3 Auditing and Monitoring

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3.1 TSANZ Advisory Committee Audits 3.2 ADTCA-TSANZ-OTA National Organ Allocation, Organ Rotation, Urgent Listing 3.3 Data collection 3.4 Governance

3 Auditing and Monitoring

The distribution and allocation of organs for transplantation in Australia is supported by the national Standard Operating Procedure (SOP): Organ Allocation, Organ Rotation, Urgent Listing. The national SOP was developed by the Australasian Donation & Transplant Coordinators Association (ADTCA), the Transplantation Society of Australia and New Zealand (TSANZ) and the Organ and Tissue Authority (OTA).

3.1 TSANZ Advisory Committee Audits

TSANZ has a number of Advisory Committees that act as peak bodies for their organ-specific special interest groups, advising in the areas of recipient eligibility, donor organ retrieval, allocation and utilisation of organs for transplantation. TSANZ Advisory Committees undertake regular scheduled auditing of organ-specific allocation and transplantation activity at local, state and national levels. Activities and outcomes that are audited include organ utilisation, inter-jurisdictional organ sharing, and the reasons why potential donors do not proceed to transplantation. Audit outcomes are reviewed at Advisory Committee meetings twice yearly and discussed at meetings of the OTA’s Transplant Liaison Reference Group, which are held three times per year.

3.2 ADTCA-TSANZ-OTA National Organ Allocation, Organ Rotation, Urgent Listing

The ADTCA-TSANZ-OTA national organ allocation audit is retrospectively conducted on a monthly basis to ensure strict adherence to the national SOP for organ allocation, rotation of inter-jurisdictional organ offers and listing for urgent transplantation. Data are collected on the number and characteristics of organs retrieved, utilisation outcomes, the number of offers made in each jurisdiction, and detailed reasons for declined offers. Deviations from the standard allocation rotation are documented and accompanied by a detailed explanation of clinical reasons supporting the decision. Urgent listings and their impact on the national rotation are also monitored and audited. Quarterly progress reports and an annual summary report are produced by ADTCA for final approval by TSANZ and OTA before broader distribution.

3.3 Data collection

Data related to organ donation and transplantation activity are required for the purposes of monitoring, to demonstrate adherence to the national SOP, and to enable the identification of opportunities to improve the care of donors, the donation and transplantation process, and recipient outcomes. The Australia and New Zealand Organ Donation (ANZOD) Registry, together with the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), the Australia and New Zealand Liver and Intestinal Transplant Registry (ANZLITR) and the Australian and New Zealand Islet and Pancreas Transplant Registry (ANZIPTR), record and report on organ donation and transplantation activities and outcomes within Australia and New Zealand.

Through these registries,1,2 information is made publicly available on:1 http://www.anzdata.org.au 2 http://www.anzlitr.org ×

  • The number of organs donated by deceased donors, including a comparison with international donation rates

  • Organ donation pathways (e.g. whether donation occurred after neurological determination of death or donation after circulatory determination of death, whether donation proceeded and, if not, reasons why)

  • The number of people awaiting transplantation for each organ type

  • The number of organs transplanted, including reasons why donated organs were not transplanted

  • Outcomes of organ transplantation.

The data collected on donation and transplantation are used by specialist advisory committees at the federal, state, and professional level to review, audit and monitor organ donation and transplantation practices. Registry reports do not include information that would allow identification of donors or recipients. However, in the event of a medical necessity the capacity exists to link donor data to the recipient(s) via transfer of medical (but not identifying) information about the donor to the transplant teams. An example of a reason for this to occur would be in the situation of an infection in a transplant recipient that might have been transmitted through the donated organ.

3.4 Governance

TSANZ is a company Limited by Guarantee, professional membership society and governed by a constitution. TSANZ Advisory Committees operate under the governance of the TSANZ Board, elected from the broader TSANZ membership. The organ-specific Advisory Committees have individual terms of reference (see Appendix A), and Advisory Committee Chairs meet annually with the Chair of the TSANZ Advisory Committees and Working Groups who is a member of, and reports to, TSANZ Board.

ADTCA promotes communication and collaboration amongst organ and tissue donor coordinators and transplant coordinators in Australia and New Zealand. ADTCA collaborates with regional and international associations or societies interested in transplant coordination and related subjects. The ADTCA President (or delegate) is a member of the TSANZ Board, and ADTCA is represented on all TSANZ Advisory Committees and Working Groups.

The OTA is a statutory authority within the Australian Government Health portfolio and works with Australian states and territories, clinicians, and the community sector to implement the Australian Government’s national reform programme to increase organ and tissue donation for transplantation.