thames Guy's St George's TOTAL

35 40 19 40 25 9 37 13 0 33 18 34 36 42 85 11 29 11 20 11 64 612

179 622 367 223 184 119 188 314 15 317 345 190 593 222 275 225 525 187 308 79 231 198 420 307 6633

(176) (670) (324) (242) (198) (130) (245) (308) (16) (336) (379) (227) (602) (218) (267) (243) (465) (215) (376) (102) (209) (195) (431) (297) (6871)

WLRTC – West London Renal and Transplant Centre 1 Donor figures in this area cannot be linked to individual transplant centres due to shared donation areas. 2 Includes 2 domino donor transplants

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5.2

Transplant list

The number of patients registered on the kidney or kidney and pancreas transplant list fell by 3% in the year: on 31 March 2012, 6,633 patients were registered as active, compared with 6,871 at the end of March 2011. The number of patients waiting for a kidney transplant represents 106 patients per million population (pmp). Of the 6,633 patients on the active transplant list at 31 March 2012, 193 required a kidney and pancreas transplant (250 at 31 March 2011). Additionally, 60 patients were registered for a pancreas only transplant (72 at 31 March 2011). The outcome of patients registered on the UK kidney and kidney/pancreas transplant list at 1 April 2011, or subsequently registered during the financial year, is shown in Table 5.2. A total of 3,160 patients joined the kidney transplant list last year, while a further 189 joined the kidney/pancreas transplant list.
Table 5.2 Kidney transplant list and new registrations in the UK, 1 April 2011 - 31 March 2012 Active and suspended patients at 1 April 2011 N Kidney transplant list Remained active/suspended Transplanted Removed Died TOTAL Kidney/pancreas transplant list Remained active/suspended Transplanted Removed Died TOTAL
1 2 3

Outcome of patient at 31 March 2012

% 70 21 5 3

New registrations in 1 2011-2012 N % 2625 468 3 42 25 3160 155 32 1 1 189 83 15 1 1

TOTAL N 9070 2441 532 303 12346 338 190 18 16 562 % 73 20 4 2

6445 1973 2 490 278 9186 183 158 17 15 373

49 42 5 4

82 17 1 1

60 34 3 3

Includes re-registrations for second or subsequent transplants Includes 12 patients removed from kidney list and made active on kidney/pancreas list Includes 5 patients removed from kidney list and made active on kidney/pancreas list

- 27 -

An indication of outcomes for patients listed for a kidney transplant is summarised in Figure 5.2. This shows the proportion of patients transplanted or still waiting one, three and five years after joining the list. It also shows the proportion removed from the transplant list (typically because they become too unwell for transplant) and those dying while on the transplant list. Only 21% of patients are transplanted within one year, while five years after listing 65% of patients have received a transplant. The median (average) waiting time for a kidney only transplant is 1168 days for an adult patient and is shown by patient blood group in Table 5.3 and patient ethnicity in Table 5.4. Because of the need to match donor and recipient blood groups and tissue types, waiting times to transplant differ according to patient blood groups and ethnicity due to differences between the donor pool and patients awaiting a kidney transplant. Note that these waiting times are not adjusted for other relevant factors which may be influential and which may differ across blood or ethnic groups.
Figure 5.2
100 90 80 70

Post-registration outcome for 3055 new adult kidney only registrations made in the UK, 1 April 2006 - 31 March 2007

2 1

6 6

8 10 17

39 76
Died Removed Still waiting Transplanted

Percentage

60 50 40 30

65 49

20 10 0 1 year 3 years Time since listing 5 years

21

- 28 -

Table 5.3 Blood group Adult O A B AB TOTAL Paediatric O A B AB TOTAL

Median waiting time to kidney only transplant in the UK, for patients registered 1 April 2005 - 31 March 2009 Number of patients registered 4036 3356 1233 366 8991 157 110 44 14 325 Median 1395 955 1330 610 1168 384 295 277 504 354 Waiting time (days) 95% Confidence interval 1357 - 1433 924 - 986 1253 - 1407 529 - 691 1143 - 1193 286 - 482 181 - 409 85 - 469 0 - 1192 283 - 425

Table 5.4 Ethnicity Adult White Asian Black Other TOTAL Paediatric White Asian Black Other TOTAL

Median waiting time to kidney only transplant in the UK, for patients registered 1 April 2005 - 31 March 2009 Number of patients registered 6927 1185 649 230 8991 231 67 19 8 325 Median 1108 1431 1388 1231 1168 243 563 623 354 Waiting time (days) 95% Confidence interval 1081 - 1135 1348 - 1514 1294 - 1482 1043 - 1419 1143 - 1193 188 - 298 395 - 731 271 - 975 283 - 425

Median waiting time not reported for fewer than 10 patients

- 29 -

5.3

Donor and organ supply

Of the 652 organ donors after brain death in the UK in 2011-2012, 612 (94%) were kidney donors. From these donors, 1,209 kidneys were retrieved. There were 419 kidney donors after circulatory death in 2011-2012. From these donors, 823 kidneys were retrieved. Table 5.5 shows this activity by donor country/Strategic Health Authority of donor’s residence. No adjustments have been made for potential demographic differences in populations. The overall rate for kidney donors after brain death is 9.8 pmp, with rates across the Strategic Health Authorities ranging from 7.1 to 15.3 pmp. The number of kidneys retrieved from donors after brain death in the UK is 19.3 pmp and varies from 14.1 to 29.9 pmp. The overall rate for kidney donors after circulatory death is 6.7 pmp, with rates across the strategic health authorities ranging from 3.6 to 12.7 pmp. The number of kidneys retrieved from donors after circulatory death is 13.2 pmp and varies from 6.8 to 25.2 pmp.
Table 5.5 Kidney donation and retrieval rates for deceased donors in the UK, 1 1 April 2011 - 31 March 2012, by country/Strategic Health Authority Kidney donors (pmp) DBD DCD 40 57 45 142 32 46 63 141 68 50 46 41 137 488 3 2 35 49 35 612 (15.3) (8.2) (8.5) (9.6) (7.1) (8.4) (10.8) (8.9) (8.7) (11.4) (11.1) (7.8) (9.9) (9.3) (37.5) (13.3) (11.6) (9.4) (19.4) (9.8) 27 46 30 103 28 35 52 115 28 20 19 67 106 352 0 1 35 28 3 419 (10.3) (6.6) (5.7) (6.9) (6.3) (6.4) (8.9) (7.3) (3.6) (4.6) (4.6) (12.7) (7.7) (6.7) (0.0) (6.7) (11.6) (5.4) (1.7) (6.7) Kidneys retrieved (pmp) DBD DCD 78 114 89 281 63 90 125 278 135 97 90 82 269 963 6 4 70 97 69 1209 (29.9) (16.4) (16.8) (18.9) (14.1) (16.5) (21.4) (17.6) (17.2) (22.1) (21.7) (15.6) (19.5) (18.4) (75.0) (26.7) (23.3) (18.6) (38.3) (19.3) 53 92 60 205 56 69 103 228 53 40 37 133 210 696 0 2 69 50 6 823 (20.3) (13.3) (11.3) (13.8) (12.5) (12.6) (17.7) (14.5) (6.8) (9.1) (8.9) (25.2) (15.2) (13.3) (0.0) (13.3) (22.9) (9.6) (3.3) (13.2)

Country/Strategic Health Authority of residence North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1

Includes 34 donors where the hospital postcode was used in place of an unknown donor postcode

- 30 -

5.4

Transplants

The number of kidney transplants by recipient country/Strategic Health Authority of residence is shown in Table 5.6. No adjustments have been made for potential demographic differences in populations. The deceased donor transplant rate ranged from 12.8 to 31.7 pmp across the Strategic Health Authorities and overall was 25.6 pmp. The living donor transplant rate ranged from 11.6 to 22.9 pmp across the Strategic Health Authorities and overall was 16.0 pmp.
Table 5.6 Kidney only transplant rates per million population (pmp), in the UK, 1 April 2011 - 31 March 2012, by country/Strategic Health Authority N DBD (pmp) (7.3) (16.0) (18.7) (15.4) (21.2) (15.6) (11.0) (15.5) (19.7) (10.3) (16.4) (8.0) (11.2) (15.0) (12.5) (6.7) (16.3) (19.2) (15.0) (15.4) N DCD (pmp) (17.2) (10.1) (13.0) (12.4) (8.5) (4.2) (14.1) (9.1) (8.3) (2.5) (8.5) (15.6) (9.3) (10.0) (12.5) (0.0) (24.3) (8.4) (0.0) (10.2) N TOTAL (pmp) (24.5) (26.1) (31.7) (27.8) (29.7) (19.8) (25.0) (24.5) (28.0) (12.8) (24.9) (23.5) (20.5) (24.9) (25.0) (6.7) (40.5) (27.6) (15.0) (25.6) N Living (pmp) (19.2) (14.6) (11.9) (14.4) (14.1) (15.0) (14.9) (14.7) (22.9) (17.8) (16.2) (11.6) (14.9) (15.9) (12.5) (46.7) (16.6) (10.9) (31.1) (16.1)

Country/Strategic Health Authority of residence North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1 2 1,2

19 111 99 229 95 85 64 244 154 45 68 42 155 782 1 1 49 100 27 960

45 70 69 184 38 23 82 143 65 11 35 82 128 520 1 0 73 44 0 638

64 181 168 413 133 108 146 387 219 56 103 124 283 1302 2 1 122 144 27 1598

50 101 63 214 63 82 87 232 179 78 67 61 206 831 1 7 50 57 56 1003

Excludes 6 recipients of a living donor kidney transplant and 1 recipient of a DCD donor transplant who reside outside of the UK Includes 1 recipient of a living donor kidney transplant where the postcode was unspecified

- 31 -

The number of kidney only transplants from deceased donors at each transplant centre is shown in Table 5.7 for adult patients only. Kidney transplants from donors after brain death include four en bloc kidneys and four double kidney transplants in 2011-2012 (seven and seven in 20102011). Kidney transplants from donors after circulatory death include no en bloc and 35 double kidney transplants in 2011-2012 (three and 25 in 2010-2011). This table excludes multi-organ transplants: 18 kidney and liver, 2 kidney, liver and pancreas and 173 kidney and pancreas.
Table 5.7 Transplant centre Belfast Birmingham Bristol Cambridge Cardiff Coventry Edinburgh Glasgow Guys Leeds Leicester Liverpool Manchester Newcastle Royal Free Royal London Nottingham Oxford Plymouth Portsmouth Sheffield St Georges WLRTC TOTAL Adult kidney only transplants from deceased donors in the UK, 1 April 2011 - 31 March 2012, by transplant centre/region 2010-2011 DBD 24 55 38 35 39 19 45 50 51 42 38 33 79 30 25 47 53 36 2 22 36 27 67 893 DCD 0 9 35 65 40 10 16 14 11 51 2 35 18 48 25 18 20 44 23 17 12 10 17 540 DBD 26 62 21 34 36 22 41 48 57 59 53 37 81 21 41 35 31 35 9 36 23 32 55 895 2011-2012 DCD 0 16 32 68 64 6 20 16 24 53 0 36 41 49 26 28 35 32 46 12 16 13 5 638

WLRTC – West London Renal and Transplant Centre

Living donor kidney transplants decreased by 1% to 1,009 in 2011-2012, representing 36% of the total kidney transplant programme. The total number of living donor adult transplants performed by each transplant centre is shown in Table 5.8. Also shown is the number as a percentage of patients listed at the end of the year, to indicate the size of the living donor programme relative to the centre's transplant list. Most living donor transplants are 'directed'. This means that a kidney is donated to a specific recipient known to the donor - a close family member or friend. There has been a 4% decrease in these transplants. In addition there are now a number of 'undirected' living donor transplants (also known as altruistic donor transplants). Last year 35 such donors donated a kidney to a recipient through the national Kidney Allocation Scheme for deceased donor kidneys (32 transplanted into an adult recipient and 3 transplanted into a paediatric recipient).

- 32 -

In 2011-2012, there were also 51 paired living kidney donor transplants. When a potential donor and recipient are biologically incompatible (blood group or tissue type), they may consider joining a list of others in the same situation with the hope that an exchange of kidneys between them can lead to a compatible living donor transplant. This is known as paired donation. Most exchanges are between two pairs (ie two donors and their respective incompatible recipients), or between three pairs. As a percentage of the number of patients on the active transplant list at 31 March 2012, the number of living donor adult transplants in the year was 14% and ranged from 7% to 29% at individual transplant centres. The high rate for Coventry is at least partly attributable to their antibody incompatible kidney transplant programme; a number of patients are referred to Coventry for such transplants.
Table 5.8 Adult living donor kidney transplants in the UK, 1 April 2010 - 31 March 2012, and percentage of active transplant list at 31 March, by transplant centre 2010-2011 Transplant centre Belfast Birmingham Bristol Cambridge Cardiff Coventry Edinburgh Glasgow Guy's Leeds Leicester Liverpool Manchester Newcastle Nottingham Oxford Plymouth Portsmouth Royal Free Royal London Sheffield St George's WLRTC TOTAL Directed 33 47 34 43 36 31 26 22 103 31 50 24 60 49 17 42 12 15 35 45 19 49 68 891 Paired/ pooled 4 0 2 2 1 2 2 1 4 0 1 2 5 1 3 3 0 1 3 0 0 1 1 39 Nondirected 2 1 0 0 1 0 0 0 3 2 3 0 3 1 1 2 0 1 0 1 0 3 1 25 TOTAL N % list 39 48 36 45 38 33 28 23 110 33 54 26 68 51 21 47 12 17 38 46 19 53 70 955 22 7 11 19 19 25 11 8 26 10 14 11 12 24 11 13 12 8 14 19 10 18 15 14 Directed 41 43 33 43 37 35 24 26 93 39 32 27 61 52 10 44 9 14 37 39 20 42 54 855 2011-2012 Paired/ pooled 7 2 1 3 0 0 0 1 5 2 3 0 7 0 1 4 3 2 3 1 0 4 2 51 Nondirected 1 5 2 1 1 0 0 1 2 2 1 1 2 3 1 2 0 1 3 1 0 4 0 34
1

TOTAL N % list 49 50 36 47 38 35 24 28 100 43 36 28 70 55 12 50 12 17 43 41 20 50 56 940 27 8 10 21 21 29 13 9 24 14 10 15 12 25 7 16 15 7 16 18 10 16 11 14

WLRTC – West London Renal Transplant Centre 1 Includes 2 domino donor transplants

- 33 -

The number of deceased donor and living donor transplants in paediatric patients (<18 years) performed by each paediatric transplant centre is shown in Table 5.9. There were 69 living donor transplants and 70 deceased donor transplants in paediatric patients in 2011-2012. The paediatric transplant list decreased by 8% from 96 patients at 31 March 2011 to 88 at the end of March 2012. Occasionally, older paediatric patients are listed and/or transplanted at adult kidney transplant centres and these are indicated in Table 5.9. At 31 March 2012, there were approximately 29,500 recipients with a functioning kidney transplant (including multi-organ transplants) being followed-up as reported to the UK Transplant Registry.
Table 5.9 Paediatric patient kidney transplants in the UK, 1 April 2010 - 31 March 2012, by transplant centre 2010-2011 Living donor DCD 0 0 1 0 1 0 0 0 0 0 0 2 7 7 8 2 9 7 5 10 2 5 4 66 TOTAL DBD 9 19 16 4 20 12 13 16 4 19 6 138 1 7 6 2 8 11 13 5 0 15 1 69 2011-2012 Living donor DCD 0 0 0 0 1 0 0 0 0 0 0 1 3 7 6 3 21 13 3 7 4 1 1 69
1

Paediatric transplant centre Belfast Birmingham Bristol Glasgow Great Ormond Street Guy's Leeds Manchester Newcastle Nottingham Adult centres TOTAL
1

TOTAL 4 14 12 5 30 24 16 12 4 16 2 139

DBD 2 12 7 2 10 5 8 6 2 14 2 70

Includes 3 non-directed donor transplants

- 34 -

Rates of pre-emptive kidney only transplantation are shown in Table 5.10. Of the 2,608 kidney only transplant recipients in 2011-2012, requirement for dialysis at time of transplant was reported for 2,506 (96%). Of these 2,506 transplants, 479 (19%) were carried out in pre-dialysis patients. Pre-emptive transplants accounted for 26% of all paediatric kidney only transplants with reported dialysis status, compared with 19% of those in adults. Living donor transplants are more likely to be carried out before the need for dialysis than deceased donor transplants: 33% and 11% respectively. This is because a living donor transplant can often be carried out more quickly than a deceased donor kidney transplant as the latter often necessitates a long waiting time.
Table 5.10 Pre-emptive kidney only transplants in the UK, 1 April 2011 - 31 March 2012 Number of kidney only transplants Adult Deceased donor transplant Living donor transplant Paediatric Deceased donor transplant Living donor transplant Number of transplants with known dialysis status at transplant (% of all) 1508 869 66 63 (98.4) (92.4) (100) (91.3) Percentage of patients transplanted prior to the need for dialysis (of those with known status) 10.2 33.5 21.2 31.9

1533 940 66 69

The length of time that elapses between a kidney being removed from the donor to its transplantation into the recipient is called the Cold Ischaemia Time (CIT). Generally, the shorter this time, the more likely the kidney is to work immediately and the better the long-term outcome. The factors which determine CIT include a) transportation of the kidney from the retrieval hospital to the hospital where the transplant is performed, b) the need to tissue type the donor and cross-match the donor and potential recipients, c) the occasional necessity of moving the kidney to another hospital if a transplant cannot go ahead, d) contacting and preparing the recipient for the transplant and e) access to the operating theatre. Median CITs are shown in addition to inter-quartile ranges in Table 5.11.
Table 5.11 Median cold ischaemia time for kidney only transplants in the UK, 1 April 2011 - 31 March 2012 Number of kidney 1 only transplants Adult DBD donors DCD donors Total Paediatric DBD donors TOTAL
1 2

Median (hours) 14.7 13.4 14.1 13.7 14.1

Inter-quartile range Q1 Q3 11.7 10.5 11.2 12.0 11.3

2

874 627 1501 64 1565

18.0 16.5 17.5 16.3 17.4

Not all cold ischaemia times are reported 25% of times are shorter than Q1, 25% are larger than Q3

- 35 -

5.5

Demographic characteristics

The age group, sex, ethnicity and blood group of deceased donors, transplant recipients and patients on the transplant list are shown in Table 5.12. Note that all percentages quoted are based only on data where relevant information was available. Ten percent of donors and seven percent of transplant list patients are aged at least 70 years. There are differences in ethnicity of deceased donors, transplant recipients and patients listed for transplant. Changes made to the Kidney Allocation Scheme in 2006 mean that tissue matching criteria between donor and recipient are less strict than previously and waiting time to transplant is now more important than it was in deciding kidney allocation. These changes have an indirect benefit for patients from ethnic minority groups, who are less often a good tissue match with the predominantly white donor pool. As a result, access to transplantation is becoming more equitable.
Table 5.12 Demographic characteristics of deceased kidney donors and transplant recipients 1 April 2011 - 31 March 2012, and transplant list patients at 31 March Donors N Age group(years) 0 - 17 18 - 34 35 - 49 50 - 59 60 - 69 70+ Mean (SD) Sex Male Female Ethnicity White Asian Black Chinese Other Not reported Blood group O A B AB TOTAL 43 147 247 257 233 104 50 524 507 988 15 11 2 15 (%) (4) (14) (24) (25) (23) (10) (17) (51) (49) (96) (1) (1) (0) (1) (46) (41) (9) (4) (100) Transplant recipients N 70 229 565 430 387 111 49 1121 671 1425 215 109 19 24 (%) (4) (13) (32) (24) (22) (6) (15) (63) (37) (80) (12) (6) (1) (1) (42) (40) (12) (6) (100) Active transplant list patients N (%) 88 738 1968 1757 1595 487 51 3900 2733 4673 1114 629 90 93 34 3412 2054 999 168 6633 (1) (11) (30) (26) (24) (7) (14) (59) (41) (71) (17) (9) (1) (1)

476 422 95 38 1031

757 717 212 106 1792

(51) (31) (15) (3) (100)

- 36 -

6

Pancreas Activity

Pancreas Activity
Key messages
• •

A new National Pancreas Allocation Scheme was introduced on 1 December 2010 The number of patients waiting on the pancreas transplant list fell by 21% during the year, to 253 at 31 March 2012 The number of pancreas donors after brain death fell by 4% to 324, while transplants from donors after brain death increased by 8% to 188 The number of pancreas donors after circulatory death increased by 23% to 86, while transplants from donors after circulatory death increased by 42% to 51 30 islet transplants were made possible by the pancreas islet transplant programme

- 37 -

6.1

Overview

The number of patients registered on the active transplant list at 31 March for a pancreas only or simultaneous kidney/pancreas (SPK) transplant has increased significantly over the last ten years from 90 patients in 2003 to 253 patients in 2012. The number of pancreas donors and transplants has also increased steadily from 92 donors resulting in 59 transplants in 2002-2003, to 410 donors and 239 transplants in 2011-2012, although the actual number of transplants is less than in 2007-2008. A summary of activity for deceased donor pancreas transplants and the transplant list for 1 April 2002 - 31 March 2012 is shown in Figure 6.1. A new National Pancreas Allocation Scheme was introduced on 1 December 2010. Patients are now prioritised according to a points system based on a range of clinical factors. A score is calculated for every potentially suitable patient on the national active transplant list and the pancreas is allocated preferentially to the patient with the most points. This differs from the previous system in which donor organs were allocated to transplant centres to select recipients rather than identifying specific patients directly. Pancreases from donors after brain death and donors after circulatory death are allocated through this scheme. Patients listed for a vascularised pancreas or islet transplant are prioritised through one combined national transplant list. The new scheme aims to reduce the incidence of long waiting patients and to improve equity in access to transplant irrespective of where in the UK each patient resides. Throughout this chapter, intestinal transplants involving a pancreas are not included in the pancreas transplant activity reported. Any pancreases retrieved and used for such transplants are however included in the pancreas donor activity. In 2011/2012 there were 10 intestinal transplants.
Figure 6.1
450 406 400 Donors Transplants Transplant list 305 300 293 253 216 245 204 200 210 239 380 386 410

Deceased pancreas and islet programme in the UK, 1 April 2002 - 31 March 2012 Number of donors, transplants and patients on the active transplant list at 31 March

350

335

322

Number

250

239 206 192 175 145 127

200

150 118 100 92 90 91 98

132

86 59

50

59

0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Year

- 38 -

6.2

Transplant list

Table 6.1 shows the number of patients on the active transplant lists at 31 March 2012 by centre. The number of patients registered on the pancreas transplant list decreased by 21% in the year: on 31 March 2012, 253 patients were registered active, compared with 322 at the end of March 2011 Of the 253 patients on the active transplant list at 31 March 2012, 193 (76%) required a SPK transplant (250 at 31 March 2011), 35 (14%) patients required a pancreas only transplant (48 at 31 March 2011) and 24 (9%) were registered for a pancreas islet transplant. The outcome of patients registered on the UK pancreas transplant list at 1 April 2011, or subsequently registered during the financial year, is shown in Table 6.2. 64 patients joined the pancreas transplant list while 189 joined the list for kidney and pancreas. Patients listed for a routine islet transplant are generally waiting for their first islet graft. The majority of islet transplant recipients are likely to require more than one graft to complete their treatment. To optimise transplant outcome the follow-up graft should be performed within six to twelve months of the first. Patients requiring follow-up grafts are priority listed.
Table 6.1 Patients on the pancreas transplant lists at 31 March 2012 (2011) in the UK, by centre Kidney/pancreas 13 2 21 27 46 10 65 0 9 193 (11) (6) (35) (22) (56) (6) (101) (0) (13) (250) Active transplant lists Pancreas alone Islet Routine 1 5 0 6 4 1 15 0 4 36
1

Centre Cambridge Cardiff Edinburgh Guy’s Manchester Newcastle Oxford Royal Free WLRTC TOTAL

TOTAL Priority 0 0 3 0 0 3 1 3 0 10 (0) (0) (1) (0) (0) (2) (0) (0) (0) (3) 14 7 24 33 54 16 85 7 13 253 (11) (7) (38) (25) (60) (17) (130) (3) (31) (322)

(0) (1) (0) (3) (2) (3) (21) (0) (18) (48)

0 0 0 0 4 2 4 4 0 14

(0) (0) (2) (0) (2) (6) (8) (3) (0) (21)

WLRTC – West London Renal and Transplant Centre 1 Includes one patient waiting for a liver and pancreas transplant

- 39 -

Table 6.2

Pancreas transplant list and new registrations in the UK, 1 April 2010 - 31 March 2011 Active and suspended patients at 1 April 2010 N % 98 24 2 20 2 144 183 158 17 15 373 68 17 14 1 New registrations 1 in 2010-2011 N 38 19 3 5 2 64 155 32 1 1 189 % 59 30 8 3 TOTAL

Outcome of patient at 31 March 2011

N 136 43 25 4 208 338 190 18 16 562

% 65 21 12 2

Pancreas transplant list Remained active/suspended Transplanted Removed Died TOTAL Kidney/pancreas transplant list Remained active/suspended Transplanted Removed Died TOTAL
1 2 3

49 42 5 4

82 17 1 1

60 34 3 3

Includes re-registrations for second or subsequent transplants Includes 6 registration removed from pancreas list but active on kidney/pancreas list Includes 2 registration removed from pancreas list but active on kidney/pancreas list

An indication of longer term outcomes for patients listed for a pancreas or kidney/pancreas transplant are summarised in Figure 6.2. This shows the proportion of patients transplanted or still waiting six months, one year, two years and three years after joining the list. It also shows the proportion removed from the transplant list (typically because they become too unwell for transplant) and those dying while on the transplant list. 43% of patients are transplanted within one year, while three years after listing 75% of patients have received a transplant. The median (average) waiting time for a pancreas transplant is 278 days and is shown by blood group in Table 6.3 and ethnicity in Table 6.4. Note that these waiting times are not adjusted for other relevant factors which may be influential and which may differ across blood or ethnic groups.

- 40 -

Figure 6.2
100

Post-registration outcome for 367 new pancreas only and kidney/pancreas registrations made in the UK, 1 April 2008 - 31 March 2009

2 1

3 2

6 5

8 7 10

80

29
Percentage

67
60

52
Died Removed Still waiting Transplanted

40

75 60

20

43 31

0 6 months 1 year Time since listing 2 years 3 years

Table 6.3 Blood group Adult O A B AB TOTAL

Median waiting time to pancreas only and kidney/pancreas transplant in the UK, for patients registered 1 April 2006 - 31 March 2010 Number of patients registered 571 537 114 31 1253 Median 344 241 267 86 278 Waiting time (days) 95% Confidence interval 297 - 391 203 - 279 142 - 392 25 - 147 247 - 309

Table 6.4 Ethnicity Adult White Asian Black Other TOTAL

Median waiting time to pancreas only and kidney/pancreas transplant in the UK, for patients registered 1 April 2006 - 31 March 2010 Number of patients registered 1166 54 18 15 1253 Median 277 400 105 269 278 Waiting time (days) 95% Confidence interval 244 - 310 256 - 544 62 - 148 0 - 653 247 - 309

- 41 -

6.3

Donor and organ supply

Of the 652 organ donors after brain death in the UK in 2011-2012, 324 (50%) donated a pancreas. There were 86 pancreas donors after circulatory death in 2011-2012. Table 6.5 shows this activity by country/Strategic Health Authority of the donor’s residence. No adjustments have been made for potential demographic differences in populations. The overall rate for pancreas donors after brain death is 5.2 pmp, with rates ranging from 3.8 to 9.2 pmp across the Strategic Health Authorities and for donors after circulatory death is 1.4 pmp, with rates ranging from 0.6 to 2.7 pmp across the Strategic Health Authorities.
Table 6.5 Pancreas donation rates for deceased donors in the UK, 1 1 April 2011 - 31 March 2012, by country/Strategic Health Authority DBD 24 28 21 73 17 25 30 72 44 31 18 24 73 262 0 0 16 28 18 324 (9.2) (4.0) (4.0) (4.9) (3.8) (4.6) (5.1) (4.6) (5.6) (7.1) (4.3) (4.6) (5.3) (5.0) (0.0) (0.0) (5.3) (5.4) (10.0) (5.2) Pancreas donors (pmp) DCD 2 8 3 13 8 6 11 25 10 5 5 14 24 72 0 0 6 7 1 86 (0.8) (1.2) (0.6) (0.9) (1.8) (1.1) (1.9) (1.6) (1.3) (1.1) (1.2) (2.7) (1.7) (1.4) (0.0) (0.0) (2.0) (1.3) (0.6) (1.4) 26 36 24 86 25 31 41 97 54 36 23 38 97 334 0 0 22 35 19 410 TOTAL (10.0) (5.2) (4.5) (5.8) (5.6) (5.7) (7.0) (6.2) (6.9) (8.2) (5.6) (7.2) (7.0) (6.4) (0.0) (0.0) (7.3) (6.7) (10.6) (6.6)

Country/Strategic Health Authority of residence North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1

Includes 9 donors where the hospital postcode was used in place of an unknown donor postcode

- 42 -

6.4

Transplants

The number of pancreas transplants by recipient country of residence/Strategic Health Authority is shown in Table 6.6. No adjustments have been made for potential demographic differences in populations. For donors after brain death the transplant rate ranged from 1.3 to 4.8 pmp across Strategic Health Authorities and overall was 3.0 pmp. For donors after circulatory death the overall rate was 0.8 pmp and ranged from 0.3 to 1.2 pmp across Strategic Health Authorities.
Table 6.6 Pancreas transplant rates per million population (pmp), in the UK, 1 April 2011 31 March 2012, by country/Strategic Health Authority DBD N 12 14 9 35 6 22 13 41 25 9 20 25 54 155 0 0 11 19 3 188 (pmp) (4.6) (2.0) (1.7) (2.4) (1.3) (4.0) (2.2) (2.6) (3.2) (2.1) (4.8) (4.7) (3.9) (3.0) (0.0) (0.0) (3.7) (3.6) (1.7) (3.0) N 1 2 3 6 3 6 7 16 7 5 3 5 13 42 1 0 5 3 0 51 DCD (pmp) (0.4) (0.3) (0.6) (0.4) (0.7) (1.1) (1.2) (1.0) (0.9) (1.1) (0.7) (0.9) (0.9) (0.8) (12.5) (0.0) (1.7) (0.6) (0.0) (0.8) N 13 16 12 41 9 28 20 57 32 14 23 30 67 197 1 0 16 22 3 239 TOTAL (pmp) (5.0) (2.3) (2.3) (2.8) (2.0) (5.1) (3.4) (3.6) (4.1) (3.2) (5.6) (5.7) (4.9) (3.8) (12.5) (0.0) (5.3) (4.2) (1.7) (3.8)

Country/Strategic Health Authority of residence North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL

There were 239 deceased donor pancreas transplants in 2011-2012 representing an increase of 14% on the 210 transplants performed in 2010-2011. Of these 239, 173 (72%) were SPK transplants, 36 (15%) were pancreas only transplants (pancreas transplants alone (PTA) or pancreas after kidney (PAK)) and 30 (13%) were islet transplants. The number of transplants performed at each centre is shown in Table 6.7 by transplant type and Table 6.8 by donor type. Note that King’s College and The Royal Free only perform islet transplants.

- 43 -

The length of time that elapses between a pancreas being removed from the donor to its transplantation into the recipient is called the Cold Ischaemia Time (CIT). Generally, the shorter this time, the more likely the pancreas is to work immediately and the better the long-term outcome. The median CIT for a DBD donor transplant is 11.9 hours (Inter-Quartile (IQ) range 9.9 - 13.6) and for a DCD donor transplant is 10.8 hours (IQ range 9.0 - 13.1) and overall is 11.8 hours (IQ range 9.6 - 13.4). At 31 March 2012, there were approximately 1,500 recipients with a functioning pancreas transplant (including multi-organ transplants) being followed-up, as reported to the UK Transplant Registry.
Table 6.7 Centre Cambridge Cardiff Edinburgh Guy’s King's College Manchester Newcastle Oxford Royal Free WLRTC TOTAL Pancreas transplants, 1 April 2011 - 31 March 2012 (2010-2011), by centre SPK 16 8 17 23 27 2 70 10 173 (24) (10) (6) (19) (20) (4) (63) (9) (155) PTA 0 4 0 2 1 0 15 0 22 (1) (1) (1) (1) (1) (2) (16) (0) (23) Transplant type PAK Routine 0 1 0 1 0 3 3 6 14 (1) (3) (0) (4) (4) (0) (4) (3) (19) 5 1 2 5 5 3 21 (-) (-) (1) (-) (1) (0) (2) (2) (2) (-) (8) Islet Priority 3 0 0 5 1 0 9 (-) (-) (0) (-) (1) (1) (0) (2) (1) (-) (5)

WLRTC - West London Renal and Transplant Centre

Table 6.8 Centre

Pancreas transplants, 1 April 2011 - 31 March 2012 by centre SPK DBD DCD 8 3 1 9 6 0 8 0 35 Transplant and donor type PTA Islet DBD DCD DBD DCD 0 2 0 2 1 3 10 5 23 0 3 0 1 0 0 8 1 13 6 1 2 9 6 3 27 2 0 0 1 0 0 3 TOTAL DBD DCD 8 7 22 16 1 24 14 78 3 15 188 8 6 3 10 0 6 1 16 0 1 51

Cambridge Cardiff Edinburgh Guy’s King's College Manchester Newcastle Oxford Royal Free WLRTC TOTAL

8 5 16 14 21 2 62 10 138

WLRTC - West London Renal and Transplant Centre

- 44 -

6.5

Demographic characteristics

The age group, sex, ethnicity and blood group of deceased donors, transplant recipients and patients on the transplant list is shown in Table 6.9.
Table 6.9 Demographic characteristics of deceased pancreas donors and transplant recipients, 1 April 2011 - 31 March 2012, and transplant list patients at 31 March Donors N Age group (years) 0 - 17 18 - 34 35 - 49 50 - 59 60 - 69 70+ Mean (SD) Sex Male Female Ethnicity White Asian Black Chinese Other Not reported Blood group O A B AB TOTAL 29 103 144 119 15 0 40 194 216 384 9 5 1 11 (%) (7) (25) (35) (29) (4) (0) (14) (47) (53) (94) (2) (1) (0) (3) Transplant recipients N 0 47 133 50 7 2 43 130 109 217 16 4 0 2 (%) (0) (20) (56) (21) (3) (1) (9) (54) (46) (91) (7) (2) (0) (1) Active transplant list patients N (%) 45 151 52 5 0 43 45 142 111 230 14 7 1 0 1 141 91 20 1 253 (18) (60) (21) (2) (0) (8) (18) (56) (44) (91) (6) (3) (0) (0) (56) (36) (8) (0) (100)

198 167 38 7 410

(48) (41) (9) (2) (100)

106 99 26 8 239

(44) (41) (11) (3) (100)

- 45 -

7

Cardiothoracic Activity

Cardiothoracic Activity
Key messages

At 31 March 2012, there were 169 patients on the active heart transplant list, 216 on the lung list and 16 on the heart/lung list Of the 652 organ donors after brain death, 235 (36%) were cardiothoracic organ donors The number of heart transplants from deceased donors increased by 5% to 138 this year; over half of these were urgent heart transplants The number of lung or heart/lung transplants from deceased donors increased by 5% to 180

- 46 -

7.1

Overview

Last year the number of heart transplants increased by 5% to 138 and the number of lung or heart/lung transplants increased by 5% to 180. There were increases in both the heart and the lung transplant lists since March 2011. The number of patients registered on the active heart transplant list at year end has increased by 52% since 2003, while the number of patients registered for a lung or heart/lung transplant has decreased by 30% since 2003. A summary of the deceased donor cardiothoracic activity from 1 April 2002 to 31 March 2012 is shown in Figure 7.1 for heart activity and Figure 7.2 for lung activity. Donors who donate both heart and lung(s) are included in both figures, but heart/lung block transplants and patients active on the transplant list for a heart/lung block are only included in Figure 7.2.
Figure 7.1
200 180 160 140 120 158 148 180 165 166 154 140141 127128 132130 126 120 115 130 126 131 136 138 157156 Donors Transplants Transplant list

Deceased donor heart programme in the UK, 1 April 2002 - 31 March 2012 Number of donors, transplants and patients on the active transplant list at 31 March

169

Number

100 80 60 40 20 0

111

105

106

110 95 88 93

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

2011-2012

Year

Figure 7.2
350

Deceased donor lung and heart/lung programme in the UK, 1 April 2002 - 31 March 2012 Number of donors, transplants and patients on the active transplant list at 31 March
Donors Transplants Transplant list 309 291 305 291 287 266 232 192 180

331 300

250 229

Number

200 159156 150 135139 169 150 135 141 123 100 141136 146 135 122 164 151

225 188 172

50

0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 Year 2008-2009 2009-2010 2010-2011 2011-2012

- 47 -

7.2

Transplant list

Table 7.1 shows the number of patients on the active transplant lists at 31 March 2012 by centre. The lung transplant list accounts for 54% of the patients waiting for a cardiothoracic transplant. Overall, Newcastle and Harefield have the largest cardiothoracic transplant lists. During 2011-2012, 257 patients joined the heart transplant list while 9 joined the heart/lung list and 250 joined the lung transplant list. Outcomes for patients on the list at 1 April 2011 and those joining the list during the year are shown in Table 7.2. An indication of longer term outcomes for adult patients listed for a cardiothoracic organ transplant is summarised in Figure 7.3 and Figure 7.4. This shows the proportion of patients transplanted or still waiting six months, one year, two years and three years after joining the non-urgent heart list or the lung list, respectively. It also shows the proportion removed from the transplant list and those dying while on the transplant list. Within six months of listing, 42% of non-urgent heart patients are transplanted while 9% have died while waiting. For patients listed for a lung transplant, only 32% are transplanted within six months, rising to 58% after three years. The patients removed from these lists may also subsequently have died.
Table 7.1 Patients on the cardiothoracic transplant lists at 31 March 2012 (2011) in the UK, by centre Heart Non-urgent Urgent Active transplant lists Heart/lung Lung TOTAL

Centre Adult Birmingham Glasgow Great Ormond Street Harefield Manchester Newcastle Papworth TOTAL Paediatric Great Ormond Street Newcastle TOTAL

7 8 1 39 16 33 42 146

(8) (6) (2) (30) (10) (22) (30) (108)

0 1 0 3 1 2 2 9

(2) (0) (0) (0) (1) (1) (1) (5)

2 0 0 2 0 3 6 13

(2) (0) (0) (2) (0) (1) (6) (11)

16 0 0 66 24 74 23 203

(20) (0) (0) (57) (34) (62) (27) (200)

25 9 1 110 41 112 73 371

(32) (6) (2) (89) (45) (86) (64) (324)

7 1 8

(7) (1) (8)

3 3 6

(3) (6) (9)

3 0 3

(2) (0) (2)

12 1 13

(10) (2) (12)

25 5 30

(22) (9) (31)

- 48 -

Table 7.2

Cardiothoracic transplant lists and new registrations in the UK, 1 April 2011 - 31 March 2012 Active and suspended patients at 1 April 2011 N % 63 37 27 11 138 9 1 4 2 16 73 86 18 30 207 46 27 20 8 New registrations in 1 2011-2012 N 110 98 32 17 257 6 2 1 0 9 141 88 1 20 250 % 43 38 12 7 TOTAL N 173 135 59 28 395 15 3 5 2 25 214 174 19 50 457 % 44 34 15 7

Outcome of patient at 31 March 2012 Heart transplant list Remained active/suspended Transplanted Removed Died TOTAL Heart/lung transplant list Remained active/suspended 2 Transplanted Removed Died TOTAL Lung transplant list Remained active/suspended Transplanted Removed Died TOTAL
1 2

64 7 29 14

55 18 9 0

60 12 20 8

35 42 9 14

56 35 0 8

47 38 4 11

Includes re-registrations for second or subsequent transplants Heart, lung or heart/lung

Figure 7.3
100

Post-registration outcome for 113 new non-urgent heart only registrations made in the UK, 1 April 2008 - 31 March 2009

9 13
80

10 20

11

13

24 29
Died Removed Still waiting Transplanted

Percentage

60

36

26

16

6

40

20

42

44

49

51

0 6 months 1 year Time since listing 2 years 3 years

- 49 -

Figure 7.4
100

Post-registration outcome for 196 new lung only registrations made in the UK, 1 April 2008 - 31 March 2009

10 6
80

17 8

20 9 18

23

11 8
Died Removed Still waiting Transplanted

Percentage

60

52

35

40

53
20

58

32

40

0 6 months 1 year Time since listing 2 years 3 years

Table 7.3 and 7.4 show the median waiting time to cardiothoracic transplant by blood group and ethnicity, respectively, for patients registered between April 2007 and March 2010. Median waiting time for adult non-urgent heart patients is 253 days overall, compared with 412 days for adult lung patients. The median waiting time for paediatric non-urgent heart patients is 94 days; this is not broken down by blood group or ethnicity due to low numbers. Paediatric recipients are aged less than 16 years at time of listing. Note that these waiting times are not adjusted for other relevant factors which may be influential and which may differ across blood or ethnic groups.

- 50 -

Table 7.3 Blood group

Median waiting time to cardiothoracic transplant in the UK, for patients registered 1 April 2007 - 31 March 2010 Number of patients registered 120 115 31 10 276 58 302 238 64 24 628 Median 741 147 293 148 253 94 548 257 591 126 412 Waiting time (days) 95% Confidence interval 83 - 211 0 - 693 17 - 279 145 - 361 40 - 148 469 - 627 198 - 316 349 - 833 21 - 231 343 - 481

Adult non-urgent heart 1 O A B AB TOTAL Paediatric non-urgent heart Adult lung O A B AB TOTAL
1

Unable to estimate 95% confidence interval

Table 7.4 Ethnicity

Median waiting time to cardiothoracic transplant in the UK, for patients registered 1 April 2007 - 31 March 2010 Number of patients registered 245 13 11 7 276 58 609 9 7 3 628 Median 249 387 253 94 402 412 Waiting time (days) 95% Confidence interval 138 - 360 0 - 844 145 - 361 40 - 148 334 - 470 343 - 481

Adult non-urgent heart White Asian Black Other TOTAL Paediatric non-urgent Adult lung White Asian Black Other TOTAL

Median waiting time not reported for fewer than 10 patients

- 51 -

Table 7.5

Cardiothoracic organ donors in the UK, 1 April 2011 - 31 March 2012 (2010-2011), by age group and retrieval centre Heart only Type of cardiothoracic donor Heart & lung DBD Lung(s) only DCD TOTAL

Allocation zone of donor hospital Adult Birmingham Glasgow Harefield Manchester Newcastle Papworth TOTAL Paediatric Birmingham Glasgow Harefield Manchester Newcastle Papworth TOTAL

13 1 9 9 9 18 59
1

(14) (5) (7) (5) (12) (13) (56)

15 3 5 6 14 26 69

(9) (5) (8) (7) (11) (14) (54)

15 6 23 17 24 13 98

(10) (10) (29) (8) (19) (24) (100)

8 2 2 2 2 5 21

(6) (1) (8) (2) (5) (4) (26)

51 12 39 34 49 62 247

(39) (21) (52) (22) (47) (55) (236)

1 1 2 2 0 3 9

(0) (3) (1) (1) (1) (3) (9)

1 1 0 0 0 0 2

(0) (1) (1) (0) (1) (4) (7)

1 0 0 0 0 0 1

(0) (0) (0) (0) (1) (0) (1)

0 0 0 0 0 1 1

(0) (0) (0) (0) (0) (0) (0)

3 2 2 2 0 4 13

(0) (4) (2) (1) (3) (7) (17)

Paediatric donors are aged 15 years or under 1 Includes 3 domino heart donors

- 52 -

7.3

Donor and organ supply

The number of cardiothoracic organ donors classified by allocation zone of the donor hospital is summarised in Table 7.5. The numbers reflect the number of organs retrieved from within each zone (by any retrieval team) rather than the number of retrievals made by that centre. 21 of the 119 adult lung only donors were donors after circulatory death. There were three domino heart donors. Of the 226 adult cardiothoracic donors after brain death, 26% donated only the heart, 31% heart and lung and 43% lung only. Of the 12 paediatric cardiothoracic donors after brain death, 75% donated only the heart, 17% heart and lung and 8% lung only. Table 7.6 shows the number of organ donors after brain death identified in each allocation zone, the number that donated cardiothoracic organs and the number of organs retrieved. Of the 652 solid organ donors after brain death, 36% donated cardiothoracic organs. Overall, 97% of the 460 organs retrieved were transplanted: 100% of hearts and 96% of lungs.
Table 7.6 Allocation zone of donor hospital Birmingham Glasgow Harefield Manchester 1 Newcastle Papworth TOTAL
1

Cardiothoracic organ donation and retrieval rates from donors after brain death in the UK, 1 April 2011 - 31 March 2012, by allocation zone Number of donors DBD solid organ 103 53 130 80 117 169 652 Cardiothoracic 46 12 39 34 47 57 235 Number of organs retrieved (used) Hearts Lungs 30 6 16 17 23 44 136 (30) (6) (16) (17) (23) (44) (136) 61 18 56 41 73 75 324 (57) (17) (54) (41) (68) (73) (310) TOTAL retrieved (used) 91 24 72 58 96 119 460 (87) (23) (70) (58) (91) (117) (446)

Newcastle transplant adult and paediatric patients

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The rates per million population for cardiothoracic donors are shown in Table 7.7 by donor country/Strategic Health Authority of residence. No adjustments have been made for potential demographic differences in populations. The overall cardiothoracic donor rate was 4.1 pmp in 2011-2012 and varied across the Strategic Health Authorities from 1.8 pmp to 6.9 pmp.
Table 7.7 Cardiothoracic donor rates for deceased donors in the UK, 1 1 April 2011 - 31 March 2012, by country/Strategic Health Authority Heart donors (pmp) DBD 8 14 10 32 4 11 19 34 17 11 3 12 26 109 2 0 12 7 6 136 (3.1) (2.0) (1.9) (2.2) (0.9) (2.0) (3.3) (2.2) (2.2) (2.5) (0.7) (2.3) (1.9) (2.1) (25.0) (0.0) (4.0) (1.3) (3.3) (2.2) 15 19 13 47 5 17 9 31 20 18 9 13 40 138 1 0 9 12 10 170 Lung donors (pmp) DBD (5.7) (2.7) (2.5) (3.2) (1.1) (3.1) (1.5) (2.0) (2.6) (4.1) (2.2) (2.5) (2.9) (2.6) (12.5) (0.0) (3.0) (2.3) (5.6) (2.7) 1 0 1 2 2 2 2 6 1 1 0 7 8 17 0 0 2 2 1 22 DCD (0.4) (0.0) (0.2) (0.1) (0.4) (0.4) (0.3) (0.4) (0.1) (0.2) (1.3) (0.6) (0.3) (0.0) (0.0) (0.7) (0.4) (0.6) (0.4) 18 27 19 64 8 24 23 55 30 22 10 25 57 206 2 0 18 16 15 257 (6.9) (3.9) (3.6) (4.3) (1.8) (4.4) (3.9) (3.5) (3.8) (5.0) (2.4) (4.7) (4.1) (3.9) (25.0) (0.0) (6.0) (3.1) (8.3) (4.1) Total (pmp)

Country/ Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1

Includes 5 donors where the hospital postcode was used in place of an unknown donor postcode

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7.4

Transplants

The number of cardiothoracic transplants by recipient country/Strategic Health Authority of residence are shown in Table 7.8. No adjustments have been made for potential demographic differences in populations. The transplant rate ranged from 3.0 to 8.0 pmp across regions and overall was 5.0 pmp.
Table 7.8 Cardiothoracic transplant rates per million population (pmp) in the UK, 1 April 2011 - 31 March 2012, by country/Strategic Health Authority Heart (pmp) DBD 9 19 6 34 12 21 13 46 9 7 7 10 24 113 0 0 8 13 4 138
2,3

Country/ Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1 2 3

Lungs (pmp) DBD DCD 12 19 10 41 13 17 17 47 19 14 4 8 26 133 0 1 10 8 3 155 (4.6) (2.7) (1.9) (2.8) (2.9) (3.1) (2.9) (3.0) (2.4) (3.2) (1.0) (1.5) (1.9) (2.5) (0.0) (6.7) (3.3) (1.5) (1.7) (2.5) 0 1 0 1 1 1 3 5 3 1 2 3 6 15 0 0 5 0 0 20 (0.0) (0.1) (0.0) (0.1) (0.2) (0.2) (0.5) (0.3) (0.4) (0.2) (0.5) (0.6) (0.4) (0.3) (0.0) (0.0) (1.7) (0.0) (0.0) (0.3)

Total (pmp) 21 39 16 76 26 39 33 98 31 22 13 21 56 261 0 1 23 21 7 313 (8.0) (5.6) (3.0) (5.1) (5.8) (7.1) (5.7) (6.2) (4.0) (5.0) (3.1) (4.0) (4.1) (5.0) (0.0) (6.7) (7.6) (4.0) (3.9) (5.0)

(3.4) (2.7) (1.1) (2.3) (2.7) (3.8) (2.2) (2.9) (1.1) (1.6) (1.7) (1.9) (1.7) (2.2) (0.0) (0.0) (2.7) (2.5) (2.2) (2.2)

1

Excludes 7 recipients who reside outside of the UK (2 DBD heart, 4 DBD lung, 1 DCD lung) Excludes 1 recipient where the postcode was unknown Includes 3 domino donor transplants

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Table 7.9 shows cardiothoracic transplant activity for each centre. In 2011-2012, a total of 321 transplants were carried out, an increase of 6% on 2010-2011. Of these, 43% were deceased donor heart transplants. The 171 adult lung transplants include 21 (12%) from donors after circulatory death: 12 were performed by Harefield, 2 by Newcastle, 4 by Manchester and 3 by Papworth. Lung transplants include the small number of heart/lung transplants performed.
Table 7.9 Cardiothoracic transplants, 1 April 2011 - 31 March 2012 (2010-2011), by age group and centre Heart Non-urgent Urgent Adult Birmingham Glasgow Great Ormond Street Harefield Manchester Newcastle Papworth TOTAL Paediatric Great Ormond Street Newcastle TOTAL 5 1 6 (2) (4) (6) 13 14 27 (16) (17) (33) 0 0 0 (0) (0) (0) 3 1 4 (3) (1) (4) 0 0 0 (0) (0) (0) 21 16 37 (21) (22) (43) 12 5 1 3 6 8 12 47
1

Transplant centre

Transplant type Heart/ lung

TOTAL Lung(s) DBD DCD

(12) (5) (1) (3) (5) (6) (9) (41)

10 4 0 6 12 9 20 61

(9) (4) (0) (6) (7) (10) (15) (51)

0 0 0 0 0 0 5 5

(0) (0) (0) (0) (0) (1) (2) (3)

15 0 1 39 22 43 30 150

(11) (0) (2) (47) (20) (36) (27) (143)

0 0 0 12 4 2 3 21

(0) (0) (0) (11) (1) (7) (3) (22)

37 9 2 60 44 62 70 284

(32) (9) (3) (67) (33) (60) (56) (260)

Paediatric recipients are aged under 16 years at time of transplant 1 Includes 3 domino donor transplants

There were 61 adult urgent heart transplants in 2011-2012, representing 56% of all adult heart transplants (53% in 2010-2011). There were 27 paediatric urgent heart transplants in 20112012, representing 82% of all paediatric heart transplants (85% in 2010-2011). A small number of hearts and lungs were imported from outside the UK for transplantation in the UK: 4 hearts from the Republic of Ireland (ROI) and 7 from elsewhere, 1 lung from ROI. The length of time that elapses between cardiothoracic organs being removed from the donor to its transplantation into the recipient is called the Cold Ischaemia Time (CIT). Generally, the shorter this time, the more likely the organ is to work immediately and the better the long-term outcome. The median CIT for a heart transplant is 3.0 hours (Inter-Quartile (IQ) range 2.5 – 3.6). The median CIT for a DBD donor lung transplant is 4.9 hours (IQ range 4.0 – 5.8) and for a DCD donor lung transplant is 5.7 hours (IQ range 4.6 – 7.2) and overall is 5.1 hours (IQ range 4.2 – 6.0). At 31 March 2012 there were approximately 3,700 recipients with a functioning cardiothoracic organ transplant being followed-up as reported to the UK Transplant Registry.

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7.5

Demographic characteristics

The age group, sex, ethnicity and blood group of deceased donors, transplant recipients and patients on the transplant list is shown in Table 7.10.
Table 7.10 Demographic characteristics of cardiothoracic donors and transplant recipients, 1 April 2011 - 31 March 2012, and transplant list patients at 31 March in the UK Donors N Age group (years) 0 - 17 18 - 34 35 - 49 50 - 59 60 - 69 Mean (SD) Sex Male Female Ethnicity White Asian Black Chinese Other Not reported Blood group O A B AB TOTAL
1 2

Transplant recipients (%) (7) (25) (35) (27) (5) (15) (45) (55) (93) (2) (2) (1) (2) N 43 59 74 88 57 42 179 142 299 15 4 0 3 (%) (13) (18) (23) (27) (18) (18) (56) (44) (93) (5) (1) (0) (1)

Active transplant list patients N (%) 36 86 101 119 59 42 225 176 371 15 8 2 5 (9) (21) (25) (30) (15) (17) (56) (44) (93) (4) (2) (0) (1)

17 66 92 71 14 40 117 143 241 5 4 2 6 2 132 90 31 7 260
1

(51) (35) (12) (3) (100)

143 116 46 16 321
2

(45) (36) (14) (5) (100)

234 122 36 9 401

(58) (30) (9) (2) (100)

Includes 3 domino heart donors Includes 3 domino donor transplants

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8

Liver Activity

Liver Activity
Key messages

The number of patients on the active liver transplant list at 31 March 2012 was 553, an increase of 8% from 2011 The number of liver donors after brain death increased by 7% to 604, while transplants from donors after brain death increased by 6% to 607 The number of liver donors after circulatory death increased by 23% to 178, while transplants from donors after circulatory death increased by 32% to 132

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8.1

Overview

The number of deceased liver donors and transplants in the UK in the last ten years is shown in Figure 8.1. Over this period, there has been a steady increase in the number of patients registered on the active transplant list at 31 March and a recent increase in the numbers of donors and transplants.
Figure 8.1
900 Donors Transplants Transplant list 705 688 668 686 782 739 676 637649 636 647 611600 632633 706 657 712 679 675

Deceased donor liver programme in the UK, 1 April 2002 - 31 March 2012 Number of donors, transplants and patients on the active transplant list at 31 March

800

700

600

Number

553 500 510

400 365 300 264 200 175 100 190 314 268 338 371

0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Year

Intestinal transplants that used a liver are not included in the liver transplant activity reported. However, any livers retrieved and used for such transplants are included in the liver donor activity. Intestinal transplant activity is reported in Chapter 9. The number of deceased donors, deceased and living donor transplants, and patients on the active transplant list, by centre, is shown in Table 8.1. The numbers of liver donors reflect the number of organs retrieved from within each zone (by any retrieval team) rather than the number of retrievals made by that centre. In 2011-2012, 782 solid organ donors donated their liver for transplant: 604 donors after brain death and 178 donors after circulatory death. There were 553 patients on the active transplant list at 31 March 2012, an increase of 8% from 2011. Overall, the number of liver transplants from donors after brain death increased by 6% to 607, and the number of transplants from donors after circulatory death increased by 32% to 132, compared with the previous financial year. Additionally, there were 38 living liver lobe donor transplants in NHS Group 1 (25) and Group 2 (13) paediatric and adult recipients, and 5 domino donor transplants in NHS Group 1 paediatric and adult recipients. There were 81 adult superurgent transplants in 2011-2012, representing 12% of all deceased donor adult transplants. There were 16 paediatric super-urgent transplants in 2011-2012, representing 20% of all deceased donor paediatric transplants. Patients are prioritised as super-urgent if they require a new liver as soon as possible due to rapid failure of the native organ. Other patients are referred to as elective.

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Table 8.1

Deceased and living liver donors and transplants, 1 April 2011 - 31 March 2012 (2010-2011) and transplant list patients at 31 March 2012 (2011) in the UK, by age group and centre Deceased donors DBD DCD TOTAL DBD Deceased transplants DCD TOTAL Living donor transplants Active transplant list

Allocation zone/transplant centre Adult Birmingham Cambridge Edinburgh King's College Leeds Newcastle Royal Free TOTAL Paediatric Birmingham Cambridge Edinburgh King's College Leeds Newcastle Royal Free TOTAL
1 2 3 4

115 91 85 134 76 34 51 586

(119) (77) (60) (115) (98) (26) (48) (543)

55 20 14 53 17 5 11 175

(38) (20) (10) (49) (13) (3) (7) (140)

170 111 99 187 93 39 62 761

(157) (97) (70) (164) (111) (29) (55) (683)

114 65 86 113 68 36 49 531

(115) (61) (71) (96) (73) (32) (43) (491)

33 21 9 44 7 3 11 128

(28) (15) (9) (31) (9) (3) (3) (98)

147 86 95 157 75 39 60 659

(143) (76) (80) (127) (82) (35) (46) (589)

1 0 1 9 3 0 3 17
1

(1) (0) (1) (6) (3) (0) (1) (12)
2

118 43 55 123 87 33 54 513

(75) (61) (46) (143) (75) (35) (43) (478)

1 2 4 7 4 0 0 18

(2) (3) (6) (5) (2) (4) (2) (24)

0 0 1 2 0 0 0 3

(1) (1) (1) (0) (2) (0) (0) (5)

1 2 5 9 4 0 0 21

(3) (4) (7) (5) (4) (4) (2) (29)

26 0 0 37 13 0 0 76

(35) (0) (0) (35) (14) (0) (0) (84)

1 0 0 3 0 0 0 4

(1) (0) (0) (1) (0) (0) (0) (2)

27 0 0 40 13 0 0 80

(36) (0) (0) (36) (14) (0) (0) (86)

2 0 0 17 7 0 0 26
3

(1) (0) (0) (10) (2) (0) (0) (13)
4

15 0 0 15 10 0 0 40

(7) (0) (0) (20) (5) (0) (0) (32)

Includes 7 and 6 living liver lobe transplants, and 4 and 0 domino transplants in NHS Group 1 and Group 2 recipients, respectively Includes 3 and 5 living liver lobe transplants, and 4 and 0 domino transplants in NHS Group 1 and Group 2 recipients, respectively Includes 18 and 7 living liver lobe transplants, and 1 and 0 domino transplants in NHS Group 1 and Group 2 recipients, respectively Includes 11 and 2 living liver lobe transplants in NHS Group 1 and Group 2 recipients, respectively

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8.2

Transplant list

During 2011-2012, 1,105 patients joined the liver transplant list. Outcomes for patients on the list at 1 April 2011 and those joining the list during the year are shown in Table 8.2.
Table 8.2 Liver transplant list and new registrations in the UK, 1 April 2011 – 31 March 2012 Active and suspended patients at 1 April 2011 N % 137 261 86 38 522 26 50 16 7 New registrations in 1 2011-2012 N 433 530 75 67 1105 % 39 48 7 6 TOTAL

Outcome of patient at 31 March 2012

N 570 791 161 105 1627

% 35 49 10 6

Remained active/suspended Transplanted Removed Died TOTAL
1

Includes re-registrations for second or subsequent transplants

An indication of longer term outcomes for patients listed for a liver transplant is summarised in Figure 8.2. This shows the proportion of patients transplanted or still waiting six months, one year and two years after joining the transplant list. It also shows the proportion removed from the transplant list and those dying while on the transplant list (which includes those patients removed due to deterioration of condition). At one year post-registration, 67% of patients had received a liver transplant while 13% of patients had either died whilst waiting or had been removed due to their condition deteriorating. 6% had been removed for other reasons such as the patient’s condition improving, as a result of non-compliance or at the request of the patient or family.
Figure 8.2
100

Post-registration outcome for 891 new elective liver only registrations made in the UK, 1 April 2008 - 31 March 2009

10 3
80

13 6 14

15 7 5
Died/Removed Removed Still waiting Transplanted
1

31
Percentage
60

40

67 55
20

73

0 6 months
1

1 year Time since listing

2 years

Removals due to condition deteriorating

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Tables 8.3 and 8.4 show the median waiting time to liver transplant for adult and paediatric elective registrations, separately, including a breakdown by blood group and ethnicity for adult elective registrations only. On average, adult patients wait 142 days for a liver transplant while paediatric patients wait an average of 78 days. Note that these waiting times are not adjusted for other relevant factors which may be influential and which may differ across blood or ethnic groups.
Table 8.3 Blood group Adult O A B AB TOTAL Paediatric Median waiting time to liver transplant in the UK, for patients registered 1 April 2007 - 31 March 2010 Number of patients registered 1104 900 316 106 2426 187 Median 184 93 274 76 142 78 Waiting time (days) 95% Confidence interval 164 - 204 83 - 103 214 - 334 51 - 101 132 - 152 60 - 96

Table 8.4 Ethnicity Adult White Asian Black Other TOTAL Paediatric
1

Median waiting time to liver transplant in the UK, for patients registered 1 April 2007 - 31 March 2010 Number of patients registered 2083 216 60 63 1 2426 187 Median 140 143 146 185 142 78 Waiting time (days) 95% Confidence interval 130 - 150 103 - 183 69 - 223 119 - 251 132 - 152 60 - 96

Includes 4 patients with ethnicity not reported

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8.3

Donor and organ supply

Of the 1,088 organ donors, 782 (72%) donated their liver and 689 (88%) of these donated livers were transplanted; see Table 8.5. Of livers retrieved from donors after brain death and donors after circulatory death, 92% and 74% were transplanted, respectively.
Table 8.5 Allocation zone of donor hospital Birmingham Cambridge Edinburgh King's College Leeds Newcastle Royal Free TOTAL Deceased liver retrieval rates in the UK, 1 April 2011 - 31 March 2012, by allocation zone Number of donors All organ donors Liver donors DBD DCD TOTAL DBD DCD TOTAL 125 97 100 146 92 40 52 652 121 67 40 95 68 28 17 436 246 164 140 241 160 68 69 1088 116 93 89 141 80 34 51 604 55 20 15 55 17 5 11 178 171 113 104 196 97 39 62 782 Number of livers retrieved (used) DBD 116 93 89 141 80 34 51 604 (109) (86) (86) (122) (74) (33) (47) (557) DCD 55 20 15 55 17 5 11 178 (39) (14) (13) (39) (14) (5) (8) (132) TOTAL 171 113 104 196 97 39 62 782 (148) (100) (99) (161) (88) (38) (55) (689)

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The rates per million population (pmp) for liver donors are shown in Table 8.6 by donor country/Strategic Health Authority of residence. No adjustments have been made for potential demographic differences in populations. The overall deceased liver donor rate was 12.5 pmp in 2011-2012 and varied across the Strategic Health Authorities from 8.3 pmp to 15.7 pmp.
Table 8.6 Liver donation and retrieval rates in the UK, 1 1 April 2011 - 31 March 2012, by country/Strategic Health Authority DBD 35 56 40 131 28 45 66 139 72 51 47 43 141 483 2 2 36 49 32 604 (13.4) (8.1) (7.5) (8.8) (6.3) (8.2) (11.3) (8.8) (9.2) (11.6) (11.4) (8.2) (10.2) (9.2) (25.0) (13.3) (12.0) (9.4) (17.8) (9.7) Deceased donors (pmp) DCD 6 12 7 25 9 16 15 40 20 12 12 37 61 146 0 0 17 13 2 178 (2.3) (1.7) (1.3) (1.7) (2.0) (2.9) (2.6) (2.5) (2.6) (2.7) (2.9) (7.0) (4.4) (2.8) (0.0) (0.0) (5.6) (2.5) (1.1) (2.8) 41 68 47 156 37 61 81 179 92 63 59 80 202 629 2 2 53 62 34 782 Total (15.7) (9.8) (8.9) (10.5) (8.3) (11.2) (13.9) (11.4) (11.7) (14.4) (14.3) (15.2) (14.6) (12.0) (25.0) (13.3) (17.6) (11.9) (18.9) (12.5)

Country/ Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1

Includes 47 donors where the hospital postcode was used in place of an unknown donor postcode

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8.4

Transplants

The number of liver transplants by recipient country/Strategic Health Authority of residence are shown in Table 8.7. No adjustments have been made for potential demographic differences in populations. The deceased donor transplant rate ranged from 6.7 to 14.2 pmp across the Strategic Health Authorities and overall was 11.5 pmp. The number of whole, reduced and split liver transplants by urgency status of the transplant (elective, super-urgent) in 2011-2012 is shown in Table 8.8. The term 'reduced' is used when only one lobe of the liver is transplanted and the term 'split' applies when both lobes of the liver are transplanted into two different recipients. Overall, the number of deceased donor liver transplants increased by 9% in 2011-2012. There were 739 deceased donor liver transplants performed in 2011-2012: 623 whole liver, including 13 liver and kidney; and 116 deceased donor liver lobe, including 5 liver and kidney. Split liver transplants accounted for 88% of liver lobe transplant activity.
Table 8.7 Liver transplant rates per million population (pmp) in the UK, 1 April 2011 - 31 March 2012, by country/Strategic Health Authority Deceased transplants (pmp) DBD North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1 1

Country/ Strategic Health Authority 32 48 52 132 26 54 46 126 88 24 39 43 106 452 0 1 21 89 25 588

DCD 3 8 4 15 4 14 17 35 23 12 10 15 37 110 0 0 7 9 3 129 (1.1) (1.2) (0.8) (1.0) (0.9) (2.6) (2.9) (2.2) (2.9) (2.7) (2.4) (2.8) (2.7) (2.1) (0.0) (0.0) (2.3) (1.7) (1.7) (2.1) 35 56 56 147 30 68 63 161 111 36 49 58 143 562 0 1 28 98 28 717

Total (13.4) (8.1) (10.6) (9.9) (6.7) (12.5) (10.8) (10.2) (14.2) (8.2) (11.8) (11.0) (10.4) (10.8) (0.0) (6.7) (9.3) (18.8) (15.6) (11.5)

Living transplants (pmp) 0 5 3 8 1 0 2 3 7 1 0 2 3 21 0 0 1 2 0 24 (0.0) (0.7) (0.6) (0.5) (0.2) (0.0) (0.3) (0.2) (0.9) (0.2) (0.0) (0.4) (0.2) (0.4) (0.0) (0.0) (0.3) (0.4) (0.0) (0.4)

(12.3) (6.9) (9.8) (8.9) (5.8) (9.9) (7.9) (8.0) (11.2) (5.5) (9.4) (8.2) (7.7) (8.7) (0.0) (6.7) (7.0) (17.0) (13.9) (9.4)

Excludes 41 recipients who reside outside of the UK (19 DBD, 3 DCD, 19 living)

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Table 8.8 Transplant centre Birmingham Cambridge Edinburgh King's College Leeds Newcastle Royal Free TOTAL

Deceased donor liver transplants performed in the UK, 1 April 2010 - 31 March 2012 Whole liver E SU 104 69 63 103 73 26 36 474 23 4 9 22 7 7 5 77 2010 - 2011 Reduced Split liver liver E SU E SU 2 0 0 6 3 0 0 11 4 0 0 5 3 0 0 12 40 3 8 25 10 2 5 93 6 0 0 2 0 0 0 8 TOTAL E 146 72 71 134 86 28 41 578 SU 33 4 9 29 10 7 5 97 Whole liver E SU 115 69 76 134 64 32 50 540 21 12 11 19 9 4 7 83 2011 - 2012 Reduced Split liver liver E SU E SU 1 0 0 5 0 0 0 6 0 0 0 6 2 0 0 8 36 5 8 31 10 3 3 96 1 0 0 2 3 0 0 6 TOTAL E 152 74 84 170 74 35 53 642 SU 22 12 11 27 14 4 7 97

E=Elective, SU=Super-urgent Birmingham, King's College and Leeds transplant paediatric patients

The length of time that elapses between a liver being removed from the donor to its transplantation into the recipient is called the Cold Ischaemia Time (CIT). Generally, the shorter this time, the more likely the liver is to work immediately and the better the long-term outcome. The median CIT for a DBD donor transplant is 8.9 hours (Inter-Quartile (IQ) range 7.2 – 10.8) and for a DCD donor transplant is 7.2 hours (IQ range 6.3 – 8.2) and overall is 8.5 hours (IQ range 6.9 – 10.5). At 31 March 2012 there were approximately 8,900 recipients with a functioning liver transplant (or multi-organ transplants including the liver) being followed-up as reported to the UK Transplant Registry.

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8.5

Demographic characteristics

The age group, sex, ethnicity and blood group of liver donors, transplant recipients and transplant list patients is shown in Table 8.9.
Table 8.9 Demographic characteristics of deceased liver donors and transplant recipients 1 April 2011 - 31 March 2012, and transplant list patients at 31 March in the UK Donors N Age group (years) 0 - 17 18 - 34 35 - 49 50 - 59 60 - 69 70+ Mean (SD) Sex Male Female Ethnicity White Asian Black Chinese Other Not reported Blood group O A B AB TOTAL 32 124 194 206 163 63 49 378 404 743 14 11 1 13 (%) (4) (16) (25) (26) (21) (8) (17) (48) (52) (95) (2) (1) (0) (2) (46) (39) (11) (4) (100) Transplant recipients N 85 83 156 215 189 11 46 454 285 630 66 23 6 12 2 295 298 98 48 739 (%) (12) (11) (21) (29) (26) (1) (19) (61) (39) (85) (9) (3) (1) (2) (0) (40) (40) (13) (6) (100) Active transplant list patients N (%) 42 48 128 200 130 5 48 344 209 460 58 15 3 17 (8) (9) (23) (36) (24) (1) (16) (62) (38) (83) (10) (3) (1) (3) (54) (29) (15) (2) (100)

360 306 84 32 782

298 160 83 12 553

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9

Intestinal Activity

Intestinal Activity
Key messages

28 patients were registered for an intestinal transplant last year (18 adults, 10 paediatric patients) 22 intestinal transplants were carried out this year (19 last year) On average, patients wait six months for transplant

• •

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9.1

Overview

Over the last two years (between 1 April 2010 and 31 March 2012), the number of intestinal transplants has remained similar with 19 transplants carried out in 2010-2011 compared to 22 in 2011-2012. During 2011-2012, there were 28 registrations for an intestinal transplant. As at 31 March 2012, 12 (43%) registrations remained active/suspended, 13 (46%) resulted in a transplant, 2 (7%) and 1 (4%) resulted in a death on, and removal from, the transplant list, respectively. 9.2 Transplant list

In 2011-2012, there were 28 registrations for an intestinal transplant. The outcome of these registrations for paediatric and adult patients, as at 31 March 2012, broken down by transplant centre can be found in Table 9.1.
Table 9.1 Transplant centre Adult Cambridge Oxford TOTAL Paediatric Birmingham King's College TOTAL 3 0 3 38 0 30 1 0 1 13 0 10 1 0 1 13 0 10 3 2 5 38 100 50 8 2 10 7 3 10 50 75 56 1 0 1 7 0 6 0 0 0 0 0 0 6 1 7 43 25 39 14 4 18 Outcome of intestinal registrations in the UK, 1 April 2011 and 13 March 2012 Transplanted N % Outcome of registrations as at 31 March 2012 Died Removed Active/Susp N % N % N % TOTAL

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Table 9.2 shows median waiting time to intestinal transplant by registration type. On average, patients wait 180 days for a transplant.
Table 9.2 Median waiting time to intestinal transplant in the UK, for patients registered 1 April 2008 - 31 March 2011 Number of patients registered 29 27 22 78 Median 195 144 140 180 Waiting time (days) 95% Confidence interval 128 – 262 17 – 271 0 – 383 128 – 232

Registration type Bowel only Including a liver Not including a liver TOTAL

9.3

Transplants

Table 9.3 shows intestinal transplant activity by transplant centre and transplant type for financial years 2010-2011 and 2011-2012. In 2011-2012, there were a total of 22 transplants, 14 adult and 8 paediatric transplants.
Table 9.3 Transplant centre Adult Cambridge Oxford TOTAL Paediatric Birmingham King's College TOTAL 0 0 0 (1) (0) (1) 4 2 6 (4) (3) (7) 2 0 2 (2) (0) (2) 0 0 0 (0) (0) (0) 0 0 0 (1) (0) (1) 6 2 8 (8) (3) (11) 0 0 0 (0) (0) (0) 1 5 6 (2) (2) (4) 1 0 1 (0) (0) (0) 6 0 6 (2) (0) (2) 1 0 1 (2) (0) (2) 9 5 14 (6) (2) (8) Intestinal failure transplants in the UK, 1 April 2011 - 31 March 2012 (2010-2011), by age group, centre and type LO BO Transplant type LBP MV MMV TOTAL

LO = Liver only - liver or part thereof BO = Bowel only (with or without large bowel) LBP = Liver, bowel and pancreas - liver or part thereof, small bowel (with or without large bowel), pancreas MV = Multivisceral - liver or part thereof, small bowel (with or without large bowel), pancreas, stomach and/or spleen and/or abdominal wall and/or kidney and/or heart and/or lung MMV = Modified multivisceral - small bowel (with or without large bowel), pancreas, stomach and/or spleen and/or abdominal wall and/or kidney and/or heart and/or lung

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10

Cornea Activity

Cornea Activity
Key messages

5,446 were supplied to the Corneal Transplant Service (CTS) eye banks, representing a 7% increase over last year There was a 2% fall in the number of transplants to 3,520 Corneas were retrieved from 34% of organ donors after brain death and 32% of organ donors after circulatory death 34% of cornea only donors were 80 years of age or over

• •

- 71 -

10.1

Overview

The number of corneas donated in 2011-2012 was 5,871, representing an increase of 5% on last year, as shown in Figure 10.1. This increase is mainly due to the Eye Retrieval Scheme (ERS) but also due to the fact that more corneas are being donated from organ donors. The ERS consists of 10 teams embedded in the selected trusts/boards across the UK, that are funded by NHSBT for the purpose of promoting, procuring and retrieving ocular tissue for the clinical use. Additionally, 281 sclera were issued and used. It should be noted that not all cornea donors and transplants in the UK are reported to the UK Transplant Registry and thus the data reported are not the full national data.
Figure 10.1 Cornea programme in the UK, 1 April 2002 - 31 March 2012 Number of corneas donated and corneas grafted

6000 Corneas donated Corneas grafted 5000 4115 4000 3499 3757 3893 3598 3107 3000 2301 2000 2364 2376 2504 2404 2514 2741 4114 4139 3574 5023 5566

5871

3520

Number

1000

0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Year

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In 2011-2012 there were 2,976 tissue donors, of whom 2,617 donated corneas only and 359 donated corneas and solid organs: see Table 10.1. Compared to 2010-2011, the number of cornea only donors increased by 143, and the number of cornea and solid organ donors increased by 21. In 2011-2012, corneas were retrieved from 34% of organ donors after brain death compared with 31% in 2010-2011. Of the 436 organ donors after circulatory death in 2011-2012, 138 (32%) also donated corneas. Table 10.1 also shows the number and rate per million population (pmp) of donors in 2011-2012 by country and English Strategic Health Authority (SHA), with figures for 2010-2011 in parentheses. No adjustments have been made for potential demographic differences in populations. England had the highest cornea donor rate in the UK in 2011-2012 (50.1 pmp). In 2011-2012, the cornea donor rate increased in England and Northern Ireland but fell in Wales and Scotland. Across the SHAs the cornea donor rate varied markedly from 14.5 pmp to 101.7 pmp.
Table 10.1 Cornea donation rates per million population, pmp, in the UK, 1 April 2011 31 March 2012 (2010 - 2011), by country/Strategic Health Authority Cornea only 191 681 78 950 214 53 151 418 155 84 277 438 799 2322 0 0 113 137 44 2617 (193) (580) (103) (876) (195) (57) (174) (426) (170) (49) (205) (462) (716) (2188) (0) (0) (120) (141) (20) (2474) Solid organ and cornea 22 25 18 65 18 26 36 80 59 22 30 37 89 293 0 0 28 21 16 359 (22) (32) (20) (74) (14) (15) (31) (60) (57) (19) (27) (43) (89) (280) (0) (0) (24) (20) (14) (338) TOTAL 213 706 96 1015 232 79 187 498 214 106 307 475 888 2615 0 0 141 158 60 2976 (215) (612) (123) (950) (209) (72) (205) (486) (227) (68) (232) (505) (805) (2468) (0) (0) (144) (161) (34) (2812) TOTAL pmp 81.6 101.7 18.1 68.4 51.8 14.5 32.1 31.6 27.3 24.1 74.2 90.1 64.3 50.1 0 0 46.8 30.3 33.3 47.6 (82.4) (88.2) (23.2) (64.0) (46.7) (13.2) (35.2) (30.8) (29.0) (15.5) (56.0) (95.8) (58.3) (47.3) (0.0) (0.0) (47.8) (30.8) (18.9) (45.0)

Country of residence/ Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1 1

Includes UK recipients where the postcode was unspecified and non-UK recipients

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10.2

Donor and tissue supply

In 2011-2012, 92.8% (91.6% in 2010-2011) of retrieved corneas reported to the UK Transplant Registry were supplied to the Corneal Transplant Service (CTS) Eye Banks in Bristol and Manchester. Table 10.2 shows the number of corneas supplied to, and taken from, the CTS Eye Banks for those centres that supplied more than 25 corneas in 2011-2012. The difference between the number supplied and number taken is also shown, together with the number of corneas that were deemed suitable for a penetrating keratoplasty (PK). Centres with a negative balance have taken more corneas than they supplied to the CTS Eye Banks.
Table 10.2
Centre ERS Merseyside ERS Southampton ERS Preston ERS Bolton ERS Bristol ERS Nottingham ERS Newcastle ERS Royal Devon ERS Norfolk ERS Glasgow East Grinstead, Queen Victoria Hospital Manchester, Royal Eye Hospital Middlesbrough, James Cook University Hospital Belfast, Royal Victoria Hospital Oxford, John Radcliffe Hospital Cardiff, University of Wales Hospital Blackburn, Royal Infirmary Leicester, Royal Infirmary Plymouth, Royal Eye Infirmary Newport, Royal Gwent Hospital Cambridge, Addenbrookes Hospital Yeovil District Hospital Taunton, Taunton & Somerset Hospital Birmingham, Birmingham & Midland Eye Centre Portsmouth, Queen Alexandra Hospital Dundee, Ninewells Hospital Lancaster, Royal Lancaster Hospital Swindon, Great Western Hospital Edinburgh, Royal Infirmary Stoke, North Staffordshire Royal Infirmary Southend Hospital Reading, Royal Berkshire Hospital Barnstaple, North Devon District Hospital Coventry & Warwickshire Hospital Eye retrieval scheme centres Centres supplying more than 25 corneas All other centres TOTAL ERS – Eye Retrieval Scheme PK - Penetrating keratoplasty

Corneas supplied to and taken from the CTS Eye Banks, 1 April 2011 - 31 March 2012
Corneas supplied 382 355 328 324 321 319 314 295 240 187 152 148 106 104 104 84 76 66 60 56 50 46 42 40 36 36 35 32 32 28 26 26 26 26 3065 1437 944 5446 Suitable for PK (%) 187 199 191 198 190 206 213 158 176 146 86 97 74 78 67 46 47 46 41 33 41 31 26 24 21 29 28 23 24 19 16 18 11 15 1864 941 650 3455 (49) (56) (58) (61) (59) (65) (68) (54) (73) (78) (57) (66) (70) (75) (64) (55) (62) (70) (68) (59) (82) (67) (62) (60) (58) (81) (80) (72) (75) (68) (62) (69) (42) (58) (61) (65) (69) (63) Corneas taken 141 84 14 22 100 114 45 16 46 123 24 229 9 49 33 17 0 83 27 7 66 0 11 108 25 0 0 3 0 20 63 43 3 23 705 843 1797 3345 Balance 241 271 314 302 221 205 269 279 194 64 128 -81 97 55 71 67 76 -17 33 49 -16 46 31 -68 11 36 35 29 32 8 -37 -17 23 3 2360 594 -853 2101

Of the 5,446 corneas supplied to the CTS Eye Banks, 3,455 (63%) were suitable for a PK. This was a decrease compared with 2010-2011, when 66% of corneas supplied to the CTS Eye Banks were suitable for a PK.

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10.3

CTS Eye Bank activity

The activity levels for the Bristol and Manchester Eye Banks are shown in Table 10.3. The numbers of corneas received by the CTS Eye Banks increased in 2011-2012 by 7%, however the number of corneas issued remained the same. In 2011-2012, 5,446 corneas were received into the CTS Eye Banks, of which 3,559 (65%) were subsequently issued for grafting. The remaining corneas were unsuitable for transplantation.
Table 10.3 Corneas received into the Bristol and Manchester Eye Banks, 1 April 2011 - 31 March 2012 (2010-2011), by year Total received Number issued
1

% issued

Difference between number received and issued 851 1036 1887 (791) (740) (1531)

Bristol Manchester Total
1

2363 3083 5446

(2266) (2824) (5090)

1512 2047 3559

(1475) (2084) (3559)

64 66 65

(65) (74) (70)

Number issued of those received in each year

The outcome of corneas received into the CTS Eye Banks is given in Table 10.4. Of the corneas supplied to the Eye Banks in 2011-2012, 61% were issued and used and 4% were issued but not used. Of the corneas supplied to the Eye Banks, 11% were unsuitable because of medication contraindications, 14% were unsuitable due to tissue quality and 5% were discarded because of bacterial or fungal contamination. 4% of corneas became outdated, that is, they exceeded 28 days storage and some of these (30%) were placed in ethanol where they can subsequently be stored for up to one year and used for glaucoma surgery. Corneas that were unsuitable for transplantation were, where possible, used for research when permission had been given by the relatives.

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10.4

Transplants

Corneal transplant activity by country of residence and Strategic Health Authority in England for the years 2010-2011 and 2011-2012 is detailed in Table 10.5 for corneas supplied through the CTS Eye Banks and transplants that have been reported to the UK Transplant Registry by Moorfields Eye Bank. Corneas from East Grinstead Eye Bank will be reported to the UK Transplant Registry during 20122013. No adjustments have been made for potential demographic differences in populations. The overall transplant rate was 57.2 pmp in 2010-2011; this decreased to 56.3 pmp in 2011-2012. The transplant rates increased in England, but fell in Wales, Scotland and Northern Ireland. England had the highest transplant rate in the UK: 59.3 pmp, this ranged from 41.4 pmp to 78.3 pmp across the SHAs.
Table 10.4 Outcome of corneas received into the Bristol and Manchester Eye Banks, 1 April 2011 - 31 March 2012 (2010 - 2011), by year Bristol N Total used Not used Issued, not used Unsuitable – tissue quality 1 Medical reason – virology 2 Medical reason – other Contaminated Other/not reported Total not used TOTAL
1 2

Outcome of cornea 1416 96 434 79 202 120 16 947 2363

Manchester % N (61) (5) (15) (8) (8) (4) (<1) (39) 1909 138 341 148 206 151 190 1174 3083 (1924) (160) (268) (141) (195) (130) (6) (900) (2824) 62 4 11 5 7 5 6 38 % (68) (6) (9) (5) (7) (5) (<1) (32) 3325 234 775 227 408 271 206 2121 5446 N 60 4 18 3 9 5 1 40

TOTAL % (3296) (263) (618) (313) (373) (214) (13) (1794) (5090) 61 4 14 4 7 5 4 39 (65) (5) (12) (6) (7) (4) (<1) (35)

(1372) (103) (350) (172) (178) (84) (7) (894) (2266)

Positive or missing serology tests Other medical contraindications

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Table 10.5

Cornea transplants performed per million population (pmp) in the UK, 1 April 2010 - 31 March 2012, by country/Strategic Health Authority Number of transplants (pmp)

1

Country of residence/ Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1 2

2010-2011 143 518 365 1026 244 330 297 871 371 240 217 271 728 2996 4 6 155 232 95 3573 (54.8) (74.6) (68.9) (69.1) (54.5) (60.4) (50.9) (55.2) (47.4) (54.7) (52.4) (51.4) (52.8) (57.4) (50) (40) (51.5) (44.4) (52.8) (57.2)

2011-2012 108 514 415 1037 254 323 336 913 430 246 245 225 716 3096 1 4 97 197 85 3521 (41.4) (74.1) (78.3) (69.8) (56.7) (59.2) (57.6) (57.9) (54.9) (56.0) (59.2) (42.7) (51.9) (59.3) (12.5) (26.7) (32.2) (37.7) (47.2) (56.3)

Corneas supplied through the CTS Eye Banks and Moorfields Eye Bank Includes UK recipients where the postcode was unspecified and non-UK recipients

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10.5

Demographic characteristics

The age group, sex and ethnicity of cornea donors and transplant recipients is shown in Table 10.6. Of the 2,617 cornea only donors, 34% were aged ≥80 years compared with 31% last year.
Table 10.6 Demographic characteristics of deceased cornea donors and transplant recipients, 1 April 2011 - 31 March 2012, in the UK Cornea only donors N Age group (years) 0 - 17 18 - 34 35 - 49 50 - 59 60 - 69 70-79 80+ Mean (SD) Sex Male Female Not reported Ethnicity White Asian Black Chinese Other Not reported TOTAL 16 56 163 238 540 716 888 71 1553 1063 1 2472 9 2 0 3 131 2617 (%) (1) (2) (6) (9) (21) (27) (34) (15) (59) (41) Solid organ and cornea donors N (%) 10 30 70 91 103 49 6 55 166 193 (3) (8) (19) (25) (29) (14) (2) (16) (46) (54) Transplant recipients N 67 520 497 345 590 834 668 60 1878 1643 (%) (2) (15) (14) (10) (17) (24) (19) (21) (53) (47)

(99) (0) (0) (0) (0) (100)

332 6 3 0 4 14 359

(96) (2) (1) (0) (1) (100)

2997 310 134 5 26 49 3521

(86) (9) (4) (0) (1) (100)

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11

Survival Rates Following Transplantation

Survival Rates Following Transplantation

- 79 -

This chapter shows graft survival rates over time for kidney, pancreas and cornea transplants, and patient survival estimates for kidney, pancreas, cardiothoracic, liver and intestinal transplants, performed in the UK. Separate estimates are presented for adult and paediatric patients (using organ specific age definitions) and for transplants from donors after brain death and donors after circulatory death. In all cases, the Kaplan-Meier estimate of the survivor function was used to provide the survival rate and groups (years) were compared using the log-rank test. The analyses do not take account of risk factors which may change over time. Graft survival is defined as time from transplant to graft failure, censoring for death with a functioning graft and grafts still functioning at time of analysis. Patient survival is defined as time from transplant to patient death, censoring for patients still alive at time of analysis.

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11.1

Kidney graft and patient survival

11.1.1 Adult kidney recipients - donor after brain death (DBD) Figure 11.1 shows long-term graft survival in adult (≥18 years) recipients for first kidney only transplant from donors after brain death. Table 11.1 shows the graft survival estimates and confidence intervals for one, two, five and ten years post-transplant. There have been significant improvements in one, two and five year survival over the time periods shown, p<0.01 in each case. Table 11.2 shows the patient survival estimates and confidence intervals for one, two, five and ten years post-transplant. There have been significant improvements in one, two and five year survival over the time periods shown, p<0.02 in each case.
Figure 11.1 Long-term graft survival after first adult kidney only transplant from donors after brain death, 1 January 1998 – 31 December 2010
100

Table 11.1 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Graft survival after first adult kidney only transplant from a DBD No. at risk on day 0 2890 2773 2469 2868 % Graft survival (95% confidence interval) One year Two year Five year Ten year 90 91 93 94 (89-91) (90-92) (92-94) (93-94) 88 89 91 (87-89) (88-90) (90-92) 82 83 85 (81-84) (81-84) (84-87) 71 (69-72)

90

80

70

60

50

% Graft survival

Table 11.2
40

Patient survival after first adult kidney only transplant from a DBD No. at risk on day 0 2890 2773 2469 2868 % Patient survival (95% confidence interval) One year Two year Five year Ten year 95 95 97 96 (94-96) (94-96) (96-97) (95-97) 93 93 95 (92-94) (92-94) (94-96) 87 88 90 (86-88) (86-89) (88-91) 75 (73-77)

30

Year of transplant
Year of transplant (Number at risk on day 0)

20

10

1998-200 0 (2890) 2001-200 3 (2773) 2004-200 6 (2469) 2007-201 0 (2868)

1998-2000 2001-2003 2004-2006 2007-2010
7 8 9 10

0 0 1 2 3 4 5 6

Years since transplant

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11.1.2 Adult kidney recipients - donor after circulatory death (DCD) Long-term graft survival in adult recipients for kidney transplants from donors after circulatory death is shown in Figure 11.2. Table 11.3 shows the graft survival estimates and confidence intervals for one, two, five and ten years post-transplant. There has been a significant improvement in one, two and five year survival over the time periods shown, p<0.01 in each case. One year patient survival is comparable for DBD and DCD donor transplants in the most recent time periods. Table 11.4 shows the patient survival estimates and confidence intervals for each time period analysed. There were no statistically significant changes in patient survival over time (p>0.1).
Figure 11.2 Long-term graft survival after first adult kidney only transplant from donors after circulatory death, 1 January 1998 – 31 December 2010
100

Table 11.3 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Graft survival after first adult kidney only transplant from a DCD No. at risk on day 0 116 232 528 1642 % Graft survival (95% confidence interval) One year Two year Five year Ten year 83 91 94 91 (75-89) (87-94) (91-96) (90-93) 82 90 92 (74-88) (85-93) (90-94) 74 83 87 (64-81) (77-87) (84-90) 60 (50-69)

90

80

70

60

50

% Graft survival

Table 11.4
40

Patient survival after first adult kidney only transplant from a DCD No. at risk on day 0 116 232 528 1642 % Patient survival (95% confidence interval) One year Two year Five year Ten year 92 96 95 96 (85-96) (92-98) (93-96) (94-97) 90 94 93 (83-95) (90-96) (91-95) 84 86 86 (75-89) (81-90) (82-89) 67 (57-75)

30

Year of transplant
Year of transplant (Number at risk on day 0)

20

10

1998-200 0 (116) 2001-200 3 (232) 2004-200 6 (528) 2007-201 0 (1642)

1998-2000 2001-2003 2004-2006 2007-2010
7 8 9 10

0 0 1 2 3 4 5 6

Years since transplant

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11.1.3 Adult kidney recipients - living donor Long-term graft survival in adult recipients for living donor kidney transplants in the UK is shown in Figure 11.3. Table 11.5 shows graft survival estimates and confidence intervals for each time period analysed. There has been a significant improvement in five year graft survival over the time periods shown, p=0.02. Table 11.6 shows the patient survival estimates and confidence intervals for one, two, five and ten years post transplant. There were no statistically significant changes in patient survival over time (p>0.1).
Figure 11.3 Long-term graft survival after first adult living donor kidney only transplant in the UK, 1 January 1998 – 31 December 2010
100

Table 11.5 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Graft survival after first adult living donor kidney transplant No. at risk on day 0 655 916 1317 2860 % Graft survival (95% confidence interval) One year Two year Five year Ten year 96 95 96 96 (94-97) (93-96) (95-97) (96-97) 94 94 95 (92-96) (92-95) (94-96) 89 89 92 (86-91) (87-91) (90-93) 80 (76-83)

90

80

70

60

50

% Graft survival

Table 11.6
40

Patient survival after first adult living donor kidney transplant No. at risk on day 0 655 916 1317 2860 % Patient survival (95% confidence interval) One year Two year Five year Ten year 98 98 99 99 (96-99) (97-99) (98-99) (98-99) 98 97 98 (96-98) (96-98) (97-99) 95 95 96 (93-97) (94-96) (95-97) 90 (87-92)

30

Year of transplant
Year of transplant (Number at risk on day 0)

20

10

1998-200 0 (655) 2001-200 3 (916) 2004-200 6 (1317) 2007-201 0 (2860)

1998-2000 2001-2003 2004-2006 2007-2010
7 8 9 10

0 0 1 2 3 4 5 6

Years since transplant

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11.1.4 Paediatric kidney recipients - donor after brain death (DBD) Figure 11.4 shows long-term graft survival in paediatric (<18 years) recipients for first kidney only transplants from donors after brain death. Graft survival estimates and confidence intervals are shown for each time period analysed in Table 11.7. There has been a significant improvement in one year survival over the time periods shown, p=0.02. Table 11.8 shows the patient survival estimates and confidence intervals for one, two, five and ten years post-transplant. There were no statistically significant changes in patient survival over time (p>0.1).

Figure 11.4 Long-term graft survival after first paediatric kidney only transplant from donors after brain death, 1 January 1998 – 31 December 2010
100

Table 11.7 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Graft survival after first paediatric kidney only transplant from a DBD No. at risk on day 0 232 223 195 239 % Graft survival (95% confidence interval) One year Two year Five year Ten year 88 92 92 96 (83-91) (87-95) (88-95) (92-98) 85 90 90 (80-89) (85-93) (85-94) 76 79 85 (70-81) (73-84) (80-90) 63 (56-69)

90

80

70

60

50

% Graft survival

Table 11.8
40

Patient survival after first paediatric kidney only transplant from a DBD No. at risk on day 0 232 223 195 239 % Patient survival (95% confidence interval) One year Two year Five year Ten year 98 100 99 100 (95-99) (-) (96-100) (-) 98 100 99 (95-99) (-) (96-100) 97 99 99 (94-99) (96-100) (96-100) 94 (90-97)

30

Year of transplant
Year of transplant (Number at risk on day 0)

20

10

1998-200 0 (232) 2001-200 3 (223) 2004-200 6 (195) 2007-201 0 (239)

1998-2000 2001-2003 2004-2006 2007-2010
7 8 9 10

0 0 1 2 3 4 5 6

Years since transplant

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11.1.5 Paediatric kidney recipients - living donor Long-term graft survival in paediatric recipients for living donor kidney transplants in the UK is shown in Figure 11.5. Table 11.9 shows graft survival estimates and confidence intervals for each time period analysed. There has been a significant improvement in five year survival over the time periods shown, p=0.01. Table 11.10 shows the patient survival estimates and confidence intervals for one, two, five and ten years post-transplant. There were no statistically significant differences in patient survival over time (p>0.05). There were insufficient paediatric recipients of first kidney only transplants from donors after circulatory death to permit reliable analysis.
Figure 11.5 Long-term graft survival after first paediatric living donor kidney only transplant in the UK, 1 January 1998 – 31 December 2010
100

Table 11.9 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Graft survival after first paediatric living donor kidney transplant No. at risk on day 0 75 115 128 229 % Graft survival (95% confidence interval) One year Two year Five year Ten year 93 96 98 96 (85-97) (91-99) (93-99) (92-98) 91 94 98 (81-95) (88-97) (93-99) 80 91 94 (69-88) (83-95) (88-97) 68 (56-78)

90

80

70

60

50

% Graft survival

Table 11.10 Year of transplant
Year of transplant (Number at risk on day 0)

Patient survival after first paediatric living donor kidney transplant No. at risk on day 0 75 115 128 229 % Patient survival (95% confidence interval) One year Two year Five year Ten year 99 96 100 99 (91-100) (91-99) (-) (96-100) 97 96 100 (90-99) (91-99) (-) 96 95 100 (88-99) (89-98) (-) 93 (84-97)

40

30

20

10

1998-200 0 (75) 2001-200 3 (115) 2004-200 6 (128) 2007-201 0 (229)

1998-2000 2001-2003 2004-2006 2007-2010
7 8 9 10

0 0 1 2 3 4 5 6

Years since transplant

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11.2

Pancreas graft and patient survival

11.2.1 Simultaneous kidney/pancreas transplants - donor after brain death (DBD) National pancreas follow-up data are only available for transplants performed since 1 January 2001. There are insufficient data available to analyse long-term survival. Figure 11.6 shows pancreas graft survival in recipients receiving their first simultaneous kidney/pancreas (SPK) transplant performed from donors after brain death, 2001 - 2003, 2004 - 2006 and 2007 - 2010. Graft and patient survival estimates and confidence intervals are shown at one year, two years and five years in Table 11.11 and Table 11.12 respectively. Results relate to adults only as there are no paediatric pancreas transplant recipients.
Figure 11.6 Pancreas graft survival after first SPK transplant from donors after brain death, 1 January 2001 – 31 December 2010

Table 11.11 Year of transplant 2001-2003 2004-2006 2007-2010

Graft survival after first SPK transplant from a DBD No. at risk on day 0 127 288 552 73 88 87 % Graft survival (95% confidence interval) One year Two year Five year (65-80) (83-91) (84-90) 71 85 (62-78) (80-89) 67 76 (58-74) (71-81)

100

90

80

70

60

% Graft survival

50

Table 11.12 Year of transplant 2001-2003 2004-2006 2007-2010

Patient survival after first SPK transplant from a DBD No. at risk on day 0 127 288 552 89 94 97 % Patient survival (95% confidence interval) One year Two year Five year (81-93) (91-96) (95-98) 89 92 (81-93) (89-95) 84 88 (76-90) (83-91)

40

30

20

Year of transplant (Number at risk on day 0)
10

2001-200 3 (127) 2004-200 6 (288) 2007-201 0 (552)

0 0 1 2 3 4 5

Years since transplant

- 86 -

11.2.2 Simultaneous kidney/pancreas transplants - donor after circulatory death (DCD) The majority of simultaneous kidney/pancreas (SPK) transplants from a DCD have been performed since 1 January 2007, so there are insufficient data available to analyse long-term survival. Figure 11.7 shows pancreas graft survival in recipients receiving their first SPK transplant performed from donors after circulatory death, 2007 - 2010. Graft and patient survival estimates and confidence intervals are shown at one year in Table 11.13 and Table 11.14 respectively. Results are for adult patients only.
Figure 11.7 Pancreas graft survival after first SPK transplant from donors after circulatory death, 1 January 2007 – 31 December 2010

Table 11.13 Year of transplant 2007-2010

Graft survival after first SPK transplant from a DCD No. at risk on day 0 73 % Patient survival (95% confidence interval) One year 86 (75-92)

100

90

80

70

60

Table 11.14 Year of transplant 2007-2010

Patient survival after first SPK transplant from a DCD No. at risk on day 0 73 % Patient survival (95% confidence interval) One year 96 (88-99)

% Graft survival

50

40

30

20

10

Year of transplant (Number at risk on day 0)

2007-201 0 (73)
0 0 1

Years since transplant

- 87 -

11.2.3 Pancreas only transplants - donor after brain death (DBD) Figure 11.8 shows pancreas graft survival in recipients receiving their first pancreas only transplant performed from donors after brain death, 2001 - 2003, 2004 - 2006 and 2007 - 2010. Graft and patient survival estimates and confidence intervals are shown at one year, two years and five years in Table 11.15 and Table 11.16 respectively. Results are for adult patients only.
Figure 11.8 Pancreas graft survival after pancreas only transplant from donors after brain death, 1 January 2001 – 31 December 2010

Table 11.15 Year of transplant 2001-2003 2004-2006 2007-2010

Graft survival after first pancreas only transplant from a DBD No. at risk on day 0 24 40 97 67 69 74 % Graft survival (95% confidence interval) One year Two year Five year (44-82) (52-81) (64-82) 50 57 (29-68) (40-70) 40 44 (20-59) (28-58)

100

90

80

70

60

% Graft survival

50

Table 11.16 Year of transplant 2001-2003 2004-2006 2007-2010

Patient survival after first pancreas only transplant from a DBD No. at risk on day 0 24 40 97 95 98 93 % Patient survival (95% confidence interval) One year Two year Five year (72-99) (84-100) (86-97) 95 94 (72-99) (79-99) 72 94 (44-87) (79-99)

40

30

20

Year of transplant (Number at risk on day 0)
10

2001-200 3 (24) 2004-200 6 (40) 2007-201 0 (97)

0 0 1 2 3 4 5

Years since transplant

- 88 -

11.2.4 Pancreas only transplants - donor after circulatory death (DCD) Figure 11.9 shows pancreas graft survival in recipients receiving their first pancreas only transplant performed from donors after circulatory death, 2007 - 2010. Graft and patient survival estimates and confidence intervals are shown at one year in Table 11.17 and Table 11.18 respectively. Results are for adult patients only.
Figure 11.9 Pancreas graft survival after pancreas only transplant from donors after circulatory death, 1 January 2007 – 31 December 2010

Table 11.17 Year of transplant 2007-2010

Graft survival after first pancreas only transplant from a DCD No. at risk on day 0 48 % Patient survival (95% confidence interval) One year 69 (53-80)

100

90

80

70

60

Table 11.18 Year of transplant 2007-2010

Patient survival after first pancreas only transplant from a DCD No. at risk on day 0 48 % Patient survival (95% confidence interval) One year 98 (85-100)

% Graft survival

50

40

30

20

10

Year of transplant (Number at risk on day 0)

2007-201 0 (48)
0 0 1

Years since transplant

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11.3

Cardiothoracic patient survival

11.3.1 Adult heart recipients Long-term patient survival for adult (≥16 years) recipients after first heart only transplants is shown in Figure 11.10. Domino and deceased donor (DBD only) transplants are included as well as urgent patients. Table 11.19 shows the patient survival estimates and confidence intervals for one, two, five and ten years post-transplant. There were no statistically significant changes in survival rates over the time periods analysed (p>0.2).
Figure 11.10 Long-term patient survival after first adult heart only transplant in the UK, 1 January 1998 – 31 December 2010
100

90

80

Table 11.19 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Patient survival after first adult heart only transplant No. at risk on day 0 598 383 378 368 % Patient survival (95% confidence interval) One year Two year Five year Ten year 80 82 82 81 (76-83) (77-85) (77-85) (76-84) 77 79 80 (74-80) (74-82) (76-84) 70 71 72 (66-73) (67-76) (67-77) 55 (50-58)

70

60

50

% Patient survival

40

30

20

Year of transplant (Number at risk on day 0)

10

1998-200 0 (598) 2001-200 3 (383) 2004-200 6 (378) 2007-201 0 (368)

0 0 1 2 3 4 5 6 7 8 9 10

Years since transplant

- 90 -

11.3.2 Adult heart/lung block recipients Patient survival for adult recipients after first heart/lung block transplants is shown in Figure 11.11. Patient survival estimates and confidence intervals for each time period analysed are shown in Table 11.20. There were no statistically significant differences in patient survival over time (p>0.3).

Figure 11.11 Long-term patient survival after first adult heart/lung block transplant in the UK, 1 January 1998 – 31 December 2010
100

90

80

Table 11.20 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Patient survival after first adult heart/lung block transplant No. at risk on day 0 117 56 21 18 % Patient survival (95% confidence interval) One year Two year Five year Ten year 67 66 67 89 (57-74) (52-77) (43-83) (62-97) 62 64 62 (53-70) (50-75) (38-79) 49 50 62 (40-58) (36-62) (38-79) 34 (25-43)

70

60

50

% Patient survival

40

30

20

Year of transplant (Number at risk on day 0)

10

1998-200 0 (117) 2001-200 3 (56) 2004-200 6 (21) 2007-201 0 (18)

0 0 1 2 3 4 5 6 7 8 9 10

Years since transplant

- 91 -

11.3.3 Adult lung recipients – donors after brain death (DBD) Patient survival for adult recipients after first lung only transplant from donors after brain death is shown in Figure 11.12, with survival estimates and confidence intervals shown in Table 11.21. There were no statistically significant differences in patient survival over time (p>0.2).

Figure 11.12 Long-term patient survival after first adult lung only transplant from donors after brain death, 1 January 1998 – 31 December 2010
100

90

80

Table 11.21
70

Patient survival after first adult lung only transplant from a DBD No. at risk on day 0 268 320 348 477 % Patient survival (95% confidence interval) One year Two year Five year Ten year 76 78 77 81 (71-81) (73-82) (72-81) (78-85) 68 68 70 (62-73) (63-73) (65-75) 51 54 54 (44-56) (48-59) (48-59) 31 (26-37)

60

Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

% Patient survival

50

40

30

20

Year of transplant (Number at risk on day 0)

10

1998-200 0 (268) 2001-200 3 (320) 2004-200 6 (348) 2007-201 0 (477)

0 0 1 2 3 4 5 6 7 8 9 10

Years since transplant

- 92 -

11.3.4 Adult lung recipients – donors after circulatory death (DCD) The majority of lung transplants from a DCD have been performed since 1 January 2007, so there are insufficient data available to analyse long-term patient survival. Patient survival for adult recipients after first lung only transplant from donors after circulatory death is shown in Figure 11.13, with survival estimates and confidence intervals shown in Table 11.22.

Figure 11.13 Patient survival after first adult lung only transplant from donors after circulatory death, 1 January 2007 – 31 December 2010
100

90

80

Table 11.22 Year of transplant 2007-2010

Patient survival after first adult lung only transplant from a DCD No. at risk on day 0 46 % Patient survival (95% confidence interval) One year 80 (65-89)

70

60

% Patient survival

50

40

30

20

10

Year of transplant (Number at risk on day 0)

2007-201 0 (46)
0 0 1

Years since transplant

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11.3.5 Paediatric heart recipients Long-term patient survival for paediatric recipients after first heart only transplant is shown in Figure 11.14. Domino and deceased donor transplants (DBD donors only) are included as well as transplants for urgent patients. Table 11.23 shows the patient survival estimates and confidence intervals for one, two, five and ten years post-transplant. There have been significant improvements in two and five year survival over the time periods shown, p<0.01 in each case. The number of paediatric lung and heart/lung transplant recipients was too small for analysis.
Figure 11.14 Long-term patient survival after first paediatric heart only transplant in the UK, 1 January 1998 – 31 December 2010
100

90

80

Table 11.23 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Patient survival after first paediatric heart only transplant No. at risk on day 0 73 80 79 121 % Patient survival (95% confidence interval) One year Two year Five year Ten year 86 96 95 93 (76-92) (89-99) (87-98) (86-96) 78 94 95 (66-86) (85-97) (87-98) 69 87 89 (57-78) (77-93) (79-94) 59 (46-69)

70

60

50

% Patient survival

40

30

20

Year of transplant (Number at risk on day 0)

10

1998-200 0 (73) 2001-200 3 (80) 2004-200 6 (79) 2007-201 0 (121)

0 0 1 2 3 4 5 6 7 8 9 10

Years since transplant

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11.4

Liver patient survival

11.4.1 Adult recipients - donor after brain death (DBD) Long-term patient survival for adult (≥17 years) recipients after first elective liver only transplants from donors after brain death is shown in Figure 11.15. Table 11.24 shows patient survival estimates at one, two, five and ten years post-transplant. There have been significant improvements in one, two and five year patient survival over the time periods analysed, p<0.001, p<0.001 and p<0.002, respectively.
Figure 11.15 Long-term patient survival after first elective adult liver only transplant from donors after brain death, 1 January 1998 – 31 December 2010
100

90

80

Table 11.24 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Patient survival after first elective adult liver only transplant from a DBD No. at risk on day 0 1206 1205 1141 1491 % Patient survival (95% confidence interval) One year Two year Five year Ten year 84 88 89 92 (82-86) (86-90) (88-91) (91-93) 80 85 86 (78-82) (83-87) (84-88) 71 76 77 (69-74) (73-78) (75-80) 59 (56-62)

70

60

% Patient survival

50

40

30

20

Year of transplant (Number at risk on day 0)

10

1998-200 0 (1206) 2001-200 3 (1205) 2004-200 6 (1141) 2007-201 0 (1491)

0 0 1 2 3 4 5 6 7 8 9 10

Years since transplant

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11.4.2 Adult recipients - donor after circulatory death (DCD) Patient survival for adult (≥17 years) recipients after first elective liver only transplants from donors after circulatory death is shown in Figure 11.16. The majority of these liver transplants have been performed since 1 January 2002, so it is not possible to estimate long term patient survival. Table 11.25 shows patient survival estimates at one, two and three years post transplant.
Figure 11.16 Liver patient survival after first elective adult liver only transplant from donors after circulatory death, 1 January 2004 – 31 December 2010
100

90

80

Table 11.25 Year of transplant 2004-2006 2007-2010

Patient survival after first elective adult liver only transplant from a DCD No. at risk on day 0 54 302 81 88 % Patient survival (95% confidence interval) One year Two year Three year (68-90) (84-91) 81 (68-90) 80 (66-88)

70

60

% Patient survival

50

40

30

20

10

Year of transplant (Number at risk on day 0)

2004-200 6 (54) 2007-201 0 (302)

0 0 1 2 3

Years since transplant

- 96 -

11.4.3 Paediatric recipients - donor after brain death (DBD) Figure 11.17 and Table 11.26 show long-term patient survival estimates for first elective liver only transplants from donors after brain death in paediatric (<17 years) recipients. There have been significant improvements in one year patient survival over the time period analysed (p=0.04). The number of paediatric transplants from donors after circulatory death was too small to estimate patient survival.
Figure 11.17 Long-term patient survival after first elective paediatric liver only transplant from donors after brain death, 1 January 1998 – 31 December 2010
100

90

80

Table 11.26 Year of transplant 1998-2000 2001-2003 2004-2006 2007-2010

Patient survival after first elective paediatric liver only transplant from a DBD No. at risk on day 0 187 158 168 182 % Patient survival (95% confidence interval) One year Two year Five year Ten year 90 96 89 96 (85-94) (91-98) (83-93) (91-98) 87 94 87 (81-91) (89-97) (81-92) 85 90 84 (79-89) (85-94) (78-89) 81 (75-86)

70

60

% Patient survival

50

40

30

20

Year of transplant (Number at risk on day 0)

10

1998-200 0 (187) 2001-200 3 (158) 2004-200 6 (168) 2007-201 0 (182)

0 0 1 2 3 4 5 6 7 8 9 10

Years since transplant

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11.5

Intestinal patient survival

The majority of intestinal transplants have been performed since 1 January 2006, so there are insufficient data available to analyse long-term patient survival. Figure 11.18 and Table 11.27 show one-year patient survival estimates for recipients receiving their first intestinal transplant, 2007 – 2010, by recipient age group.

Figure 11.18 Patient survival after first intestinal graft in the UK, 1 January 2006 – 31 December 2010

100

90

80

Table 11.27 Recipient age group Adult Paediatric

Patient survival after first intestinal transplant in the UK, 1 January 2006 - 31 December 2010 No. at risk on day 0 24 37 % Patient survival (95% confidence interval) One year 75 84 (52-88) (67-92)

70

60

% Patient survival

50

40

30

20

10

Recipient age group (Number at risk on day 0)

Adult (24 ) Paediatric (37)

0 0 1

Years since transplant

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11.6

Cornea graft survival

Good quality cornea follow-up data were only available for transplants performed since 1 April 1999. There are insufficient data available to analyse long-term survival effects. Figure 11.19 shows graft survival estimates for first penetrating keratoplasty (PK) for grafts 2001 - 2003, 2004 - 2006 and 2007 - 2010. Graft survival estimates and confidence intervals are shown by transplant year at one, two and five years in Table 11.28.

Figure 11.19 Cornea graft survival after first PKP graft in the UK, 1 January 2001 – 31 December 2010

100

90

80

Table 11.28
70

Cornea graft survival after first PK in the UK No. at risk on day 0 3533 3566 3280 93 94 92 % Graft survival (95% confidence interval) One year Two year Five year (92-94) (93-95) (91-93) 87 87 (86-88) (86-89) 75 73 (73-77) (71-75)

60

Year of transplant 2001-2003 2004-2006 2007-2010

% Graft survival

50

40

30

20

Year of transplant (Number at risk on day 0)
10

2001-200 3 (3533) 2004-200 6 (3566) 2007-201 0 (3280)

0 0 1 2 3 4 5

Years since transplant

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12

NHS Organ Donor Register

NHS Organ Donor Register
Key messages
• • •

18.7 million people on the ODR at March 2012 (30% of UK population) 37% of 1,088 deceased organ donors last year were on the ODR 57% of registrations last year were through the Driver and Vehicle Licensing Agency (DVLA)

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By the end of March 2012 the NHS Organ Donor Register (ODR) held just under 18.7 million registrations. A summary of the number of registrations at the end of each financial year from 31 March 2003 to 31 March 2012 is shown in Figure 12.1. During the year, data on the register were continually reviewed and validated. Of the 1,088 deceased organ donors in 2011-2012, 37% were registered on the ODR compared with 33% of organ donors in 2010-2011. Similarly, 41% of cornea-only donors in 2011-2012 were registered on the ODR, compared with 39% in 2010-2011.
Figure 12.1 Number on the NHS Organ Donor Register at 31 March
20.0 18.7 18.0 16.1 16.0 14.2 14.0 12.2 12.0 10.4 10.0 8.0 6.0 4.0 2.0 0.0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 Year 2008-2009 2009-2010 2010-2011 2011-2012 11.2 15.1 13.1 17.8 17.1

Number on the ODR (millions))

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Those registered on the ODR come from all parts of the UK. Table 12.1 shows the percentage of the population registered in each Strategic Health Authority at 31 March 2012, and the number of registrants. This information is also illustrated in Figure 12.2. No adjustment has been made for any differences in demographics of the populations.
Table 12.1 Registrants on the NHS Organ Donor Register at 31 March 2012, by Country/Strategic Health Authority Registrants Country/Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL
1 1

N 724,348 1,896,184 1,470,373 4,090,905 1,254,255 1,349,552 1,785,355 4,389,162 1,952,495 1,465,919 1,344,504 1,871,223 4,681,646 15,114,208 10,596 13,257 942,798 2,024,869 520,975 18,693,549

pmp 277,528 273,225 277,429 275,482 279,968 247,171 306,236 278,324 249,361 333,922 324,759 355,071 339,250 289,378 132,450 88,380 313,222 387,906 289,431 299,145

Proportion of population registered 28% 27% 28% 28% 28% 25% 31% 28% 25% 33% 32% 36% 34% 29% 13% 9% 31% 39% 29% 30%

Includes 66,846 registrants where the postcode was unknown

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There are a number of registration routes: Health Department registration leaflets readily available in the community; campaigns in both national and regional newspapers and by community groups; the European Health Insurance Card; when registering as a patient with a General Practitioner (via the Family Health Services Authorities); with driving licence applications and reminders (via the Driver and Vehicle Licensing Agency (DVLA)); from the Passport Agency when applying for a new passport; when applying for a Boots Advantage Card; online registrations via the Organ Donation and Transplantation (ODT) website (www.organdonation.nhs.uk) and by telephone.

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The source of applications for registration on the ODR is illustrated in Figure 12.3. This figure shows that 21% of registrations in 2011-2012 arrived by means of the Family Health Services Authorities/GP, 57% from driving licence applications and reminders through the DVLA and 8% online through the ODT website.
Figure 12.3 Source of applications for registration on the NHS Organ Donor Register, 1 April 2010 - 31 March 2012

2010-2011
DVLA 58%

2011-2012
DVLA 57%

Online 9% Registration leaflet 1% Other 7% Boots 7%

Online 8% Registration leaflet 1% Other 7% Boots 6%

GP registration 18%

GP registration 21%

At the end of March 2012, 88% of registrants, where the information was available, indicated a willingness to donate all organs and tissue (kidneys, pancreas, heart, lungs, liver and corneas). However, of those who were not willing to donate all organs, the majority (87%) did not wish to donate their corneas. Of the restricted registrations, only 7% (less than 1% of the total register) did not wish to donate their kidneys. Willingness to donate, by organ type, is shown in Table 12.2.
Table 12.2 Preparedness of those registered on the NHS Organ Donor Register at 1 31 March 2012 to donate different organs 88%

Registrants prepared to donate all organs

Of those not prepared to donate all organs ('restricted donors'): Not prepared to donate: Kidney Pancreas Heart Lungs Liver Corneas
1

% of 'Restricted donors' 7 24 25 22 14 87

% of all registrants 0.8 2.8 2.9 2.6 1.6 10.1

This information was not available for approximately 7% of the total register

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People of all ages are eligible for organ donor registration: the distribution of age by sex at time of registration is shown in Figure 12.4. The highest proportion of registrations (22% of males and 24% of females) are in the 21-30 years age group. The lowest proportions are in the under 11 and 11-15 age groups. Of all people registered on the NHS Organ Donor Register, 48% are male and 52% are female.
Figure 12.4 Age and gender of people registered on the NHS Organ Donor Register by 31 March 2012

30%

25%

23.7% 21.6% 20.4%

Percentage of people registered

20%

18.8%

19.4% 19.0% Male Female

15%

14.4% 13.9%

10%

9.9% 9.7% 8.4% 6.6%

5% 2.3% 1.9% 0% <11 11-15 16-20 21-30 31-40 41-50 51-60 61-70 1.4% 1.7%

3.9%

3.2%

71+

Age group (years)

The breakdown of registrants on the ODR during 2011-2012 by socio-economic group (using the ACORN1 classification, based on postcode) is shown in Figure 12.5, where it is compared with the general UK population. Though having basically similar distributions, there were proportionately more 'wealthy achievers' and less 'hard pressed' on the ODR than in the general population.
Figure 12.5 Registrants on the NHS Organ Donor Register, 1 April 2011 - 31 March 2012, and the general population, by socio-economic group

ODR registrants

UK population

wealthy achiever 31% urban prosperity 15%

wealthy achiever 29%

urban prosperity 17%

hard-pressed 16%

comfortably off hard-pressed 18% 27%

comfortably off 25%

moderate means 11%

moderate means 11%

1

ACORN data supplied by CACI Ltd.

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13

National Potential Donor Audit

National Potential Donor Audit
Key messages

There were 28,977 audited deaths reported through the Potential Donor Audit in 2011-2012, including 1,026 (94%) of the 1,088 deceased organ donors The neurological death testing rate has increased since last year from 72% to 74% Improvements have been observed since last year in the overall referral rate of possible donors (from 52% to 60%) and the rate of approach to donor families (from 60% to 66%) A decrease in the overall consent/authorisation rate has been observed since last year (from 57% to 55%), while the actual number of families that consented to/authorised donation has increased by more than 100 families (from 1,378 to 1,487) The consent/authorisation rate is higher when a Specialist Nurse – Organ Donation (SN-OD) is involved in the family approach compared with approaches where a SN-OD is not involved (66% and 38%, respectively) but more than a third of approaches go ahead without SN-OD involvement The consent/authorisation rate is lower for patients from ethnic minority groups (24%) compared with the rate observed for white patients (61%)

• •

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13.1

Introduction

In this chapter, summary data from the national Potential Donor Audit (PDA) are shown for 1 April 2011 to 31 March 2012 and data from the previous financial year are also provided for comparison purposes. The data comprise all audited patient deaths in UK Intensive Care Units (ICUs) and emergency departments, excluding cardiothoracic ICUs and patients aged 76 years and over, in the time period. The data are based on information received by 5 July 2012. The number of solid organ donors reported in this chapter will differ from that shown in the rest of the report, due to the national PDA excluding certain patients. 13.2 Definitions

All data shown in this chapter use the following definitions. Potential donors after brain death (DBD) are defined as patients for whom death was confirmed following neurological tests and who had no absolute or relative medical contraindications to solid organ donation. Potential donors after circulatory death (DCD) are defined as patients for whom imminent death was anticipated and treatment was withdrawn and who had no absolute or relative medical contraindications to solid organ donation. Absolute or relative medical contraindications are defined as known HIV positive, known or suspected CJD, active untreated tuberculosis, any malignancy within the past 12 months (excluding brain tumour) and multi-organ failure. The referral rate is the percentage of patients for whom neurological death was suspected, or imminent death was anticipated, that were discussed with the Specialist Nurse - Organ Donation (SN-OD). The approach rate is the percentage of potential donor families approached for consent to/authorisation for donation. The consent/authorisation rate is the percentage of potential donor families approached about donation that consented to/authorised donation. The conversion rate is the percentage of potential donors who became actual donors. Note that there are many reasons why potential donors do not become actual donors including the family not being approached or the family not consenting to/authorising donation but also coroner/procurator fiscal refusal and the potential donor being found to have additional medical contraindications. 13.3 Breakdown of audited deaths in ICUs and emergency departments

In the 12-month period there were a total of 28,977 audited patient deaths in the UK. Figures 13.1 and 13.2 show a detailed breakdown from the number of audited patient deaths to the number of solid organ donors for potential DBD and DCD, respectively.

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Figure 13.1 Donation after brain death Audited Deaths 28,977 Was the patient ever on mechanical ventilation? No 13,754 Yes 15,223

Figure 13.2 Donation after circulatory death Audited Deaths 28,977 Was the patient ever on mechanical ventilation? No 13,754 Yes 15,223

Were all criteria for neurological testing met? No 13,564 Yes 1,659

Was death confirmed using neurological criteria? No 14,005 Yes 1,218

Were neurological tests to confirm death performed? No 427 Yes 1,232

Was imminent death anticipated? No 7,112 Was treatment withdrawn? No 444 Yes 6,449 Yes 6,893

Was death confirmed using neurological criteria? No 14 Yes 1,218

Were there any absolute or relative medical contraindications to solid organ donation? No 1,168 Yes 50

Were there any absolute or relative medical contraindications to solid organ donation? No 2,926 Yes 3,523

Were the family formally approached for consent/authorisation for solid organ donation? No 78 Yes 1,090

Were the family formally approached for consent/authorisation for solid organ donation? No 1,334 Yes 1,592

Was consent/authorisation for solid organ donation given by the family? No 396 Did solid organ donation occur? No 58 Yes 636 Yes 694

Was consent/authorisation for solid organ donation given by the family? No 799 Did solid organ donation occur? No 403 Yes 390 Yes 793

What type of donation happened? DBD 625 DCD 11

What type of donation happened? DCD 390

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Table 13.1 shows the key percentages calculated from the flow chart information. Consent/authorisation rates have also been provided for cases where the SN-OD was/was not involved in the approach to the family and/or whether the patient was on the NHS Organ Donor Register (ODR). Although it is unrealistic to expect any of these rates to be 100%, it should be noted that the DCD conversion rate is particularly low, partly due to a large proportion of potential DCD having a prolonged time to death which results in deterioration of organs making them unsuitable for transplant. Figure 13.3 uses the flow chart information to illustrate the stages where opportunities for organ donation are not realised. A large proportion of possible DCD donors are not categorised as potential DCD donors due to absolute or relative medical contraindications (55%), most commonly multi-organ failure and malignancy. Additionally, as stated above, a large proportion of potential DCD donors have a prolonged time to death, contributing to the 51% of patients with consent/authorisation who did not become actual donors.
Table 13.1 Summary of key percentages, 1 April 2011 to 31 March 2012 DBD 74.3% 90.7% 93.3% 63.7% 53.3% 67.9% 91.6% 92.6% 54.5% DCD 52.5% 54.4% 49.8% 30.3% 64.1% 76.5% 81.8% 13.3% ALL 59.9% 65.5% 55.4% 37.6% 65.8% 82.9% 86.5% 25.1%

Neurological death testing rate Referral rate Approach rate Consent/authorisation rate - when SN-OD not involved in approach - when SN-OD involved in approach - when patient on ODR - when SN-OD involved in approach and patient on ODR Conversion rate

Figure 13.3 Stages at which possible organ donors lose the opportunity to become actual donors, 1 April 2011 to 31 March 2012

26% 1% 4%

7%

55%

36% 8% 46%

50% 51%

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13.4

Potential donors

The number of potential donors and rates per million population (pmp) are shown in Table 13.2, by country and English Strategic Health Authority (SHA). The corresponding number of actual donors pmp can be found in Table 3.2 of Chapter 3. Potential DBD ranged from 11.4 pmp in East Midlands SHA to 31.0 pmp in London SHA. Potential DCD ranged from 33.0 pmp in South East Coast SHA to 98.1 pmp in North East SHA. Across the countries, there was a range of 41.2 potential donors pmp in Scotland to 83.1 potential donors pmp in Wales. Overall, there were 1,168 potential DBD (18.7 pmp) and 2,926 potential DCD (46.8 pmp) in the UK. Tables 13.3 and 13.4 show more detailed information by country and English SHA for DBD and DCD data, respectively.
Table 13.2 Potential donor rates per million population (pmp), in the UK, 1 April 2011 to 31 March 2012, by country and English Strategic Health Authority Potential DBD Country/Strategic Health Authority of donation North East North West Yorkshire and the Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL N 75 126 81 282 51 91 96 238 243 66 86 62 214 977 2 3 57 72 57 1168 (pmp) (28.7) (18.2) (15.3) (19.0) (11.4) (16.7) (16.5) (15.1) (31.0) (15.0) (20.8) (11.8) (15.5) (18.7) (25.0) (20.0) (18.9) (13.8) (31.7) (18.7) Potential DCD N 256 303 286 845 167 322 249 738 386 145 152 245 542 2511 5 3 193 143 71 2926 (pmp) (98.1) (43.7) (54.0) (56.9) (37.3) (59.0) (42.7) (46.8) (49.3) (33.0) (36.7) (46.5) (39.3) (48.1) (62.5) (20.0) (64.1) (27.4) (39.4) (46.8) N 331 429 367 1127 218 413 345 976 629 211 238 307 756 3488 7 6 250 215 128 4094 TOTAL (pmp) (126.8) (61.8) (69.2) (75.9) (48.7) (75.6) (59.2) (61.9) (80.3) (48.1) (57.5) (58.3) (54.8) (66.8) (87.5) (40.0) (83.1) (41.2) (71.1) (65.5)

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Table 13.3

DBD key metrics from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by country and English Strategic Health Authority Number of patients where Neurological death neurological testing rate death was (%) suspected 97 183 112 392 82 135 122 339 339 90 122 93 305 1375 3 4 89 102 86 1659 85.6 73.8 73.2 76.5 70.7 71.9 80.3 74.6 74.6 76.7 77.0 66.7 73.8 75.0 66.7 75.0 68.5 76.5 66.3 74.3 Number of potential DBD donors 75 126 81 282 51 91 96 238 243 66 86 62 214 977 2 3 57 72 57 1168 Number of potential DBD donors whose family were approached 73 116 74 263 49 86 94 229 226 60 76 58 194 912 2 3 52 69 52 1090 Conversion rate of DBD consent/ potential authorisation DBD donors rate (%) (%) 63.0 64.7 67.6 65.0 63.3 60.5 64.9 62.9 54.4 66.7 64.5 63.8 64.9 61.8 100.0 66.7 65.4 78.3 73.1 63.7 56.0 54.8 58.0 56.0 56.9 54.9 59.4 57.1 44.9 51.5 50.0 56.5 52.3 52.7 100.0 66.7 56.1 69.4 61.4 54.5

Country/Strategic Health Authority of donation North East North West Yorkshire and the Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL

DBD referral rate (%) 95.9 89.6 94.6 92.6 84.1 94.1 91.8 90.9 95.3 86.7 88.5 87.1 87.5 91.7 100.0 100.0 89.9 87.3 77.9 90.7

DBD approach rate (%) 97.3 92.1 91.4 93.3 96.1 94.5 97.9 96.2 93.0 90.9 88.4 93.5 90.7 93.3 100.0 100.0 91.2 95.8 91.2 93.3

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Table 13.4

DCD key metrics from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by country and English Strategic Health Authority Number of patients for whom imminent DCD referral death was rate (%) anticipated 462 929 728 2119 417 621 403 1441 853 341 352 647 1340 5753 13 10 466 391 260 6893 74.0 58.3 52.6 59.8 33.3 54.4 67.0 51.8 54.4 35.2 51.1 50.5 46.8 54.0 15.4 10.0 58.8 33.5 41.5 52.5 Number of potential DCD donors whose family were approached 98 170 135 403 81 178 136 395 213 74 94 180 348 1359 1 1 103 92 36 1592 DCD consent/ authorisation rate (%) 57.1 48.8 45.9 49.9 42.0 47.2 48.5 46.6 41.8 52.7 43.6 65.6 56.9 49.4 100.0 100.0 55.3 51.1 41.7 49.8 Conversion rate of potential DCD donors (%) 10.9 15.5 9.4 12.1 10.2 12.4 12.4 11.9 10.6 11.0 11.2 26.1 17.9 13.1 0.0 33.3 16.6 18.2 4.2 13.3

Country/Strategic Health Authority of donation North East North West Yorkshire and the Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL

Number of potential DCD donors 256 303 286 845 167 322 249 738 386 145 152 245 542 2511 5 3 193 143 71 2926

DCD approach rate (%) 38.3 56.1 47.2 47.7 48.5 55.3 54.6 53.5 55.2 51.0 61.8 73.5 64.2 54.1 20.0 33.3 53.4 64.3 50.7 54.4

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Tables 13.5 and 13.6 show more detailed information on the key metrics by Organ Donation Services Team (ODST) for DBD and DCD data, respectively. Specialist Nurses - Organ Donation work within an ODST, which covers an area of the UK. As seen in Table 13.5, the neurological death testing rate was highest for the Northern team, the DBD referral rate was also highest for the Northern team, the DBD approach rate was highest for the Eastern team and the DBD conversion rate was highest for the Scotland team. Table 13.6 indicates that for DCD patients, the highest referral rate was for the Northern team, the highest approach rate was for the South West team and the highest conversion rate was also for the South West team. No account has been taken of the demographics of the populations within the teams which may impact on the rates presented.
Table 13.5 DBD key metrics from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by Organ Donation Services Team (ODST) Number of patients where neurological death was suspected 126 308 191 204 99 86 102 139 125 71 82 126 1659 Number of potential Neurological DBD DBD death testing referral rate donors rate (%) (%) 81.0 75.3 70.7 74.5 85.9 66.3 76.5 75.5 74.4 64.8 67.1 73.0 74.3 92.1 95.5 91.1 89.7 96.0 77.9 87.3 87.8 88.8 90.1 87.8 92.9 90.7 99 223 125 141 77 57 72 97 89 44 55 89 1168 Number of potential DBD donors whose family were approached 97 208 119 128 75 52 69 87 81 42 51 81 1090 Conversion rate of potential DBD donors (%) 59.6 45.7 55.2 53.2 55.8 61.4 69.4 48.5 48.3 65.9 60.0 57.3 54.5

ODST Eastern London Midlands North West Northern Northern Ireland Scotland South Central South East South Wales South West Yorkshire TOTAL

DBD approach rate (%) 98.0 93.3 95.2 90.8 97.4 91.2 95.8 89.7 91.0 95.5 92.7 91.0 93.3

DBD consent/ authorisation rate (%) 64.9 54.8 60.5 64.1 62.7 73.1 78.3 62.1 63.0 71.4 68.6 66.7 63.7

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Table 13.6

DCD key metrics from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by Organ Donation Services Team (ODST) Number of Number of Number Conversion patients potential DCD of rate of for whom DCD donors DCD potential DCD consent/ potential imminent whose DCD DCD death was referral family were approach authorisation rate (%) donors (%) anticipated rate (%) donors approached rate (%) 415 733 904 976 498 260 391 478 471 409 542 816 6893 67.0 58.1 46.9 56.8 74.9 41.5 33.5 51.3 33.8 59.2 50.4 50.0 52.5 256 356 448 304 281 71 143 195 178 180 210 304 2926 140 205 234 173 107 36 92 126 83 98 153 145 1592 54.7 57.6 52.2 56.9 38.1 50.7 64.3 64.6 46.6 54.4 72.9 47.7 54.4 50.0 42.0 44.4 50.3 56.1 41.7 51.1 46.0 51.8 55.1 66.7 46.2 49.8 13.3 11.5 10.7 15.8 11.4 4.2 18.2 13.8 9.6 16.1 26.2 9.9 13.3

ODST Eastern London Midlands North West Northern Northern Ireland Scotland South Central South East South Wales South West Yorkshire TOTAL

Table 13.7 shows key metrics separately for patients who died in an ICU or an emergency department, for DBD and DCD, respectively. Note that patients are often referred to the SN-OD in the emergency department and then die in an ICU, but this table reports on the unit where the patient died. Although the DBD conversion rate appears higher for patients dying in emergency departments compared with ICUs, this should be interpreted with caution because the neurological death testing rate is much lower in the emergency departments leading to a relatively small number of potential donors. Table 13.8 shows key metrics separately for adult and paediatric patients, for DBD and DCD, respectively. Note that of the 125 paediatric patients for whom neurological death was suspected, tests were not performed on 52 patients, 10 of whom were less than two months post term.

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Table 13.7

DBD and DCD key metrics from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by unit where the patient died Number of potential donors Conversion Consent/ Number of whose family rate of Approach authorisation actual were potential 2 rate (%) rate (%) donors approached donors (%) 1064 26 1090 1495 97 1592 93.3 92.9 93.3 57.5 29.6 54.4 63.3 76.9 63.7 51.6 21.6 49.8 618 18 636 379 11 390 54.2 64.3 54.5 14.6 3.4 13.3

Potential Unit where donor patient died type DBD Critical care Emergency dept. TOTAL Critical care Emergency dept. TOTAL

Number of patients who Neurological met referral death testing 1 rate (%) criteria 1549 110 1659 6449 444 6893 77.7 25.5 74.3

Referral rate (%) 93.2 55.5 90.7 53.8 33.6 52.5

Number of potential donors 1140 28 1168 2598 328 2926

DCD

1 2

DBD referral criteria: patients where neurological death was suspected; DCD referral criteria: patients for whom imminent death was anticipated Actual donors resulting from potential DBD donors includes 10 DCD donors from intensive care and 1 DCD donor from an emergency department

Table 13.8

DBD and DCD key metrics from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by age group Number of potential Conversion donors Consent/ Number of rate of whose family Approach authorisation actual potential were 2 rate (%) rate (%) donors donors (%) approached 1034 56 1090 1543 49 1592 94.0 82.4 93.3 55.5 33.1 54.4 63.9 58.9 63.7 50.2 36.7 49.8 606 30 636 379 11 390 55.1 44.1 54.5 13.6 7.4 13.3

Potential donor Age group type DBD Adult (>=18) Paediatric (<18) TOTAL Adult (>=18) Paediatric (<18) TOTAL

Number of patients who Neurological met referral death testing 1 rate (%) criteria 1534 125 1659 6605 288 6893 75.6 58.4 74.3

Referral rate (%) 91.2 84.0 90.7 53.3 35.1 52.5

Number of potential donors 1100 68 1168 2778 148 2926

DCD

1 2

DBD referral criteria: patients where neurological death was suspected; DCD referral criteria: patients for whom imminent death was anticipated Actual donors resulting from potential DBD donors includes 11 DCD donors aged 18 years and over

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13.5

Consent/authorisation rates

The overall DBD consent/authorisation rate was 63.7% and the 95% confidence limits for this percentage are 60.8% - 66.6%. For DCD, the overall rate was 49.8% and the 95% confidence limits are 47.3% - 52.3%. Consent/authorisation rates by English SHA or country are illustrated in Figure 13.4 and by Organ Donation Services Team in Figure 13.5 for both DBD and DCD. Caution should be applied when interpreting these consent/authorisation rates as no adjustment has been made for the mix of patients in terms of age, sex and ethnicity. Across the English SHA and countries, the DBD consent/authorisation rates range from 54.4% in the London SHA to 78.3% in Scotland. DCD consent/authorisation rates range from 41.7% in Northern Ireland to 65.6% in the South West SHA.

Across the Organ Donation Services Teams, the DBD consent/authorisation rates range from 54.8% in the London team to 78.3% in the Scotland team. DCD consent/authorisation rates range from 41.7% in the Northern Ireland team to 66.7% in the South West team.

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Table 13.9 shows the consent/authorisation rate separately for white patients and patients from ethnic minority groups. The DBD consent/authorisation rates for white patients and patients from ethnic minority groups were 69.1% and 29.1%, respectively. A similar difference was observed for DCD consent/authorisation rates: 54.8% and 18.8%, respectively. Note that there were an additional 23 DBD and 98 DCD families approached where the ethnicity was not known or not reported. Approximately half of families from ethnic minority groups approached for a decision about organ donation were in London, a further quarter were either in the Midlands or South Central, but most teams had a very small proportion, therefore accounting for some of the variation observed in overall consent/authorisation rates between teams. Note that consent/authorisation rates have not been provided where the number of families approached is less than ten.

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Table 13.9

DBD and DCD consent/authorisation rates from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by Organ Donation Services Team (ODST) and ethnicity White potential donors Potential donors from ethnic minority groups All

ODST Eastern London Midlands North West Northern Northern Ireland Scotland South Central South East South Wales South West Yorkshire TOTAL
1

Number of Number of Number of Number of potential potential potential potential DBD DCD Overall DBD DCD Overall Overall DBD donors DCD donors DBD donors DCD donors consent/ consent/ consent/ consent/ consent/ consent/ consent/ whose family whose family whose family whose family authorisation authorisation authorisation authorisation authorisation authorisation authorisation were were were were 1 rate (%) rate (%) rate (%) rate (%) rate (%) rate (%) rate (%) approached approached approached approached

90 130 98 114 75 51 66 69 76 39 45 73 926

67.8 68.5 69.4 67.5 62.7 74.5 78.8 68.1 65.8 74.4 73.3 67.1 69.1

127 146 193 148 95 36 85 106 76 93 137 135 1377

52.8 52.1 50.8 54.1 62.1 41.7 54.1 52.8 53.9 57.0 70.1 49.6 54.8

59.0 59.8 57.0 59.9 62.4 60.9 64.9 58.9 59.9 62.1 70.9 55.8 60.5

5 77 20 8 0 1 1 14 4 0 6 5 141

31.2 20.0 28.6 29.1

7 51 23 8 2 0 1 9 4 1 6 5 117

19.6 13.0 18.8

33.3 26.6 16.3 18.8 21.7 41.7 20.0 24.4

56.1 48.4 49.9 56.1 58.8 60.2 62.7 52.6 57.3 60.0 67.2 53.5 55.4

Includes 121 families approached where the ethnicity was not known or not reported

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13.6

Specialist Nurse - Organ Donation (SN-OD) involvement

Table 13.10 shows the proportion of family approaches that involved a SN-OD, for DBD and DCD separately, and overall. Nationally, 71.1% of DBD and 57.9% of DCD family approaches involved a SN-OD, but there is wide variation between teams. Table 13.11 shows the effect on the consent/authorisation rate when a SN-OD is involved or not involved in the approach to a family for a decision about organ donation. Evidence shows that the family are more likely to consent to/authorise donation when a trained SN-OD is involved in the approach and this is particularly apparent for potential DCD donors. Again, there is wide variation between teams. Caution should be applied when interpreting these rates as no account has been taken of approaches initiated by the family, ODR status or ethnicity.
Table 13.10 Percentage of family approaches involving a Specialist Nurse - Organ Donation (SN-OD) from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by Organ Donation Services Team (ODST) Number of potential DBD donors whose family were approached 97 208 119 128 75 52 69 87 81 42 51 81 1090 Number of potential DBD donors where SN-OD involved in approach 78 181 78 98 34 39 47 62 56 30 17 55 775 Percentage of DBD approaches that involved a SN-OD (%) 80.4 87.0 65.5 76.6 45.3 75.0 68.1 71.3 69.1 71.4 33.3 67.9 71.1 Number of potential DCD donors whose family were approached 140 205 234 173 107 36 92 126 83 98 153 145 1592 Number of potential DCD donors where SN-OD involved in approach 97 153 110 115 37 22 49 82 54 59 60 83 921 Percentage of DCD approaches that involved a SN-OD (%) 69.3 74.6 47.0 66.5 34.6 61.1 53.3 65.1 65.1 60.2 39.2 57.2 57.9 Overall percentage of DBD/DCD approaches that involved a SN-OD (%) 73.8 80.9 53.3 70.8 39.0 69.3 59.6 67.6 67.1 63.6 37.7 61.1 63.2

ODST Eastern London Midlands North West Northern Northern Ireland Scotland South Central South East South Wales South West Yorkshire TOTAL

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Table 13.11

DBD and DCD consent/authorisation rates with/without SN-OD involvement from the Potential Donor Audit, 1 April 2011 to 31 March 2012, by Organ Donation Services Team (ODST) SN-OD involved in approach SN-OD not involved in approach All

ODST Eastern London Midlands North West Northern Northern Ireland Scotland South Central South East South Wales South West Yorkshire TOTAL

Number of Number of Number of Number of potential potential potential potential DBD DCD Overall DBD DCD Overall Overall DBD donors DCD donors DBD donors DCD donors consent/ consent/ consent/ consent/ consent/ consent/ consent/ whose family whose family whose family whose family authorisation authorisation authorisation authorisation authorisation authorisation authorisation were were were were rate (%) rate (%) rate (%) rate (%) rate (%) rate (%) rate (%) approached approached approached approached

78 181 78 98 34 39 47 62 56 30 17 55 775

67.9 53.0 64.1 72.4 58.8 84.6 91.5 67.7 62.5 80.0 76.5 83.6 67.9

97 153 110 115 37 22 49 82 54 59 60 83 921

60.8 47.1 62.7 73.0 70.3 63.6 81.6 62.2 59.3 57.6 93.3 63.9 64.1

64.0 50.3 63.3 72.8 64.8 77.0 86.5 64.6 60.9 65.2 89.6 71.7 65.8

19 27 41 30 41 13 22 25 25 12 34 26 315

52.6 66.7 53.7 36.7 65.9 38.5 50.0 48.0 64.0 50.0 64.7 30.8 53.3

43 52 124 58 70 14 43 44 29 39 93 62 671

25.6 26.9 28.2 5.2 48.6 7.1 16.3 15.9 37.9 51.3 49.5 22.6 30.3

33.9 40.5 34.5 15.9 55.0 22.2 27.7 27.5 50.0 51.0 53.5 25.0 37.6

56.1 48.4 49.9 56.1 58.8 60.2 62.7 52.6 57.3 60.0 67.2 53.5 55.4

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13.7

Comparison with previous year

Table 13.12 shows the key metrics from the PDA for the 2010-2011 and 2011-2012 financial years. An increase has been observed in the neurological death testing rate, but still more than a quarter of patients who meet the criteria are not tested. Details, such as the reasons for not testing, can be found in the PDA Annual Report available on the ODT website. Increases have been observed in the DBD and DCD approach rates, but there has been a slight decrease in consent/authorisation rates. Improvements have been observed in the proportion of potential donors becoming actual donors (conversion rates) and the largest increases have been observed in the rates of referral to the SN-ODs for both DBD and DCD.
Table 13.12 DBD and DCD key metrics from the Potential Donor Audit, by financial year Number of Number of Number of Conversion patients potential families who Number of donors whose Consent/ Number rate of who met Neurological consented death testing Referral potential potential referral family were Approach to/authorise authorisation of actual 1 2 rate (%) rate (%) rate (%) donors rate (%) donors donors (%) criteria approached d donation 1676 1659 7223 6893 8899 8552 72.1 74.3 84.5 90.7 44.3 52.5 51.9 59.9 1144 1168 2886 2926 4030 4094 1059 1090 1362 1592 2421 2682 92.6 93.3 47.2 54.4 60.1 65.5 683 694 695 793 1378 1487 64.5 63.7 51.0 49.8 56.9 55.4 617 636 344 390 961 1026 53.9 54.5 11.9 13.3 23.8 25.1

Potential Financial donor year type DBD DCD TOTAL
1 2

2010-2011 2011-2012 2010-2011 2011-2012 2010-2011 2011-2012

DBD referral criteria: patients where neurological death was suspected; DCD referral criteria: patients for whom imminent death was anticipated Actual donors resulting from potential DBD donors includes 6 DCD donors in 2010-2011 and 11 DCD donors in 2011-2012

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Appendices

Appendices

- 122 -

Appendix I provides details of the 652 deceased solid organ donors reported in 2011-2012. Details are given for each donating hospital and the hospitals have been grouped by English Strategic Health Authority and country. This appendix does not reflect regional retrieval rates: for example, in Wales three of the donating hospitals reported are listed under Liverpool for kidney retrievals. The number of donors by donor country/Strategic Health Authority of residence is given for donors after brain death in Appendix IIA and donors after circulatory death in Appendix IIB. The populations used for country/Strategic Health Authority per million population are given in Appendix III these populations are mid-2010 estimates based on ONS 2001 Census figures.

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Appendix 1

Deceased solid organ donors and donated organs in the UK, 1 April 2011 - 31 March 2012 (2010-2011), by donating hospital
DBD DCD All donors Multi-organ donor Kidney Heart Lung Liver Pancreas

Donating hospital

East Midlands
Boston, Pilgrim Hospital Chesterfield, Chesterfield Royal Hospital Derby, Royal Derby Hospital Kettering, Kettering General Hospital Leicester, Glenfield General Hospital Leicester, Leicester Royal Infirmary Lincoln, Lincoln County Hospital Northampton, Northampton General Hospital Nottingham, Nottingham City Hospital Nottingham, Nottingham University Hospital Sutton-In-Ashfield, King's Mill Hospital Total 3 2 5 3 0 9 1 2 0 6 1 32 (1) (2) (4) (4) (1) (4) (4) (1) (1) (7) (2) (31) 0 0 2 3 0 1 3 1 1 6 2 19 (0) (1) (1) (0) (1) (1) (2) (0) (1) (8) (1) (16) 3 2 7 6 0 10 4 3 1 12 3 51 (1) (3) (5) (4) (2) (5) (6) (1) (2) (15) (3) (47) 2 1 4 3 0 9 1 2 1 8 3 34 (1) (2) (4) (3) (0) (3) (3) (1) (1) (14) (2) (34) 6 4 12 11 0 20 6 5 2 24 6 96 0 0 1 1 0 1 0 0 0 1 0 4 0 0 2 0 0 2 0 0 0 5 0 9 2 1 5 2 0 9 2 2 1 7 3 34 1 0 3 0 0 6 1 0 0 6 1 18

East of England
Basildon, Basildon Hospital Bedford, Bedford Hospital Bury St Edmunds, West Suffolk Hospital Cambridge, Addenbrooke's Hospital Chelmsford, Broomfield Hospital Colchester, Colchester General Hospital Great Yarmouth, James Paget Hospital Harlow, Princess Alexandra Hospital Huntingdon, Hinchingbrooke Hospital Ipswich, Ipswich Hospital Kings Lynn, The Queen Elizabeth Hospital Luton, Luton And Dunstable Hospital Norwich, Norfolk And Norwich University Hospital Papworth, Papworth Hospital Peterborough, Peterborough City Hospital Peterborough, Peterborough District Hospital Stevenage, Lister Hospital Watford, Watford General Hospital Welwyn Garden City, Queen Elizabeth Hospital 3 2 1 17 1 1 3 1 1 3 0 4 7 2 2 0 2 4 3 (1) (4) (1) (15) (6) (2) (0) (1) (1) (2) (1) (4) (5) (0) (1) (0) (1) (0) (0) 0 9 2 14 0 0 2 0 3 3 0 3 4 1 0 0 2 1 0 (0) (2) (1) (10) (0) (2) (0) (2) (1) (7) (1) (3) (7) (4) (0) (1) (3) (1) (0) 3 11 3 31 1 1 5 1 4 6 0 7 11 3 2 0 4 5 3 (1) (6) (2) (25) (6) (4) (0) (3) (2) (9) (2) (7) (12) (4) (1) (1) (4) (1) (0) 3 4 1 20 1 1 4 1 0 5 0 7 8 2 2 0 3 5 3 (1) (4) (0) (17) (5) (4) (0) (2) (1) (5) (0) (4) (9) (2) (0) (0) (3) (0) (0) 6 20 6 62 2 2 10 2 8 12 0 14 22 6 4 0 8 10 6 1 1 0 5 0 1 0 0 0 0 0 1 3 0 0 0 0 1 1 0 3 0 3 0 2 2 0 0 0 0 0 2 0 0 0 2 0 2 3 4 1 20 1 1 4 1 0 5 0 6 7 2 2 0 3 5 3 3 3 1 9 0 1 0 0 0 2 0 6 3 0 1 0 1 2 1

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Donating hospital Westcliff On Sea, Southend Hospital Total

DBD 3 60 (4) (49)

DCD 0 44 (1) (46)

All donors 3 104 (5) (95)

Multi-organ donor 2 (3) 72 (60)

Kidney 4 204

Heart 0 14

Lung 0 16

Liver 3 71

Pancreas 1 34

London
Barnet, Barnet General Hospital Carshalton, St Helier Hospital Chelsea, Chelsea And Westminster Hospital Croydon, Mayday University Hospital Enfield, Chase Farm Hospital Epsom General Hospital Evelina Childrens Hospital Harefield, Harefield Hospital Harrow, Northwick Park Hospital Ilford, King George Hospital Isleworth, West Middlesex University Hospital Kingston, Kingston Hospital London, Central Middlesex Hospital London, Charing Cross Hospital London, Great Ormond Street Hospital For Children London, Guy's Hospital London, Hammersmith Hospital London, Heart Hospital London, King's College Hospital London, National Hospital For Neurology And Neurosurgery London, Newham General Hospital London, North Middlesex Hospital London, Queen Elizabeth Hospital London, Royal Brompton Hospital London, Royal Free Hospital London, St George's Hospital London, St Mary's Hospital London, St Thomas' Hospital London, The London Chest Hospital London, The Royal London Hospital (Whitechapel) London, The Whittington Hospital London, University College Hospital London, University Hospital Lewisham 1 2 1 4 0 0 0 1 3 0 2 1 0 10 2 0 1 1 8 10 1 2 0 0 4 19 3 5 1 18 2 0 0 (0) (0) (0) (1) (1) (2) (0) (0) (2) (1) (3) (1) (1) (4) (1) (0) (0) (0) (12) (10) (0) (1) (3) (0) (11) (14) (3) (3) (0) (14) (2) (3) (2) 0 0 0 0 0 0 1 1 1 0 0 0 0 2 3 0 0 1 5 4 0 0 0 1 1 4 1 5 3 4 0 1 1 (0) (0) (1) (0) (1) (0) (0) (0) (2) (0) (1) (0) (1) (2) (0) (1) (1) (0) (5) (3) (0) (0) (3) (1) (2) (7) (1) (2) (0) (4) (0) (1) (1) 1 2 1 4 0 0 1 2 4 0 2 1 0 12 5 0 1 2 13 14 1 2 0 1 5 23 4 10 4 22 2 1 1 (0) (0) (1) (1) (2) (2) (0) (0) (4) (1) (4) (1) (2) (6) (1) (1) (1) (0) (17) (13) (0) (1) (6) (1) (13) (21) (4) (5) (0) (18) (2) (4) (3) 1 2 1 4 0 0 0 2 2 0 1 0 0 11 4 0 1 2 13 11 1 2 0 1 3 22 3 4 3 19 2 1 0 (0) (0) (1) (1) (1) (2) (0) (0) (2) (1) (3) (1) (2) (5) (1) (0) (1) (0) (15) (10) (0) (1) (3) (1) (10) (15) (3) (4) (0) (17) (2) (2) (3) 2 4 2 7 0 0 1 4 6 0 4 0 0 22 10 0 2 4 25 26 2 4 0 2 8 45 6 13 6 38 4 2 2 0 1 0 1 0 0 0 0 0 0 0 0 0 2 2 0 0 0 2 6 0 1 0 0 1 6 0 0 0 3 0 0 0 0 2 0 4 0 0 0 2 0 0 0 0 0 6 0 0 0 0 8 10 0 0 0 0 2 16 2 0 0 7 0 0 0 1 2 1 3 0 0 0 2 3 0 1 1 0 12 3 0 1 2 13 12 1 2 0 1 4 22 4 7 4 21 2 0 0 1 1 0 1 0 0 0 1 0 0 1 0 0 7 3 0 1 2 10 6 0 2 0 0 2 13 1 3 2 13 1 1 0

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Donating hospital London, Whipps Cross Hospital Orpington, Princess Royal University Hospital Romford, Queens Hospital Sidcup, Queen Mary's Hospital Southall, Ealing Hospital Stanmore, Royal National Orthopaedic Hospital Uxbridge, Hillingdon Hospital Total

DBD 0 0 7 0 0 1 3 113 (0) (1) (9) (1) (1) (0) (0) (107)

DCD 2 0 8 0 0 0 0 49 (0) (0) (1) (0) (0) (0) (1) (42)

All donors 2 0 15 0 0 1 3 162 (0) (1) (10) (1) (1) (0) (1) (149)

Multi-organ donor 1 (0) 0 (1) 10 (9) 0 (0) 0 (1) 1 (0) 3 (1) 131 (119)

Kidney 2 0 27 0 0 1 6 287

Heart 0 0 5 0 0 1 0 31

Lung 0 0 8 0 0 0 0 67

Liver 1 0 11 0 0 1 3 141

Pancreas 1 0 7 0 0 1 1 82

North East
Ashington, Wansbeck Hospital Darlington, Darlington Memorial Hospital Durham, University Hospital Of North Durham Gateshead, Queen Elizabeth Hospital Hartlepool, University Hospital Of Hartlepool Middlesbrough, The James Cook University Hospital Newcastle, Freeman Hospital Newcastle, Newcastle General Hospital Newcastle, Royal Victoria Infirmary North Shields, North Tyneside General Hospital Northallerton, Friarage Hospital South Shields, South Tyneside District General Hospital Stockton-On-Tees, University Hospital Of North Tees Sunderland, Sunderland Royal Hospital Total 2 0 4 2 1 5 1 0 19 1 0 2 2 3 42 (1) (0) (2) (2) (0) (4) (1) (11) (8) (1) (0) (1) (2) (2) (35) 3 5 0 2 0 8 3 0 4 0 1 1 2 3 32 (1) (1) (0) (2) (0) (3) (3) (6) (4) (1) (0) (1) (1) (2) (25) 5 5 4 4 1 13 4 0 23 1 1 3 4 6 74 (2) (1) (2) (4) (0) (7) (4) (17) (12) (2) (0) (2) (3) (4) (60) 2 1 4 1 1 7 2 0 19 1 0 1 1 3 43 (1) (0) (2) (2) (0) (5) (1) (8) (8) (0) (0) (1) (2) (2) (32) 10 10 8 8 2 25 8 0 42 2 2 6 8 10 141 0 0 0 0 0 2 0 0 5 0 0 0 1 0 8 0 0 4 0 0 6 0 0 22 0 0 0 1 0 33 2 1 4 1 1 7 1 0 18 1 0 1 1 3 41 1 0 4 0 0 4 1 0 14 0 0 1 1 1 27

North West
Ashton-Under-Lyne, Tameside General Hospital Barrow-In-Furness, Furness General Hospital Blackburn, Royal Blackburn Hospital Blackpool, Blackpool Victoria Hospital Bolton, Royal Bolton Hospital Bury, Fairfield General Hospital Carlisle, Cumberland Infirmary Chester, Countess Of Chester Hospital Crewe, Leighton Hospital Lancaster, Royal Lancaster Infirmary 2 1 3 1 1 0 0 1 1 3 (1) (1) (5) (3) (2) (2) (0) (2) (2) (2) 1 0 3 2 3 2 2 1 3 0 (0) (0) (1) (1) (2) (0) (2) (0) (0) (2) 3 1 6 3 4 2 2 2 4 3 (1) (1) (6) (4) (4) (2) (2) (2) (2) (4) 2 0 3 1 3 1 1 0 2 3 (1) (0) (5) (2) (3) (2) (1) (1) (2) (2) 6 2 10 6 8 4 4 2 8 4 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 0 3 1 2 1 0 1 2 3 0 0 2 0 3 1 1 0 0 1

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Donating hospital Liverpool, Alder Hey Children's Hospital Liverpool, Liverpool Heart And Chest Hospital Liverpool, Royal Liverpool University Hospital Liverpool, University Hospital Aintree Liverpool, Walton Centre For Neurology And Neurosurgery Macclesfield, Macclesfield District General Hospital Manchester, Manchester Royal Infirmary Manchester, North Manchester General Hospital Manchester, Royal Manchester Children's Hospital Manchester, Trafford General Hospital Manchester, Wythenshawe Hospital Oldham, Royal Oldham Hospital (Rochdale Road) Prescot, Whiston Hospital Preston, Royal Preston Hospital Rochdale, Rochdale Infirmary Salford, Salford Royal Southport, Southport District General Hospital Stockport, Stepping Hill Hospital Warrington, Warrington Hospital Whitehaven, West Cumberland Hospital Wigan, Royal Albert Edward Infirmary Wirral, Arrowe Park Hospital Total

DBD 1 1 3 2 10 1 6 0 2 0 5 1 2 6 0 6 4 1 0 1 3 3 71 (1) (0) (1) (0) (7) (2) (3) (0) (1) (1) (2) (3) (0) (6) (0) (7) (4) (0) (3) (1) (0) (4) (66)

DCD 0 0 2 1 4 0 0 2 0 0 2 1 1 7 0 9 0 0 1 2 0 3 52 (2) (0) (1) (3) (6) (2) (1) (0) (0) (0) (2) (0) (0) (5) (2) (1) (2) (1) (1) (0) (0) (2) (39)

All donors 1 1 5 3 14 1 6 2 2 0 7 2 3 13 0 15 4 1 1 3 3 6 123 (3) (0) (2) (3) (13) (4) (4) (0) (1) (1) (4) (3) (0) (11) (2) (8) (6) (1) (4) (1) (0) (6) (105)

Multi-organ donor 1 (2) 1 (0) 2 (0) 3 (3) 9 (9) 1 (2) 6 (3) 1 (0) 2 (1) 0 (0) 3 (2) 2 (2) 2 (0) 10 (5) 0 (0) 7 (7) 4 (3) 1 (0) 0 (4) 1 (1) 3 (0) 3 (3) 78 (66)

Kidney 2 2 8 6 26 2 8 4 4 0 12 4 6 26 0 30 8 2 2 6 6 12 230

Heart 1 0 1 0 1 0 1 0 1 0 2 0 0 2 0 3 0 1 0 0 2 0 16

Lung 0 0 2 0 4 0 8 0 0 0 0 0 1 3 0 5 2 0 0 0 4 2 34

Liver 1 1 2 3 10 1 6 1 2 0 3 2 2 10 0 7 3 1 0 1 3 3 77

Pancreas 0 0 2 1 4 0 2 1 1 0 1 0 0 8 0 3 2 1 0 1 3 2 40

South Central
Aylesbury, Stoke Mandeville Hospital Basingstoke, North Hampshire Hospital Milton Keynes, Milton Keynes General Hospital Newport, St Mary's Hospital Oxford, John Radcliffe Hospital Portsmouth, Queen Alexandra Hospital Reading, Royal Berkshire Hospital Slough, Wexham Park Hospital Southampton, Southampton University Hospitals Winchester, Royal Hampshire County Hospital Wycombe, Wycombe General Hospital Total 4 0 1 1 15 8 1 3 9 1 1 44 (2) (2) (4) (1) (20) (0) (4) (4) (8) (0) (2) (47) 1 1 0 1 5 2 1 1 5 1 0 18 (0) (2) (0) (0) (7) (3) (2) (1) (5) (0) (0) (20) 5 1 1 2 20 10 2 4 14 2 1 62 (2) (4) (4) (1) (27) (3) (6) (5) (13) (0) (2) (67) 4 0 1 2 19 10 2 4 12 1 1 56 (2) (4) (3) (1) (24) (2) (6) (5) (11) (0) (2) (60) 10 2 2 4 39 20 4 8 27 4 2 122 0 0 0 0 1 0 0 0 0 0 0 1 0 0 2 0 6 2 0 0 4 0 0 14 4 0 1 2 18 10 2 4 12 1 1 55 2 0 1 0 8 3 0 2 6 0 1 23

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Donating hospital

DBD

DCD

All donors

Multi-organ donor

Kidney

Heart

Lung

Liver

Pancreas

South East Coast
Ashford, William Harvey Hospital Brighton, Royal Sussex County Hospital Camberley, Frimley Park Hospital Canterbury, Kent And Canterbury Hospital Chertsey, St Peter's Hospital Chichester, St Richard's Hospital Dartford, Darent Valley Hospital Eastbourne, Eastbourne District General Hospital Gillingham, Medway Hospital Guildford, Royal Surrey County Hospital Hastings, Conquest Hospital Haywards Heath, Hurstwood Park Hospital Haywards Heath, Princess Royal Hospital Maidstone, Maidstone District General Hospital Margate, Queen Elizabeth The Queen Mother Hospital Redhill, East Surrey Hospital Tunbridge Wells, Kent And Sussex Hospital Worthing, Worthing Hospital Total 3 3 1 1 3 1 0 3 4 2 2 3 0 0 1 1 2 4 34 (1) (3) (1) (0) (2) (1) (2) (1) (5) (0) (3) (5) (2) (2) (0) (2) (1) (5) (36) 2 2 3 0 1 0 1 2 0 2 1 0 0 3 0 1 1 1 20 (2) (0) (2) (2) (1) (1) (0) (1) (0) (0) (2) (1) (1) (2) (0) (0) (1) (2) (18) 5 5 4 1 4 1 1 5 4 4 3 3 0 3 1 2 3 5 54 (3) (3) (3) (2) (3) (2) (2) (2) (5) (0) (5) (6) (3) (4) (0) (2) (2) (7) (54) 3 3 2 0 3 1 1 4 4 2 3 3 0 2 0 1 2 3 37 (3) (3) (1) (0) (1) (0) (2) (1) (3) (0) (2) (5) (1) (4) (0) (2) (1) (5) (34) 8 8 8 0 8 2 2 9 7 6 6 6 0 4 0 2 4 10 90 1 0 0 0 0 0 0 1 2 0 1 0 0 0 0 0 1 1 7 2 4 2 0 0 2 0 6 6 2 2 0 0 0 0 0 3 2 31 4 4 2 1 3 1 1 3 4 3 3 3 0 3 1 1 2 3 42 3 2 1 0 2 1 1 1 3 1 2 1 0 1 0 1 2 2 24

South West
Barnstaple, North Devon District Hospital Bath, Royal United Hospital Bournemouth, Royal Bournemouth General Hospital Bristol, Bristol Royal Hospital For Children Bristol, Bristol Royal Infirmary Bristol, Frenchay Hospital Bristol, Southmead Hospital Cheltenham, Cheltenham General Hospital Dorchester, Dorset County Hospital Exeter, Royal Devon And Exeter Hospital (Wonford) Gloucester, Gloucestershire Royal Hospital Plymouth, Derriford Hospital Poole, Poole General Hospital Salisbury, Salisbury District Hospital 0 0 3 3 3 11 0 0 0 0 0 4 0 0 (3) (2) (3) (0) (0) (7) (0) (1) (3) (3) (2) (3) (2) (2) 2 3 1 0 5 11 1 1 3 2 3 15 1 2 (0) (4) (2) (0) (5) (10) (0) (0) (0) (2) (6) (11) (3) (1) 2 3 4 3 8 22 1 1 3 2 3 19 1 2 (3) (6) (5) (0) (5) (17) (0) (1) (3) (5) (8) (14) (5) (3) 2 1 2 3 6 17 0 0 1 1 1 12 1 1 (3) (4) (4) (0) (4) (12) (0) (1) (2) (3) (3) (7) (4) (2) 4 6 6 6 14 44 2 2 6 4 6 38 1 4 0 0 0 2 2 3 0 0 0 0 0 1 0 0 0 0 2 4 2 16 0 0 0 2 0 2 0 0 1 1 3 3 7 15 0 0 1 0 1 12 1 1 2 1 2 2 3 8 0 0 1 0 0 2 0 1

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Donating hospital Swindon, Great Western Hospital Taunton, Taunton And Somerset Hospital (Musgrove Park) Torquay, Torbay Hospital Truro, Royal Cornwall Hospital (Treliske) Weston-Super-Mare, Weston General Hospital Yeovil, Yeovil District Hospital Total

DBD 2 2 3 2 1 1 35 (1) (2) (0) (0) (2) (2) (38)

DCD 4 2 5 3 1 1 66 (1) (2) (2) (1) (1) (0) (51)

All donors 6 4 8 5 2 2 101 (2) (4) (2) (1) (3) (2) (89)

Multi-organ donor 3 (1) 3 (4) 6 (0) 5 (0) 1 (3) 1 (2) 67 (59)

Kidney 12 8 14 10 2 4 193

Heart 0 1 1 0 0 0 10

Lung 0 0 0 2 0 0 30

Liver 3 3 7 5 2 1 67

Pancreas 0 2 4 2 0 0 30

West Midlands
Birmingham, Birmingham Children's Hospital Birmingham, Birmingham Heartlands Hospital Birmingham, City Hospital Birmingham, Queen Elizabeth Hospital Birmingham Birmingham, Selly Oak Hospital Burton-On-Trent, Queen's Hospital Coventry, University Hospital Dudley, Russells Hall Hospital Hereford, The County Hospital Nuneaton, George Eliot Hospital Redditch, The Alexandra Hospital Shrewsbury, Royal Shrewsbury Hospital Solihull, Solihull Hospital Stafford, Stafford Hospital Stoke, North Staffordshire Royal Infirmary Stoke-On-Trent, University Hospital North Staffordshire Sutton Coldfield, Good Hope District General Hosp. Telford, The Princess Royal Hospital Walsall, Manor Hospital Warwick, Warwick Hospital West Bromwich, Sandwell General Hospital Wolverhampton, New Cross Hospital Worcester, Worcestershire Royal Hospital Total 1 1 2 12 0 0 8 0 2 1 1 0 0 2 8 0 2 1 2 0 1 4 3 51 (0) (2) (3) (10) (0) (1) (5) (2) (3) (0) (0) (3) (1) (0) (12) (0) (2) (4) (2) (0) (1) (2) (2) (55) 0 0 1 7 0 0 5 1 2 1 3 1 1 0 8 1 2 0 2 1 0 2 2 40 (1) (0) (1) (5) (1) (0) (9) (1) (1) (0) (2) (2) (0) (0) (4) (0) (2) (1) (2) (1) (0) (0) (2) (35) 1 1 3 19 0 0 13 1 4 2 4 1 1 2 16 1 4 1 4 1 1 6 5 91 (1) (2) (4) (15) (1) (1) (14) (3) (4) (0) (2) (5) (1) (0) (16) (0) (4) (5) (4) (1) (1) (2) (4) (90) 0 1 2 17 0 0 9 0 2 1 3 1 1 2 13 1 3 1 2 0 1 5 4 69 (1) (1) (3) (11) (1) (1) (9) (1) (4) (0) (1) (5) (1) (0) (15) (0) (3) (3) (3) (1) (0) (2) (3) (69) 2 2 6 38 0 0 22 2 8 4 8 2 2 3 32 2 6 2 6 2 2 12 8 171 0 0 0 3 0 0 2 0 1 0 0 0 0 0 2 0 0 1 1 0 0 0 1 11 0 0 2 8 0 0 8 0 0 0 2 0 0 0 6 0 4 1 2 0 0 2 3 38 0 1 2 15 0 0 9 0 2 1 3 1 1 2 13 1 3 1 2 0 1 4 5 67 0 0 0 9 0 0 7 0 2 0 1 0 1 1 7 0 1 0 1 0 1 2 2 35

Yorkshire and the Humber
Barnsley, Barnsley District General Hospital Bradford, Bradford Royal Infirmary 0 6 (1) (6) 0 1 (3) (0) 0 7 (4) (6) 0 6 (2) (5) 0 14 0 0 0 4 0 5 0 2

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Donating hospital Cottingham, Castle Hill Hospital Dewsbury, Dewsbury And District Hospital Doncaster, Doncaster Royal Infirmary Grimsby, Diana Princess Of Wales Hospital Halifax, Calderdale Royal Hospital Harrogate, Harrogate District Hospital Huddersfield, Huddersfield Royal Infirmary Hull, Hull Royal Infirmary Leeds, Leeds General Infirmary Leeds, St James's University Hospital Rotherham, Rotherham District General Hospital Scarborough, Scarborough General Hospital Scunthorpe, Scunthorpe General Hospital Sheffield, Northern General Hospital Sheffield, Royal Hallamshire Hospital Sheffield, Sheffield Children's Hospital Wakefield, Pinderfields General Hospital Worksop, Bassetlaw District General Hospital York, York District Hospital Total

DBD 0 1 3 0 2 1 5 5 9 2 1 1 1 1 3 1 2 0 1 45 (0) (0) (3) (2) (1) (0) (0) (8) (7) (2) (1) (0) (0) (4) (6) (0) (2) (1) (1) (45)

DCD 0 1 2 0 0 1 3 4 3 3 3 0 1 2 1 1 2 0 1 29 (1) (0) (2) (0) (1) (0) (1) (5) (6) (4) (0) (0) (0) (4) (3) (0) (4) (0) (0) (34)

All donors 0 2 5 0 2 2 8 9 12 5 4 1 2 3 4 2 4 0 2 74 (1) (0) (5) (2) (2) (0) (1) (13) (13) (6) (1) (0) (0) (8) (9) (0) (6) (1) (1) (79)

Multi-organ donor 0 (0) 1 (0) 4 (3) 0 (2) 2 (2) 0 (0) 6 (0) 5 (7) 9 (7) 1 (3) 1 (1) 1 (0) 1 (0) 2 (3) 2 (9) 2 (0) 2 (2) 0 (1) 1 (1) 46 (48)

Kidney 0 4 10 0 4 2 14 18 24 8 8 2 4 5 8 4 8 0 4 141

Heart 0 0 1 0 0 0 2 1 5 0 0 0 0 0 0 0 1 0 0 10

Lung 0 0 2 0 2 0 8 4 5 0 2 0 0 0 1 0 0 0 0 28

Liver 0 1 3 0 2 1 5 4 9 1 1 1 1 2 2 1 2 0 1 42

Pancreas 0 0 3 0 1 0 2 4 6 1 1 0 1 0 1 2 2 0 0 26

Channel Islands
Guernsey, Princess Elizabeth Hospital St Helier, Jersey General Hospital Total 2 0 2 (0) (2) (2) 1 0 1 (0) (0) (0) 3 0 3 (0) (2) (2) 2 0 2 (0) (2) (2) 6 0 6 0 0 0 0 0 0 2 0 2 0 0 0

Isle of Man
Douglas, Nobles I-O-M Hospital Total 2 2 531 (0) (0) (511) 0 0 370 (0) (0) (326) 2 2 901 (0) (0) (837) 2 2 637 (0) (0) (583) 4 4 1685 1 1 113 2 2 302 1 1 640 0 0 339

England Northern Ireland
Belfast, Antrim Hospital Belfast, Belfast City Hospital Belfast, Mater Infirmorum Hospital Belfast, Royal Belfast Hospital For Sick Children

1 0 1 0

(0) (3) (0) (2)

0 0 0 0

(0) (1) (0) (0)

1 0 1 0

(0) (4) (0) (2)

1 0 1 0

(0) (2) (0) (2)

2 0 2 0

0 0 0 0

0 0 0 0

1 0 1 0

0 0 1 0

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Donating hospital Belfast, Royal Victoria Hospital Belfast, The Ulster Hospital Coleraine, Causeway Hospital Enniskillen, Erne Hospital Londonderry, Altnagelvin Area Hospital Portadown, Craigavon Area Hospital Total

DBD 16 3 3 2 9 1 36 (22) (3) (2) (1) (3) (2) (38)

DCD 2 1 0 0 0 0 3 (1) (0) (0) (0) (0) (0) (2)

All donors 18 4 3 2 9 1 39 (23) (3) (2) (1) (3) (2) (40)

Multi-organ donor 16 (22) 4 (3) 1 (1) 2 (1) 9 (3) 0 (2) 34 (36)

Kidney 33 8 6 4 18 2 75

Heart 3 0 1 0 2 0 6

Lung 15 0 0 0 6 0 21

Liver 16 4 1 2 9 0 34

Pancreas 11 0 1 1 5 0 19

Scotland
Aberdeen, Aberdeen Royal Infirmary Airdrie, Monklands District General Hospital Dumfries, Dumfries And Galloway Royal Infirmary Dundee, Ninewells Hospital Dunfermline, Queen Margaret Hospital East Kilbride, Hairmyres Hospital Edinburgh, Royal Hospital For Sick Children Edinburgh, Royal Infirmary Of Edinburgh Edinburgh, Western General Hospital Glasgow, Victoria Infirmary Glasgow, Golden Jubilee National Hospital Glasgow, Royal Hospital For Sick Children Glasgow, Southern General Hospital Glasgow, Western Infirmary Greenock, Inverclyde Royal Hospital Glasgow, Golden Jubilee National Hospital Inverness, Raigmore Hospital Kilmarnock, Crosshouse Hospital Kirkcaldy, Victoria Hospital Larbert, Forth Valley Royal Hospital Livingston, St John's Hospital Melrose, Borders General Hospital Paisley, Royal Alexandra Hospital Perth, Perth Royal Infirmary Stirling, Stirling Royal Infirmary Wishaw, Wishaw General Hospital Total 2 1 0 9 3 0 1 4 10 1 0 0 2 0 0 2 2 0 1 2 3 1 5 2 1 1 53 (4) (1) (1) (5) (2) (0) (1) (2) (16) (4) (0) (0) (3) (0) (0) (0) (2) (1) (0) (0) (1) (0) (3) (1) (1) (1) (49) 1 0 2 1 3 1 0 3 6 0 2 1 1 2 1 0 0 0 0 0 2 0 0 0 0 2 28 (0) (0) (0) (1) (1) (0) (0) (5) (3) (0) (0) (1) (3) (1) (0) (1) (0) (1) (0) (0) (1) (0) (0) (0) (0) (0) (18) 3 1 2 10 6 1 1 7 16 1 2 1 3 2 1 2 2 0 1 2 5 1 5 2 1 3 81 (4) (1) (1) (6) (3) (0) (1) (7) (19) (4) (0) (1) (6) (1) (0) (1) (2) (2) (0) (0) (2) (0) (3) (1) (1) (1) (67) 3 1 1 10 3 1 1 4 14 1 2 1 2 0 1 2 2 0 1 2 3 1 3 1 1 1 62 (4) (0) (1) (6) (2) (0) (1) (4) (17) (3) (0) (1) (6) (0) (0) (1) (2) (1) (0) (0) (1) (0) (3) (1) (1) (1) (56) 5 2 4 20 10 2 2 13 31 2 4 2 6 3 2 4 4 0 2 4 7 2 6 4 2 6 149 0 0 0 2 1 0 0 0 2 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 6 2 0 0 4 3 0 0 0 6 0 2 0 0 0 0 2 0 0 0 0 1 0 0 0 0 2 22 3 1 1 10 2 1 1 3 14 1 2 1 2 0 1 2 2 0 1 2 3 1 5 1 1 1 62 1 0 1 5 1 1 1 3 10 0 2 1 0 0 0 2 2 0 0 2 0 0 2 0 0 0 34

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Donating hospital

DBD

DCD

All donors

Multi-organ donor 1 1 3 4 6 14 0 1 0 2 3 0 2 5 0 1 43 (7) (2) (2) (1) (6) (16) (3) (2) (0) (0) (2) (0) (0) (2) (0) (2) (45)

Kidney

Heart

Lung

Liver

Pancreas

Wales
Abergavenny, Nevill Hall Hospital Aberystwyth, Bronglais Hospital Bangor, Ysbyty Gwynedd District General Hospital Bodelwyddan, Glan Clwyd District General Hospital Bridgend, Princess Of Wales Hospital Cardiff, University Of Wales Hospital Carmarthen, Glangwili General Hospital Haverford West, Withybush General Hospital Llanelli, Prince Philips Hospital Merthyr Tydfil, Prince Charles Hospital Newport, Royal Gwent Hospital Penarth, Llandough Hospital Pontypridd, Royal Glamorgan Hospital Swansea, Morriston Hospital Swansea, Singleton Hospital Wrexham, Maelor General Hospital Total 1 1 2 2 7 7 0 1 1 2 1 0 2 3 1 1 32 (5) (2) (2) (1) (4) (11) (3) (2) (0) (0) (3) (0) (0) (3) (0) (3) (39) 1 1 1 3 1 14 0 0 2 1 4 0 1 5 0 1 35 (2) (0) (1) (3) (2) (13) (1) (1) (0) (1) (1) (1) (1) (0) (0) (0) (27) 2 2 3 5 8 21 0 1 3 3 5 0 3 8 1 2 67 (7) (2) (3) (4) (6) (24) (4) (3) (0) (1) (4) (1) (1) (3) (0) (3) (66) 4 4 6 10 14 41 0 2 4 6 8 0 4 16 0 4 123 0 0 0 0 2 3 0 1 0 0 1 0 1 2 0 1 11 2 0 2 4 4 7 0 0 0 0 0 0 0 2 0 0 21 1 1 3 3 7 13 0 1 1 2 4 0 3 5 1 1 46 0 0 2 0 1 7 0 1 0 2 1 0 1 2 0 1 18

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Appendix IIA Numbers of donors after brain death and organs retrieved in the UK, 1 April 2011 - 31 March 2012, by country/SHA Country/Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL All donors 41 63 48 152 32 50 68 150 75 54 47 43 144 521 3 2 37 53 36 652 pmp 15.7 9.1 9.1 10.2 7.1 9.2 11.7 9.5 9.6 12.3 11.4 8.2 10.4 10.0 37.5 13.3 12.3 10.2 20.0 10.4 Donors Multi-organ donors 37 56 41 134 29 44 62 135 67 49 46 41 136 472 3 2 34 47 32 590 pmp 14.2 8.1 7.7 9.0 6.5 8.1 10.6 8.6 8.6 11.2 11.1 7.8 9.9 9.0 37.5 13.3 11.3 9.0 17.8 9.4 Kidney 78 114 89 281 63 90 125 278 135 97 90 82 269 963 6 4 70 97 69 1209 Heart 8 14 10 32 4 11 19 34 17 11 3 12 26 109 2 0 12 7 6 136 Organs Lung 29 36 23 88 10 32 17 59 40 35 16 26 77 264 2 0 17 22 19 324 Liver 35 56 40 131 28 45 66 139 72 51 47 43 141 483 2 2 36 49 32 604 Pancreas 24 28 21 73 17 25 30 72 44 31 18 24 73 262 0 0 16 28 18 324

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Appendix IIB Numbers of donors after circulatory death and organs retrieved in the UK, 1 April 2011 - 31 March 2012, by country/SHA Country/Strategic Health Authority North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL All donors 28 47 30 105 29 37 52 118 32 23 19 69 111 366 0 1 38 28 3 436 pmp 10.7 6.8 5.7 7.1 6.5 6.8 8.9 7.5 4.1 5.2 4.6 13.1 8.0 7.0 0.0 6.7 12.6 5.4 1.7 7.0 Donors Multi-organ donors 6 14 8 28 12 16 18 46 19 10 12 39 61 154 0 0 16 14 2 186 pmp 2.3 2.0 1.5 1.9 2.7 2.9 3.1 2.9 2.4 2.3 2.9 7.4 4.4 2.9 0.0 0.0 5.3 2.7 1.1 3.0 Kidney 53 92 60 205 56 69 103 228 53 40 37 133 210 696 0 2 69 50 6 823 Heart 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Organs Lung 2 0 2 4 3 4 3 10 2 2 0 14 16 32 0 0 4 4 2 42 Liver 6 12 7 25 9 16 15 40 20 12 12 37 61 146 0 0 17 13 2 178 Pancreas 2 8 3 13 8 6 11 25 10 5 5 14 24 72 0 0 6 7 1 86

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Appendix III SHA

Populations for SHA's, 2011-2012 Mid-2010 estimates based on ONS 2001 Census figures Retrieval population million 2.61 6.94 5.30 14.85 4.48 5.46 5.83 15.77 7.83 4.39 4.14 5.27 13.80 52.23 0.08 0.15 3.01 5.22 1.80 62.49

North East North West Yorkshire and The Humber North of England East Midlands West Midlands East of England Midlands and East London South East Coast South Central South West South of England England Isle of Man Channel Islands Wales Scotland Northern Ireland TOTAL

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