Dr Shibu Chacko MBE
Specialist Nurse in Organ Donation (SNOD)
NHS Blood and Transplant UK.
Location London
Activity
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Dr Shibu Chacko MBE made a comment
I am keen to help students to find their best course in the UK
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Dr Shibu Chacko MBE made a comment
Hello I am a Consultant from UK
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@LornaH-M Organ transplants are not carried out purely on the basis of blood group matching alone; it is a complex matching process using tissue typing and HLA compatibility as well. All these matches have to be in place prior to proceeding with a transplant.
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@DzifaTorkornoo
According to the NHSBT figures, common blood groups among the UK population are as below.
O positive: 35%
O negative: 13%
A positive: 30%
A negative: 8%
B positive: 8%
B negative: 2%
AB positive: 2%
AB negative: 1%
Data accurate at December 2018. Percentage figures have been rounded to the nearest whole number.
Blood groups - O Rh... -
In the UK there is a high proportion of people from these ethnic backgrounds developing high blood pressure, diabetes and certain forms of hepatitis making them more likely to need a transplant at some point in their lives. Blood and tissue types need to be a match for the transplant to be a success and people from the same ethnic group are more likely to be...
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Testing for rabies is not a usual investigation carried out in the UK; but the nature and types of investigations needed are always decided based on the medical, social and travel history assessment during the donor characterisation process by following the national guidelines.
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@MatthewHennessy Please follow this link for more information
https://www.nbta-uk.org.uk/wp-content/uploads/2019/04/BAME-Donation-review-29.5.18.pdf -
Dr Shibu Chacko MBE replied to nicola smith
@nicolasmith Thank you for your feedback, please feel free to download and save the materials for future reference. Hope you will enjoy the second week too.
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Dr Shibu Chacko MBE replied to Jolene Galbreath
@JoleneGalbreath Thank you for your feedback, please feel free to download and save the materials for future reference. Hope you will enjoy the second week too.
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@EmilyJ Currently, England has an opt-in system to sign up to the ODR, but is moving to an opt out system from Spring 2020. More information can be found on the following link.
https://www.organdonation.nhs.uk/helping-you-to-decide/about-organ-donation/faq/what-is-the-opt-out-system/ -
@SharonCastellanos The upper age limit for donors varies among different transplant organisations in various countries. In the UK, 85 years is the upper age limit for potential donors. The council of Europe document attached in this section will provide you an insight into the practices and standards among the various EU countries.
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Bone marrow / stem cell can/only be donated by living donors after matching a donor and the potential recipient. The stem cells are separated from the donors blood using a cell-separator machine without the need for a general anaesthetic.
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Welcome @AlisonBlake-Reed to the course. Hope the learning will help you to better support the organ retrieval’s in future.
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Welcome @MohammadShabbir to the course. Hope you will enjoy learning with us.
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@TEMITAYOFASUYI The recipient of an organ transplantation can donate any of their organs for transplantation after their death except the one/s they have received.
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@brendanO'Neill Welcome to the course.
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A small bowel transplant may be considered for people with bowel failure who develop complications from total parenteral nutrition (TPN), or if TPN isn't possible. A small bowel (intestinal) transplant is an operation to replace a diseased or shortened small bowel with a healthy bowel from a donor.
It's a complicated and highly specialised operation that's... -
@JoelAllotey Thank you for sharing the story
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Dr Shibu Chacko MBE replied to philippa parkinson
@philippaparkinson Currently anyone upto the age of 85 can be considered as an organ donor in the UK, if that patient dies in circumstances where organ donation is possible. This will be explained in detail on week 2. Also organ matching is performed based on several factors such as HLA typing, donor organ function, microbiology screening, donor size etc in...
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In India, organ donation is allowed among patients who are not directly related, but the practices and guidelines may vary in various states. For example, the organ donation and transplantation activities are strictly monitored and coordinated by the department of health in Kerala who has set out strict guidelines on brain stem death testing, retrieval and...
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Skin donation is considered as tissue donation and it is normally used to help patients with burn injuries. The donated skin is retrieved form deceased human donors only.
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Dr Shibu Chacko MBE replied to Janine Langthorne
The corneal donation is not carried out in the theatre and is performed by experts in the mortuary within 24-48 hours of death. The corneal donation doesn't leave any marks or bruises as well.
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Coroners are independent judicial officers who enquire into those deaths reported to him or her. It is the Coroner’s duty to find out the medical cause of the death, if it is unknown, and to enquire about the cause of it if it was due to violence or otherwise appears to be unnatural. There are a number of occasions when a death will need to be reported to the...
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@MilercyOliverosFonseca The link is working now. Thank you
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You are welcome @YokoKawazoe
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@YvonneNicolson Maximum 4 hours from the withdrawal of treatment. Thanks
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@SamanthaMoore Thank you for sharing your experience. Could you please share a bit more about your experience as I am very keen to know why you felt as an unpleasant procedure even though it is a non invasive and straightforward procedure? Is it the emotional aspect you found it hard?
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Dr Shibu Chacko MBE replied to Ted Lambert
@MarB Thank you for all your comments.
Please feel free to post the hyperlinks of the research articles and evidences you have quoted in your comments here rather than just the names of authors. It will be hard for the learners to search for an evidence or article with just the authors name.For example, a link to management of heartbeating brain...
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Dr Shibu Chacko MBE replied to Ted Lambert
Dear learners from all around the globe,
Thank you all for your comments and participation in the course discussions and we the course leaders really enjoyed it from the beginning. This course is designed following all the accepted guidelines and protocols in the UK and is mainly aimed at healthcare professionals with an interest in Organ Donation. We have...
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Dr Shibu Chacko MBE replied to Ted Lambert
@TedLambert Let me please reiterate - organ donation is only facilitated from eligible patients who are declared DEAD either by following the neurological criteria or by the cardio respiratory criteria. So a dead person doesn’t require any anaesthetic drugs and this doesn’t have any impact on the quality of the organs. The quality of the Organ depends on the...
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Dr Shibu Chacko MBE replied to Ted Lambert
@BarbaraK-S Agree with you. First of all the AMU is not the place for organ retrieval; this has to be done in a sterile theatre. Secondly, AMU doesn't have the facilities or expertise to manage a brain-dead patient on multiple infusions on a ventilator - this is only possible in an ICU. I also felt that the story is far from true.
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@MayaVio maybe this will be an area which will develop in the future!
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Dr Shibu Chacko MBE replied to Ted Lambert
@MarB
1. "whoever thinks of turning off the ventilator for several minutes" - During apnoea testing, the patient is disconnected from the ventilator for 5 minutes to check whether the patient can initiate a breath with the rise in CO2 levels. During this period, the patient is attached to an oxygen source to maintain the oxygen levels and is... -
@MarB The research on organ donation and transplantation is evolving rapidly with new technologies on preservation and transplantation. A dead body is never electively intubated and attached to a ventilator for the purpose of donation. Organ donation is only considered if a patient becomes brainstem dead on a ventilator. Donation by cardiorespiratory...
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@MarB
6. "don't hear about all the complications, the shelf life of organs" - The complications are well communicated to all the potential recipients prior to going on the transplant waiting list and are well aware of it. The transplantation is always risky, but it will bring quality to the life of the recipients, at least for a number of years,... -
@MarB
1. "When you travel you are under the law of that country in this case and when not registered there, you are a donor" - Certainly NOT the case in UK for Organ Donation - Please refer to the Human Tissue Act and Welsh Legislation before causing confusion among other learners - The law is only applicable for ordinary residents - Visitors are... -
@LucyAlford @NiculinaBica Following the donation, the patients body is washed and appropriate clothing is put on. Sometime family members also wanted to be part of this process. If the patients body is going for post mortem, the coroner usually instructs us to leave all the lines, drains, tubes etc. in place following the donation. As a registered medical...
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Dr Shibu Chacko MBE replied to Lucy Alford
@LucyAlford The theatre staff members are always very helpful to complete the last offices for the patient, even though this is not something they do on a day to day basis. Bed pressures with in ITU are always understandable!
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@stellashackle Following the minimum period of observation and the clear evidence of irreversible brain injury, the clinical tests for brain stem death declaration are performed. The tests are done by two doctors - one must be a Consultant and second doctor must be some with 5 years post registration experiences.
This is not difficult in UK standards as...
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@stellashackle The head elevation at 30 degrees is maintained for all patients to reduce the possibility of aspiration of oropharyngeal secretions and subsequent development of aspiration / ventilator associated pneumonia which may prevent the potential donor from donating his / her lungs.
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@MarB Thank you for your comment and the information on systems practiced in other countries.
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@MarB Thank you for your comments. This course is designed based on the guidelines published by the UK Intensive Care Society, Academy of Medical Royal Colleges, Royal college of physicians, European Directorate for the Quality of Medicines & HealthCare, Royal College of Emergency Medicine, Faculty of intensive care Medicine, The National Organ...
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Dr Shibu Chacko MBE replied to Ted Lambert
@MarB
Please see the links to the Welsh legislation on organ donation.
https://www.hta.gov.uk/sites/default/files/Code%20-%20Human%20Transplantation%20Wales%20Act%202013%20-%20v.%20July%202017.pdf -
@SANKARANARAYANANMUTHUIYER Welcome to the course.
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@ciaramcguigan Welcome to the course. Looking forward to hear your experiences of the Australian model of Organ Donation Services too.
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@RogerioAgostinho Welcome to the course!
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@ClaireHarcourtWatkins Welcome to the course!
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@LucyAlford Yes, it’s a national service now, offered by the Cardiothoracic centres.
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@LucyAlford Thank you for the feedback.
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Once the patient is transferred to the theatre table, the cardiothoracic team performs bronchoscopy prior to commencing the retrieval surgery to evaluate the status of lungs. They also performs recruitment maneuvers and possible collection of bronchial washings at this stage if required. The size of the ETT is a factor when considering advancing the...
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@NiculinaBica During the retrieval surgery, if a suspicious lesion or tumour is identified, a biopsy of the same will be collected and sent to the transplant centres for analysis. Many of the transplant centres in the UK has an Oncall Histopathology service who will be notified as soon as a suspicious lesion is identified with an estimated time of arrival of...
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@ValmieNgassamF.T The tissue donation can be performed with in 24 hours of someone's death regardless of the cause (excluding those patients with absolute contraindications for donation) and is usually performed in the hospital mortuary by the specialists from the tissue retrieval teams. The potential tissue donor has to meet all the eligibility conditions...
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@TrillyRachelMathew The assessment of brain stem death in a comatose patient should always proceed with certain principles in mind; establishing the cause of coma, ascertaining irreversibility, excluding major confounders and accurately testing all brain stem reflexes.
A diagnosis of Brain Stem Death based on clinical tests should NOT be performed unless...
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@PETAJELLIS The assessment of brain stem death in a comatose patient should always proceed with certain principles in mind; establishing the cause of coma, ascertaining irreversibility, excluding major confounders and accurately testing all brain stem reflexes.
A diagnosis of Brain Stem Death based on clinical tests should NOT be performed unless both the...
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The average duration for facilitating an organ donation is anywhere between 16 hours to 30 hours from the point of family consent to completion of the organ retrieval. This can vary depending on the location of the donor hospital, the location of the recipients, the availability of the organ retrieval teams etc. Once the organs are retrieved, they are sent to...
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Cystic Fibrosis is not an absolute contraindication for organ or tissue donation.
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@SumanaNavin The reasons for this are multifactorial and are summed up in the attached documents....
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@PetraWorthington Thank you for your question. Yes, it is possible to donate the body to medical science. More information can be found on the following links.
https://www.rcseng.ac.uk/about-the-rcs/support-our-work/donate/donate-your-body-to-medical-science/
https://www.kcl.ac.uk/lsm/study/departments/anatomy/lao/donation/LAO-booklet.pdf -
@gailtumelty You are right. Please refer to the WHO guidelines on assessing the donor suitability for blood donation here if you are interested to know more http://www.who.int/bloodsafety/publications/guide_selection_assessing_suitability.pdf
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After the first clinical exam, the patient should be observed for a defined period of time for clinical manifestations that are inconsistent with the diagnosis of brain stem death. Most experts agree that a 6 hour observation period is sufficient and reasonable in adults and children over the age of 1 year. Longer intervals are advisable in young children.
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Dr Shibu Chacko MBE replied to Nadia Martini
@NadiaMartini Thanks for sharing this videos. I watched this when it was telecasted; very interesting!
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@JeanetteBidwell Thanks. It’s very useful as it is easy to use and structured form of communication that enables information to be transferred accurately when a referral to SNOD is made remotely.
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Dr Shibu Chacko MBE replied to Lucy Alford
@LucyAlford You are right. On average there are around 10-15 patients on the active transplant waiting list for small bowel transplant at any time - so its very rare. Small bowel transplant is mainly offered for patients with short bowel syndrome (also known as short gut syndrome), extensive and unresponsive Crohns disease and also for patients who had...
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@NadiaMartini Between April 2017 and March 2018, 479 donors donated their heart valves in the UK. However, NHS Blood and Transplant estimates 720 were needed over that time. Only 14 donations came from paediatric donors.
Unfortunately no data on the number of tissue donors available in the public domain - will speak to stats department for this information.
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Implementation of the recommendations from the Organ Donation Taskforce has introduced for the first time into the UK a nationwide framework for deceased donation. The Organ retrieval, allocation, and transplantation are necessarily nationwide processes, while donation is the responsibility of individual acute hospitals.
The availability of organs for...
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@RichardSpooner Welcome to the course!
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@LucyAlford As part of the organ retrieval process, blood and tissue samples (i.e. lymph and spleen) are retrieved and will accompany an organ to the transplant centre to allow the recipient centres to undertake any necessary tissue typing and additional microbiological testing. In addition, blood vessels may also be required to aid the implanting surgeon...
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@NadiaMartini According to the NHSBT transplant activity report (2016-17), UK had 2791 donors who donated their Corneas which went onto help 4139 patients to gain the gift of sight.
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Opinion polls suggest that as many as 90% of the UK population support donation and transplantation but the family consent and authorisation rate hovers around 60-65%. This shortfall perhaps reflects the difference between what an individual might wish to happen after their death and the reality that faces a grieving family.
An increase in...
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The Government in England intends to change the law on consent for organ donation. Under the new system (commonly known as ‘deemed consent’ or ‘opt out’), everybody would be considered a potential donor unless they have added their details to the NHS Organ Donor Register to say that they do not wish to donate their organs, or are in one of the excluded...
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The problem of insufficient blood, stem cell and organ donation are fundamentally one of supply and demand. BAME people are disproportionately affected by this as they are subject to a higher demand and shorter supply than other groups in the UK.
If we accept the status quo, the number of preventable deaths in England’s BAME population will rise. For a nation... -
@SianTaylor-Caitens I have checked the pdf attachments and it appears to be under the relevant sections.
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@TaniaLeMarinel Yes you are right. In order to be considered as an organ donor, one must die on a ventilator in an intensive care unit or in an accident emergency department which is around 1% of the total number of deaths in the UK.
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Almost anyone can be considered as a tissue donor, however, there are some rare exemptions. To ensure that all donated tissues are safe, the donor´s medical and lifestyle history will be assessed at the time of donation.The best time for donation is within 24 hours after someone has died. However, sometimes it is possible to donate up to 48 hours after death....
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Welcome to the course. Hope this will help you to develop a deeper understanding of the process and assist with the professionals involved in the organ retrieval process. Shibu
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Out of the half a million people (approx.) die in the UK every year, just under 50% of patients die in hospitals.
According to the ICNARC data 2015-16 published in 2017, 21,950 patients died during their intensive care stay that year. Out of this pool, only around 30-35% patients can be considered as organ donors as the potential organ donors has to be on...
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@PETAJELLIS A stem cell or bone marrow transplant is an important treatment for some people with ALL. Patients who are aged between 17-40 are eligible to become a donor.
9 out of 10 people donate their stem cells via the bloodstream, in a straightforward process called peripheral blood stem cell collection. The donor will be connected to a cell-separator...
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This course focuses on deceased Organ and Tissue donation, which accounts for the majority of donations and transplants within the UK.
The solid organ donation is facilitated from patients who are on ventilator and are either declared brain stem dead or certified dead by following the cardiorespiratory criteria ( Discussed in detail on week 2). In contrary,... -
Hi Rajeev, Welcome to the course. Please share your thoughts and experiences as you go along - we are very keen to learn from your experience as well. Shibu
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Hi Alexander, welcome to the course and hope to see you joining our team soon. Shibu
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@SeanaMaguire Good luck and enjoy your learning!
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Dr Shibu Chacko MBE replied to ruban Victor
Hi Ruban, We hope the course will help you to develop an understanding of the processes and protocols followed while facilitating a deceased organ donation. Shibu
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Dr Shibu Chacko MBE replied to Emma Smith
Dear Emma, many thanks for joining the course and we hope the course will help you to achieve your learning objectives and be able to offer a fantastic service to those patients in ICU and their family members. Shibu
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Thank you Bonnie. Hope it will be a good learning experience for you. As this is an international program, learners from South Africa are welcome to join as well. We will announce the dates of the future runs soon. Shibu
