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Welcome to the Human Tissue Authority IA bulletin
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Issue 46 / December 2015

Welcome to issue 46 of the Independent Assessor (IA) bulletin.

This month’s issue contains information on: We would like to take this opportunity to wish you a very Merry Christmas and a happy and peaceful New Year.  We look forward to continuing to work with you all in 2016. 

As always, please contact us if you have any questions or comments. 

Referral letters

Living Donor Coordinators (LDCs): Please ensure that you keep copies of all referral letters until the HTA has made a decision on a case. These are statutory referrals made to the HTA and occasionally we will request copies of referral letters directly from units if there are errors in the information provided or if they get lost or delayed in the post. Please ensure the letters are accurate before sending to IAs and the HTA to avoid delays. From 1 February 2016 the HTA will not assess cases until this documentation has been received. This is already the case for those cases requiring panel decision.

Independent Assessors: Please be aware that referral letters and donor declarations must be sent to the HTA promptly after interviews have taken place. The referral has not been made to the HTA until this information has been received. Where possible they should be uploaded along with the report as this makes it much easier for staff at the HTA and ensures efficient and timely case assessment. From 1 February 2016 the HTA will not assess cases until this documentation has been received. This is already the case for those cases requiring panel decision. 

Discussion of risks specific to the donor

Living Donor Coordinators: If a donor has a particular medical condition that may create specific risks to them, these risks should be discussed during the work up to ensure the donor has a full understanding of the implications. This should be documented in the referral letter to the HTA.

Independent Assessors: If risks to the donor due to specific medical conditions are mentioned in the referral letter they should be discussed with the donor during the independent assessment to ensure the donor has a full understanding and is aware of any specific implications to them.  Please document that conversation in the report to the HTA.

Conflicts of interest

Independent Assessors: Please be aware that when undertaking an independent assessment the donor and recipient should not be known to the IA. If there is a conflict of interest with a referral please contact the HTA for advice or contact the person making the referral to ask that the case is re-assigned to an alternative IA.

Difference between directed and directed altrusitc donations

Please take care when categorising donations as directed or directed altruistic donation. Directed donation is where a healthy person donates an organ to a specific, identified recipient with whom they have a genetic or pre-existing emotional relationship e.g. spouse, sibling, long standing friend.  

The HTA describes a spectrum of relationships that constitute directed altruism and defines two categories:
  1. Genetic relationship and no established emotional relationship
  2. No pre-existing relationship between donor and recipient prior to the need for a transplant
Please be vigilant when selecting the category of donation on the IA report and ensure that it matches the category stated on the referral letter as a number of cases recently have been incorrect.  This has led to a great deal of confusion and is very timely to correct. Comprehensive information on the correct categories of donation can be found in the HTA Guidance to Transplant Teams and Independent Assessors

Management of cases requiring prompt HTA approval

The HTA has seen an increase in requests for cases to be considered with very short turnaround times, where the surgery date is scheduled within a week of the IA interviews. While we accept, in some circumstances, the need for a prompt turnaround where it is unavoidable we would like to remind you of our service standards so that suitable plans can be made by units: 

We aim to assess all: 
  • non-panel cases within five working days of submission to the HTA, and 
  • panel cases within ten working days (of the case being referred to the panel)
The timeline begins once we have received all the information required in order to consider a case as we may need to seek further information. 

It is the responsibility of the clinician or LDC to notify us of a case requiring a prompt turnaround. 

We will always try our best to support with these requests to ensure surgery dates can be met. However, the more frequently this happens, the greater the risk that we are unable to do so. Please continue to schedule as much time as possible for IA assessment and HTA decision in all cases.  

Christmas office opening hours for transplant assessmnets

The HTA office is closed on: 
  • Friday 25 December 
  • Monday 28 December 
  • Friday 1 January 
Members of the Living Donation Assessment Team (LDAT) will be available throughout the festive period as usual (except for the three dates above). 

*Please note: We will not be referring cases to panel between 23 and 30 December.

Changes to living donation team structure 

Jess Porter has taken up a new post as Head of Regulation within the HTA so will be less involved in the operational day to day enquiries on living donation. Dr Chitvan Amin will be taking over from Jess as the new Transplant Manager in the New Year. Chitvan can be contacted on the following:

E-mail Chitvan
HTA switchboard: 0207 269 1900

Please continue to direct enquiries to this email address to ensure a timely response or call 0207 269 1969. 

Re-accreditation

The process of IA re-accreditation is currently under way. All reports submitted between 1 December 2014 and 30 November 2015 will be taken into consideration. Re-accreditation assessments and refresher training (if necessary) will take place in the New Year in order for accreditation notices to be sent out in March 2016. All re-accreditation notices and information will be sent electronically so please keep an eye on your inboxes. 

Actions from the HTA internal audit

Independent Assessors: As you are aware it has been recommended in a recent HTA internal audit report that DBS checks (or equivalent) must be in place for all IAs. This has been very complex and we are still considering the next steps in light of legal advice that has been received recently. We will be in contact as soon as possible to update you on this. 

IA recruitment

If there is a definite need for additional IAs at your transplant unit and you know of anyone that would be interested in becoming an IA, please let us know and we can reserve a place for them at the next training session which will take place on 26 March 2016.  

Amendments to the portal form

Independent Assessors: Please be aware that the portal form through which IA reports are submitted will be amended in early 2016. In Section G the two questions confirming the absence of duress, coercion and reward will each be separated into two questions, one focussing on discussions held with the donor and one focussing on discussions held with the recipient. These changes are being made as these are the areas in which we regularly have to seek further clarification from IAs. This change should enable clearer reporting of the discussion with both the donor and the recipient.  

If you have questions regarding these changes please let us know and thank you for your understanding. 

 
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