Environmental Sustainability in Transplantation guidance

Set up a Green/Sustainability Working Group in your unit with leadership representation.

• Consider designating 'Green Champions' to drive projects forward
  • Use the resources available on the Centre for Sustainable Healthcare website to support your Green Champions with engaging colleagues
• Ensure broad involvement across the service (e.g. anaesthetics, theatre management, outpatients, immunology services, dietetics, psychology, and more)
• Consider carbon literacy training
• Use the way that Quality Improvement activity can overlap with better sustainability
• Join the relevant sustainability networks through the Sustainable Healthcare Networks Hub to share good ideas, opportunities and encouragement
• Engage with Operational Delivery Networks and other regional structures like Transplant Collaboratives on sustainability, sharing ideas, activity and best practise
• Get your patients involved as patient ambassadors on sustainability, read the community ambassador template

Consider how to reduce travel for your unit.

Patient travel

• Aim to offer at least 25% virtual clinics
• Create or use one stop diagnostic/treatment hubs to reduce the number of visits to your unit
• Try to reduce aborted transport (e.g. hospital transport sent to patients who are away or already in hospital)
• Set up a regular review of hospital transport processes for your unit and a working group to reduce this over time

Staff travel

• Use clinics localised to the patients where possible to reduce overall travel
• Promote flexible working (including working from home) where appropriate
• Actively avoid non-essential flights, including for organ transplantation
• Use low carbon routes when travelling to meetings and conferences

Use of flights

• Make every effort to reduce use of flights whether for organ transportation, staff movement, conferences or supply chains

• Adopt the intercollegiate Green Theatre checklist. Find out more about the checklist or download the Green Theatre Checklist (PDF 364KB)
• Anaesthetic considerations. E.g. Total Intravenous Anaesthesia (TIVA) and re-usable equipment
• Preparation for surgery. E.g. Adoption of reusable textiles and reduction of water consumption
• Consider what intra-operative equipment is essential or optional. Reduce, reuse, replace
• Post-operative care. E.g. Greener waste streams, recycling batteries and metals and turning off any equipment no longer in use

• Find ways to increase the number of transplants in your patient population, this includes both living (where appropriate) and deceased donors
• Create specific and measurable targets to improve access to transplantation for disadvantaged groups appropriate to the population the unit serves
• Improve organ utilisation - review the Organ Utilisation Group recommendations and apply them to your unit
• For kidney units, remember that kidney transplants are greener than dialysis and pre-emptive transplants help even more
• Set measurable strategic targets to increase living donor transplantation

• Apply interventions that have been shown to reduce injury at transplantation and/or reduce post transplant damage
• Apply evidence based interventions to improve graft survival, and life years gained, in longer term transplant management
• Make use of both prehabilitation and rehabilitation around transplantation
• Focus on reducing poor concordance where appropriate

You can request an environmental audit through estates and facilities. This audit may have already taken place in many Trusts and can lead to many outcomes which help the Trust as well as the environment, such as:

• Retrofitting buildings to reduce heat loss with cost effective insulation
• Improving resilience of the estate to cope with high temperature environmental events
• Utilising smart heating to maintain appropriate temperatures at specific times (E.g. adjusting temperatures when buildings are occupied or empty)
• Switching all lights to LEDs

You can also work with IT to ensure energy efficient monitors and computers are being used.

Lead in these areas or encourage and support your Trust leadership in the following:

• Aim for 100% renewable energy by decarbonising energy sources
• Improve the impact of procurement as this is a significant component of a unit's carbon footprint. Any significant or recurring purchases need careful consideration from an environmental perspective
• Consider where funds are banked and switch accounts away from banks that promote funding for fossil fuels or single use plastics. This matters at an individual level too - find out which banks promote sustainable practice
• Promote engagement with innovations that improve sustainability
• Help the transplant unit green/sustainability group engage with the Trust level sustainability group and strategy
• Promote the known positive overlap between Quality Improvement activity and sustainability