Donor Safety Committee

The LTSI Donor Safety Committee is a multidisciplinary group within the LTSI, headed by the President. Its aim is to improve donor safety standards and to support transplant teams in crisis situations.

Aims:

  1. Develop standard of care guidelines for liver donor hepatectomy.
  2. Provide a support network of experienced LDLT clinicians who give confidential advice on clinical issues and dilemmas regarding live donor hepatectomy.
  3. Perform an unbiased peer review in the event of a live donor mortality, and act as a liaison between transplant units and regulatory authorities (NOTTO and SOTTO).

Constitution of the Committee:

Chair: LTSI President

Ex-officio executive members: Past-president, Secretary, Treasurer

Additional members are nominated by the LTSI President for 2-year terms. They must satisfy all of the following criteria:

  • Full members of the LTSI
  • From centers performing at least 50 LDLT per year
  • From centers actively contributing to the ILTR

Current Members:

Chair

  • Prof Mohamed Rela (Chair)

Ex-officio Members

  • Dr Sonal Asthana
  • Dr Abhideep Chaudhary
  • Dr Mettu Srinivas Reddy

Nominated Members

  • Dr Sanjiv Saigal
  • Dr Vijay Vohra
  • Prof Sudhindran S
  • Dr Shaleen Agarwal
  • Dr Viniyendra Pamecha
  • Dr Kauser Makki
  • Dr Zubair Umer Mohamed
  • Dr Selvakumar Malleeshwaran

Areas of Work:

1. Development of donor guidelines

  • Live donor evaluation guidelines
  • Donor hepatectomy: postoperative care protocols
  • A multi-lingual consent form for live donor hepatectomy

2. Guidance for LDLT teams during donor evaluation or for unexpected intraoperative issues

The concerned surgeon or anaesthetist can contact any member of the DSC team for advice and guidance. If the member feels it is necessary, they can discuss the case with other committee members and then provide guidance.

3. Crisis support during ongoing donor complications

The surgeon or anaesthetist in a transplant team can contact any DSC member for advice about a live donor with an unexpected postoperative course. The member approached first depends on the clinician's choice and the DSC member's availability. It may also depend on the nature of the problem: surgical, anaesthesia or ICU.

If the contacted DSC member feels it is necessary, they can discuss the case with other committee members on a semi-elective basis. In special circumstances, the member or committee can also seek advice from other specialists (radiology, IR, hepatology, ID) before refining the advice. All of this is done confidentially, with patient and center information anonymised as far as possible.

Any discussion of an evolving donor situation with a complication of grade 3B or higher (reoperation or organ failure) will be communicated to the Taskforce Chair. These cases should be followed until resolution, and the initiating member should write a brief report for the record.

The treating team should document the discussions and the advice given by the DSC in the donor's medical file. This provides legal safety cover for the team and hospital in case of any untoward donor event.

4. Role of the DSC in the event of a reported live donor mortality

The DSC team should investigate any perioperative mortality after live donor hepatectomy (within 90 days). The aim is to review the perioperative management and identify areas of improvement, if any. The DSC will write to the clinical team, the hospital and SOTTO/ROTTO with a summary of its findings and recommendations.

Information about a donor death may come directly from the donor team. Alternatively, the LTSI President can contact the donor team based on information from SOTTO or other sources.

DSC report

The DSC meets every 3 months on Zoom, and during the annual and mid-term meetings, to review the work done and identify areas for improvement.

A summary of each case referred to the DSC should be prepared at the end of each donor event where the DSC is involved. The report should cover the nature of the problem, the advice given, the treatment actually provided, the eventual outcome and any learning points. Anonymised reports can be collated and published in JCEH every year as the LTSI Annual Liver Safety Report.

Process for Discussing a Case Confidentially:

  1. Transplant team contacts any DSC member by phone or by email at ltsi.donorsafety@gmail.com.
  2. Initial discussion of the case, and plan of action agreed.
  3. Transplant team sends a formal email to the DSC with anonymised details of the case. The DSC member replies with the discussed action plan.
  4. DSC member can contact more members of the DSC to discuss the case confidentially. Any updated advice is forwarded to the treating clinician.
  5. Transplant team documents the details of the discussion and the proposed management plan in the patient notes for legal purposes.

DSC Flowchart

DSC Flowchart