The role of the TROD

We have both been in the TROD role for a little over 8 months now. If you haven’t come across this new addition to NHS Blood and Transplant’s (NHSBT) list of acronyms, it stands for Trainee Representative in Organ Donation (TROD).

It is a new regional role for intensive care medicine (ICM) trainees that is gaining momentum around the country.  Appointed last August we were two of the earlier TRODs in the country and would like to describe what the role entails, what we have done so far and what we hope to do going forward.

The Role

The role is open to ICM trainees ST6 and above from all backgrounds - including PICU and neonatal trainees. Our role is primarily to work alongside our regional CLODs (clinical leads for organ donation) and SNODS (specialist nurses for organ donation) to support the promotion of organ donation as part of working in clinical service. We also have a role in supporting educational initiatives both locally and regionally for all members of the MDT surrounding organ donation. Wider roles can include helping run the regional collaborative meetings and taking part in data analysis and quality improvement projects. Since our appointment, a national network of TRODs has been established which is facilitated by Jill Featherstone, NHSBT Professional Development Specialist Medical Education Lead and by Dr Dale Gardiner, National Clinical Lead for Organ Donation.  

Day to day we see the role of the TROD as having trainees with an interest in organ donation embedded within our clinical landscape. You may be asking why we need TRODS when we have CLODS and SNODS already?

Local Projects

On a local level we have focused on developing projects and delivering educational material that supports the work of our local organ donation and multidisciplinary teams. Since starting in the role we have been lucky enough to get stuck into some great ventures so far. A new donor optimisation bundle for patients following death diagnosed by neurological criteria was developed just prior to our appointment. This bundle is being piloted in a couple of regions around the country, one of which is the North East. We have had the opportunity to be involved in the educational and promotional work for the bundle pilot and will be involved in its evaluation.

SIGNET trial

The other big project that several TRODS around the country have been involved in is the SIGNET trial. This trial is a randomised controlled trial looking at the effect of giving statins to donors following death by neurological criteria on organ recipients. This trial is part of the NIHR associate principal investigator (PI) scheme which means trainees can enrol on this six-month programme whilst they work on SIGNET. We therefore get experience being involved in the day to day running of the trial and have the opportunity to get signed off on the nationally approved research scheme.

The role of the SNOD is vital to organ donation practice and has grown from strength to strength as their scope of practice continues to expand. As TRODS we work closely with the SNODS to help facilitate best practice surrounding all aspects of organ donation. As trainees we are in a unique position as we are embedded into units as we rotate around the regions where we work. This may not always be the case for the wider team who may be regionally based. We therefore can act as a point of contact to answer questions, escalate queries, or facilitate education to the MDT.  As we rotate around our regions we are exposed to a variety of practices and gain insight into what works well and can make suggestions for changes in practice that may optimise clinical processes.

As trainees we understand the various educational curricula and where there may be gaps in knowledge and experience surrounding organ donation particularly with changes in legislation. Through the TROD role we hope to act as a point of contact for trainees across the regions we work in and to foster an interest in organ donation across all training grades. In our role as TRODS we will get the opportunity to be involved in teaching on a local and regional level about organ donation and can support some of the more difficult ethical discussions. The TROD network has allowed us to share the regional work we have each done as well as get involved in larger national projects.

On a personal level, being a TROD offers an opportunity for those of us with an interest in organ donation to foster this regardless of the placements we have experienced in training. Surprisingly, despite rotating through a variety of units as ICM trainees, we don’t always get the exposure to organ donation that we might hope and expect. It is very placement dependent. As a TROD we also get the opportunity to work more closely with the SNODs, gain insight into to their roles, their priorities when a patient is consented to be an organ donor, and to learn from their experience and expertise - particularly in the areas of communication skills and language used in and surrounding organ donation. We know organ donation is  a highly effective healthcare intervention however it can also be incredibly emotive for those involved.

As TRODs we will complete the NHSBT deceased donation course, some of us will also go on be faculty on the course. Providing education whilst building on our own knowledge and experience are key parts of the TROD role. We can also build on our organisational, leadership and management skills through helping the regional CLODS in preparation for the regional collaborative meetings, attending national organ donation committee meetings and being involved in data analysis and research. Hopefully you can see there are a variety of opportunities both on a personal and organisational level for TRODs as part of the NHSBT organ donation team.

Why we applied

We thought we would finish by mentioning some of the reasons why we both applied for the role. We hope many other trainees will take on these roles over the coming years and hope to make a positive impact in the world of organ donation.

“As a dual anaesthetics and intensive care trainee I felt privileged to be able to see so many aspects of the organ donation and transplantation process. Pre-assessing the renal transplant recipients who have been on the transplant list for years and listening to their hopes as they have been called in for the opportunity to be freed from their dialysis machine is a testament to the impact of donation.

Conversely the pain associated with an unsuccessful transplant hammers home the importance of good donor care and organ screening. To be involved with a family watching their loved one go from a life on a transplant list, to no life at all is heart-breaking for everyone involved. As I rotate around different units, I can see people’s frustrations when organs that seem good get screened out, or delays that come from the donation process seem to cause distress. I have seen the upset that can be caused by the seemingly brutal operation as seen by the theatre staff. I am only too aware that others are not as fortunate as me and do not see the many sides of a donation. I am passionate about doing what ever I can to improve the process, but also to improve education about organ donation. I hope that gaining more experience in the world of organ donation will give me even more insight into other peoples’ perceptions of the process, and I will have the opportunity to educate people about the lives they are touching beyond their individual, but essential, step in the process. I hope that this is the start of a career where organ donation will always play a role.”

Maddie Wood ST7 ICM and anaesthetics trainee, Northern region.

“I applied for this position as organ donation has been something of interest to me as far back as medical school. During an elective I had the opportunity to be part of a retrieval which at the time was fascinating to me.  Though it was a lot to take in, receiving the thank you letter from the donation team telling us how patients had benefited from the generosity of the family really reinforced how valuable and important organ donation is. However, as we have mentioned being involved in the organ donation processes isn’t something we get that much exposure to in our training. With regulations changing and education being a priority I felt taking on this role would help with my understanding of how NHSBT works, the role of the wider team involved with NHSBT and the SNOD role. I have an interest in education and this role gave me the opportunity to integrate some of the work of NHSBT into my experience and will allow me to reach new groups of people and broaden my experience. “

Claire Mitchell ST7 ICM and anaesthetic trainee, Northern Region.

We have both really enjoyed starting our TROD journey and it has been especially exciting being able to link up with all the other TRODs around the country. We have the first national TROD meeting coming up in June and hope to continue to develop our roles further. If anyone has any questions, please do get in touch, or ask your regional CLODS who your local TRODS are.