Dr Gardiner is a Consultant in Adult Intensive Care Medicine at Nottingham University Hospitals NHS Trust, UK. Through an interest in ethics, the diagnosis of death and deceased organ donation he has been a Clinical Lead for Organ Donation since 2009. In June 2018 he was appointed national Clinical Lead for NHS Blood and Transplant. Dr Gardiner is chair of Nottingham’s Ethics of Clinical Practice Committee and co-chair in a European deceased donation ethics working group (ELPAT). He served for four years as a member of the UK Donation Ethics Committee until its closure in 2016

1. Dr Dale Gardiner
National Clinical Lead for Organ Donation
Consultant in Intensive Care Medicine, Nottingham
dale.gardiner@nhsbt.nhs.uk
@dalecgardiner
Opt in, Opt out:
Shaken not stirred?

2. Opt in, Opt out:
STIRRED not SHAKEN

3. SOA18
UK Deceased Organ Donation
609 612 623 637 652 705 780 772 785 829 955
200 288 336 373 436
507
540 510 579 584
619
0
200
400
600
800
1000
1200
1400
1600
DBD Donors DCD Donors

4. SOA18
UK Deceased Organ Donation
609 612 623 637 652 705 780 772 785 829 955
200 288 336 373 436
507
540 510 579 584
619
0
200
400
600
800
1000
1200
1400
1600
DBD Donors DCD Donors
13.4 pmp
24.1 pmp
95% more donors
80% increase in pmp

5. SOA18
WHO should I thank?

6. SOA18
50
55
60
65
70
75
80
0
5
10
15
20
25
PercentConsent/
AuthorisationRate
MillionsofPeopleontheODR Organ Donor Registrations (ODR)
over time
38% of the
population

7. SOA18
50
55
60
65
70
75
80
0
5
10
15
20
25
PercentConsent/
AuthorisationRate
MillionsofPeopleontheODR Organ Donor Registrations (ODR)
and Consent / Authorisation Rate over time

8. SOA18
DBD
Donation after
Brainstem Death
DCD
Donation after
Circulatory Death
I thank
approached
39% more
families
approached
644% more
families
the secret of UK improvement
From 2007 to 2017

9. SOA18
0
1500
3000
4500
6000
7500
9000
Transplant waiting list
Transplants from
Deceased and Living
Donors
Transplants from
Deceased Donors
Transplants from Living
Donors
Transplants and the transplant waiting list 2002 - 2018
Transplant waiting list has fallen for 8 consecutive years

10. SOA18
Cross party support
Opt out

11. SOA18
Current UK Legal Basis for Consent / Authorisation
Opt-In Opt-Out
England
X
(In process of changing law)
Scotland
X
(In process of changing law)
N. Ireland X
Wales X
Jersey
X
(But not yet ‘live’)
Guernsey X
Isle of Man
X
(In process of changing law)

12. SOA18
UK Legal Basis for Consent / Authorisation in 2021 ?
Opt-In Opt-Out
England X
Scotland X
N. Ireland X
Wales X
Jersey X
Guernsey X
Isle of Man X

13. SOA18
Scotland
Progress to date/ ongoing
• Major legislative bill to introduce Deemed Authorisation.
• Committee stage underway.
• Bill introduces new legislation regarding pre-death procedures.
• Scotland does not use ‘best interests’ or the Mental Capacity Act.
• Adults with Incapacity (Scotland) Act 2000, authorises medical treatment ‘to safeguard or
promote the physical or mental health of the adult.’
• Bill outlines requirements for standard and non-standard donation pre-death procedures.
Next steps
• Consideration of draft report in January 2019
• Stage 1 Debate March 2019.
• ? Enacted: Summer 2019: Go Live: Summer 2020

14. SOA18
England
Progress to date/ ongoing
• Amends the current Human Tissue Act 2004.
• Government response to public consultation, includes new actions:
• NHSBT is working with DH and NHS Digital to integrate the ODR with the new
NHS App. Initial service will launch mobile web pages. With full ‘Push and
Pull’ facility aimed for 2019.
• Introducing a new button on the ODR to support faith / belief declaration.
• The Bill includes a requirement for a one year public information campaign in
advance of implementation; aim of ensuring that at least 80% of the public are
aware of the law change,

15. New (non mandatory)
Faith Question in the ODR
SOA18
Go Live: within days

16. SOA18
England
Legislation process
• House of Commons: Bill passed by Committee with
unanimous support and passed 3rd Reading.
• House of Lords: Bill passed 2nd reading with
unanimous support.
? Go Live: April 2020
? March 2019

17. SOA18
England
Deemed Consent Legislation
1. Adults.
2. Ordinarily resident in England for 12 months immediately before
dying.
3. Who have not expressed or recorded a decision.
4. Who did not lack capacity for a significant period before dying.
5. Who die in England.
6. Human Tissue Authority empowered to give practical guidance.

18. SOA18
England
‘… we will make sure that there are enough
highly trained staff to make the most of the
changes resulting from this Bill. Our current
estimate is that 27 more nurses would be
required but, of course, if that number were to
rise, we would make sure that they are fully
trained and fully financed for the future.’
Lord O’Shaughnessy
Parliamentary Under Secretary of State for Health (Lords)
• English Government commitment to extra 100 donors and 700 transplants.
• Unique opportunity to improve organ donation and transplant infrastructure.

19. SOA18
Number of eligible DBD donors approached
Standardisedteststatistic
Deemed Consent in Wales (since December 2015)
Detect 10%
difference in
consent rate
at < 0.05
significance
Wales better
England better
Quarterly Monitoring
DBD

20. SOA18
DBD consent rate
1 April 2018 to 31 September 2018, data as at 8 October 2018

21. SOA18
Number of eligible DCD donors approached
Standardisedteststatistic
Deemed Consent in Wales (since December 2015)
Detect 10%
difference in
consent rate
at < 0.05
significance
Wales better
England better
Quarterly Monitoring
DCD

22. SOA18
DCD consent rate
1 April 2018 to 31 September 2018, data as at 8 October 2018

23. SOA18
All Wales donor numbers
YTD
October
2018
=
7
months
Predicted 15 extra donors / year

24. Families strong armed. X
Why is it working?
1. Advertising. ✓
2. Confidence. ✓
1 + 2 = Donation expected. ✓

25. SOA18
0
5
10
15
20
25
30
35
40
45
50
International deceased donors pmp, 2016
DBD DCD

26. SOA18 www.orgamites.com
STIRRED not SHAKEN