Cardiothoracic Advisory Group

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The statutory obligations of NHSBT with respect to organ donation and transplantation are set out in the Directions. The Solid Organ Advisory Groups (SOAGs) play a highly valued and essential role in providing NHSBT with the necessary clinical advice on organ donation and transplantation. In addition, they work with NHSBT and other organisations to increase the quality and number of solid organ transplants in the UK.

Although the major role of the Solid Organ Advisory Groups is to advise NHSBT to help promote all aspects of organ transplantation and ensure equity of access to transplant and optimal patient outcomes, it is recognised that the SOAGs provide a much broader resource to help promote deceased and living organ donation and transplantation in the UK and internationally, and to provide a unique forum for all those involved in organ transplantation in the UK to meet and to discuss and promote evidence based improvements in patient outcomes.

The work of the SOAGs is integral to organ donation and transplantation: the SOAGs are integrated into the structure of the Directorate of Organ Donation and Transplantation (ODT) through the Chairs of the Advisory Groups Committee and to the Senior Management Team of ODT. Policies relating to organ donation, patient selection for transplant listing and transplantation are reviewed and agreed by the Transplant Policy Review Committee (TPRC) on behalf of the NHSBT Board. The Advisory Group Chairs are members of the TPRC.

CARDIOTHORACIC ADVISORY GROUP (CTAG)

TERMS OF REFERENCE

Advisory Group

The Cardiothoracic Advisory Group will comprise of two sections:

One section to advise on issues related to heart transplantation
One section to advise on issues related to lung transplantation

Membership

Chair:

Appointment: applications will be invited from transplant health care professionals (see person specification in Appendix 1). The Chair will be appointed by NHSBT through a formal appointment committee with a panel of at least three people and will include the Associate Medical Director (AMD) of ODT and the President (or nominee) of the British Transplantation Society.

The AMD will develop the Job Plan and Person Specification for the Chair

Tenure:

The Chair will be appointed for 3 years
The Chair may apply and be re-appointed for a second and final two year-term
A person who has been Chair may re-apply at any date more than three years after standing down

Remuneration: The Chair will receive a Special Duty Payment allow them to devote time to carry out their duties.

Appraisal: The Chair will meet the AMD of ODT annually for a formal review of progress made and to agree future work plans and associated targets.

The role of the Chair will include:

Chairing the twice-yearly meetings of the Heart Advisory Group and the Lung Advisory Group
Chairing the meetings of the Cardiothoracic Centre Directors
Attending bi-annual meetings with patient/lay members
Attending the meetings of the National Retrieval Group
Attending the meetings of the Advisory Group Chairs Committee
Chairing the CTAG Adjudication Panel, as described in POL229 (Heart Patient Selection Policy) and POL231 (Lung Patient Selection Policy)
Helping the AMD of ODT assess response to signals from outcomes monitoring
Providing ad hoc advice to ODT

Where appropriate, the Chair may nominate a Deputy to attend meetings on behalf of the Chair; the nominated Deputy will have the full authority of the Chair.

Membership of the Hearts and Lungs Advisory Groups

Membership of the Hearts and lungs Advisory Groups will include:

Voting members

Chair
One Physician representative from each designated cardiothoracic transplant centre
One Surgeon representative from each designated cardiothoracic transplant centre
Two Lay Member representatives
One Transplant Centre manager

Non-voting members

One representative from each of the Commissioning groups for the four UK nations
One representative from each of the national Departments of Health
One representative nominated by the British Transplantation Society Director of Organ Donation and Transplantation (ODT)
Associate Medical Director ODT
Relevant NHSBT Statistician
Associate Director of Statistics and Clinical Studies / Head of Organ Donation and Transplantation Studies
ODT Scientific Advisor
National Clinical Leads for:
Retrieval
Governance
Living Donation
Organ Donation
Organ Donation Services Team representative
Recipient Co-Ordinator representative
Other members co-opted by the Group (may include representatives from relevant professional bodies, societies and colleges)
The Chair, in discussion with members of the Group, may include other appropriate members

Representatives from the Republic of Ireland will be welcome as observers (unless selection and allocation is shared between UK and Ireland).

Members will be responsible for

Bringing to the Advisory Group any relevant concerns or suggestions from the centres they represent: where possible this should be in writing so that the paper can be circulated prior to the meeting
Circulating minutes and other discussion items and items of relevance within their organisations (to clinicians, managers and other relevant parties)
Responding to relevant items on the Agenda
The Chair will appoint a Deputy Chair from the CTAG (Heart) Group and a Deputy Chair from the CTAG (Lung) Group
If there is more than one applicant, the candidates will be interviewed by the Chair and NHSBT representatives
The Deputy Chair will assume the role and duties of the Chair when the Chair is unavailable, when there are possible conflicts of interest or at the request of the Chair
On occasions when the Deputy Chair assumes the chairing role, it would be appropriate for their centre to be represented by another centre representative
Each Deputy Chair will be appointed for the period of the Chair’s tenure
When a Deputy Chair ceases to be the CTAG Group representative for their own transplant centre, they will also demit from being Deputy Chair
The representative(s) from each transplant centre will be determined by the Centre Director(s) in collaboration with senior clinicians in their centre(s) who will also agree the tenure for each representative’s membership
Members unable to attend should send a deputy who will have the same voting rights as the member
Members will be expected to attend at least 80% of the meetings
The Minutes will record membership attendance
The Transplant Managers Forum will agree the Transplant Manager who will be appointed for four years
Patient/lay representatives will be appointed through an independent process for a four-year term

Role of the Cardiothoracic Advisory Group

The role of the Advisory Group will be to provide a forum whereby clinicians and other interested parties (including commissioners, regulators and non-clinical stakeholders) can work with NHSBT and other organisations to improve the number and quality of organs donated and transplanted; and improve the outcome of patients awaiting and following transplantation.

Delivery of this aim will include:

Agree a rolling two-year work plan and review progress annually
Agree membership of Working Groups as required with additional expertise co-opted as required (it is not necessary that members of the Working Group are all members of the Advisory Group)
Task the Working Group to investigate and report on specific issues in a given time frame
Review, approve or amend recommendations from the Working Group
Review relevant current guidelines and policies at least annually and advise NHSBT on operational aspects of transplantation including:
Organ retrieval
Recipient selection criteria
Organ allocation schemes
Organ offering
Transplant activity and outcome
Recommend, as necessary, promote and implement changes to the nationally agreed protocols
Advise NHSBT and other bodies on appropriate risk factors and context for outcome monitoring and interpretation of findings
Monitor and report on clinical governance with especial reference to outcomes and deviations from expected outcome
Monitor deviation from agreed protocols in selection and/or allocation
Ensure equity of access of patients to transplantation throughout the UK
Evaluate and comment on issues raised by investigations into triggers from outcomes analysis, investigations and other issues
Identify and promote areas of audit and research
Remit to ODT matters of practice or policy that require consideration within a broader framework.
Liaise as necessary with the British Transplantation Society and other professional bodies in the development of national standards
Provide six-monthly reports of clinical governance
Respond to, advise on, or support implementation aspects of organ donation and transplantation policy that arise from legal and/or policy developments both within the UK and more widely
Co-ordinate a programme of peer review (with other appropriate bodies)

Reporting

The CTAG will report to Senior Management Team of ODT

Voting

If an agreement cannot be reached by consensus, a vote will be taken of the voting members; a majority will be binding. The Chair will have a casting vote but will not take part in the initial vote

Where a consensus is not reached on policies, the Chair must ensure that the Chair of the Transplant Policy Review Committee is informed of the centres and the nature of concerns of those who did not support the policy

Frequency of Meetings

The CTAG Advisory Group will meet at least twice a year at a venue to be agreed
The CTAG Advisory Group meeting will be in two parts:
One part is for the CTAG Hearts section members to discuss matters pertaining to heart transplantation
One part is for the CTAG Lungs section members to discuss matters pertaining to lung transplantation

CTAG Centre Directors Group

The Chair of the Advisory Group, or deputy, will chair the Unit Directors Group.
Membership of the Group will comprise of:
The Clinical Directors, or deputy, of each of the Cardiothoracic Transplant Centre
The relevant statistical lead
The group will meet between the CTAG Advisory Group meetings by telecon as agreed by the group.
The main roles of the group are to:
Monitor the progress of tasks as required by the Advisory Group and report back to that Group. Review performance of centres to identify outliers, suggest corrective action and improvements to working practice and monitor implementation

CTAG Clinical Audit Group

The main role of the CTAG Clinical Audit Group is to oversee specific audit projects as required by the Advisory Group and to advise NHSBT on data collection and audit. The CTAG Clinical Audit Group will meet every quarter at a venue/by telecon as agreed by the Group.
The Chair of the Cardiothoracic Advisory Group will chair the CTAG Clinical Audit Group; but may devolve this responsibility to another member of the Advisory Group
The membership of the CTAG Clinical Audit Group will be selected by the voting members of CTAG, representing:
heart transplantation
lung transplantation
paediatric cardiothoracic transplantation
donor organ retrieval
mechanical circulatory support
the relevant statistical lead
specialist nurse/transplant coordinator
Members of the Clinical Audit Group are expected to attend at least 80% of the meetings
Members of the Clinical Audit Group will not act as representatives of their own centre
The Clinical Audit Group may invite other members of NHSBT and others as required
The Clinical Audit Group will also, on behalf of the Advisory Group, assess applications for access to data for research and advise statisticians as required

Working Group

It is anticipated that the Advisory Groups will have Working Groups to address specific aspects of transplantation or issues; the nature, membership, frequency, lifetime and venue of these meetings will be at the discretion of the Advisory Group. Teleconference work is encouraged
The Chair of the Advisory Group, or nominated deputy, will chair the Working Group
Members of the Working Group are expected to attend at least 80% of the meetings
Members of the Working Group will not act as representatives of their own centre
Members unable to attend may nominate a Deputy who will have the same rights as the member
The relevant statistical lead will attend as a non-voting member.
The Working Group may invite other members of NHSBT and others as required to consider specific topics

Patient Group Meetings

The Chair will attend and (when required Co-Chair) 6 monthly meetings of the Cardiothoracic Patient Group. Stakeholders include representatives from the designated transplant centres as well as associated organisations and charity groups.

Minutes and publication of papers on the ODT website

The Minutes of each meeting will be taken by the NHSBT (ODT) Secretariat.

Publication of Minutes and Papers

The Agenda, Papers and agreed Minutes of the Advisory Group meetings will be published on the ODT website
The Agenda, Minutes and papers of the Stakeholders’ Meeting will be published on the ODT website
Meeting papers for the working groups will not be published as these will be work in progress, although reports to the Advisory Group will be included in the minutes of the Advisory Group Meeting
The Agenda and Papers will be published on the ODT website when these are circulated to members of CTAG. Minutes will be published after they have been approved
Redacted papers will be published only if the originals contain patient-identifiable material, commercially sensitive or published details would preclude publication in a peer-reviewed journal
Minutes will be circulated electronically

Support

Budget

CTAG will be allocated an agreed budget, administered by NHSBT, which will include travel expenses, hosting of meetings, working parties, consensus meetings and other relevant activities. Accountability for the budget will be with the Chair of CTAG but the budget will be held within ODT.

Statistical and analytical support

CTAG will be allocated an agreed level of support from the Department of Statistics and Clinical Studies to support the activities of CTAG: this support will be used for analysis of outcomes, audit, governance issues, service evaluation, modelling of alternative methods of service delivery and other projects, agreed with the Chair of the Advisory Group, the Assistant Director, Statistics and Clinical Studies / Head of ODT Studies and the Associate Medical Director ODT

The Chair of CTAG, Assistant Director, Statistics and Clinical Studies / Head of ODT Studies and Associate Medical Director will meet at least every six months to agree the agenda, new projects and assign priorities
The statistical lead will prepare and circulate at each Advisory Group meeting an outline of projects agreed and estimated completion dates

Administrative support

The Clinical & Support Services section of ODT will provide an agreed level of administrative support, to help with the planning and organisation of meetings, minute taking and other relevant matters.

Appendix 1

Person Specification for Chair of a solid Organ Advisory Group

The Chair will:

Be currently active in the relevant field of solid organ transplantation
Have a knowledge of donation and transplantation both in the UK and internationally
Be registered with the General Medical Council
Have a substantive or honorary Clinical Contract at Consultant status with a Hospital/Trust/Board within the UK
Have at least 5 years’ experience in organ transplantation at a Consultant level (or equivalent)
Have the support of the clinicians and scientists in the relevant field of transplantation
Have support from his/her employer to devote the necessary time to act as Chair
Able to devote sufficient time to fulfil the role

Cardiothoracic Advisory Group

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