Table 1: Summary of the key elements of reform Key elements of reform Spain Croatia Portugal Australia United Kingdom European Union (EU) An appropriate legal and ethical framework introduced organ donor legislation in 1979, which established presumed consent Croatia implement a presumed consent system in 1988 and a new Transplant Act in 2013 Portugal introduced transplant legislation in 1993 and revised it in 2007 The Australian system of organ donation is based on an informed consent (‘opt in’) model. Individuals have the option to record intent to donate their organs after death on the Australian Organ Donor Register. Transplantation guidelines for ethical practice for health professionals were developed by the National Health and Medical Research Council (NHMRC) in 2007 Guidance on donation was published for each country and an UK Donation Ethics Committee was established in 2010 A national coordinating body A national coordinating body was established in 1989 A National Transplant Coordinator was appointed in 2001 and the Ministry of Health employs staff responsible for manage reform initiatives and a coordination office A national coordinating body was introduced in 2007 and amended in 2012 A national coordinating body was officially established in 2009 and is responsible for implementing the reform programme The role of the NHS Blood and Transplant was expanded to be the organ donation organisation for the whole of the United Kingdom The EU issued a directive requiring member states to identity a Competent Authority with responsible to ensure compliance with various quality and safety requirements Hospital-based clinical donation specialists Dedicated clinical staff were introduced in 1995 Hospital based teams of Transplant Coordinators were initially established from 1998-2000 Hospital Donor Coordinators were appointed in 2007 and 2008. A network of donation specialists – the DonateLife Network - was established across Australia Clinical leads for organ donation were appointed and the Specialist Nurse for Organ Donating network was reconfigured and expected to increase by 146% (as at 2011) The action plan included an action to promote transplant donor coordinators Specialist training for clinical staff in management of deceased donation process and family donation conversations Training on organ donation was first made available in 1991 and is mandatory for all doctors specialising in intensive care Professional training to clinicians was first made available in 2003 and remains an ongoing priority Professional training was made available in 2008 and all staff employed as Hospital Donor Coordinator receive specific training Specialist training for clinical staff in management of the deceased donation process and family donation conversations are available as part of the Professional Education Package The taskforce recommended all clinical staff likely to be involved in the treatment of potential organ donors receive mandatory training in the principle of donation The action plan included an action to improve the knowledge and communication skill of health professionals and patient support groups on organ transplantation
Table 1 Continued: Summary of the key elements of reform Key elements of reform Croatia Portugal Australia United Kingdom European Implementation of a clinical governance framework that supports quality assurance and audit of hospital clinical practice and governance of donation process Quality assurance programme is on a continuous clinical chart review of all deaths occurring in critical care units. It includes both an internal and external audit Hospital audits were initially commenced in 2002 and have been gradually refined into a clinical practice improvement programme and quality assurance process by 2010 As of 2013, Portugal was planning its method for conducting hospital audits Reporting and auditing of organ and tissue donation practice has been enhanced and embedded across hospitals in the DonateLife Network. In March 2012, the DonateLife leadership the Clinical Governance Framework (CGF) and Clinical Practice Improvement Program (CPIP) was established to support and guide DonateLife Network (DLN) staff in achieving the national objective of increasing organ and tissue donation rates across Australia Data on donation activity is issued to the national body every six months and used to monitor performance The EU issued a Directive requiring member states to establish and maintain a framework for quality and safety. The action plan included an action to promote quality improvement programmes Financial support to donor hospitals to ensure that costs related to management are not a barrier to donation A specific budget is allocated to fund the donation management at hospital In 2006 a funding model was introduced to ensure hospitals are funded for all additional costs associated with organ and tissue donation Financial support for organ donation activity was introduced in 2006 and revised in 2011 Organ Donation Hospital Support Funding (ODHSF) provides a contribution towards the costs associated with organ donation activity An analysis of the costs involved in the management of potential organ donation was undertaken and additional funding provided to cover these costs engagement and national community awareness and education The national coordinating body utilises media to promote organ donation through the dissemination of positive news Coordinated public awareness campaigns have been progressively introduced 1998 Since 2009, the national body has organised joint community events and has worked with the media on general awareness National community awareness and education campaigns were implemented, including engagement with culturally and linguistically diverse communities A high-prolife, campaign to promote organ donation was launched in 2009, followed by targeted campaigns in early 2010. The action plan included an action to improve the knowledge and communication skill of health professionals and patient support groups on organ transplantation International cooperation to share best practice Joined the Eurotransplant in 2007 Australia has based its reform on international best practice through engagement with high performing countries The action plan included an action to facilitate the identification of donors across Europe and donation trial