The use of video conferencing platforms
We are supporting the use of video conferencing for interviews during this period. Equally, if transplant centres feel they can safely facilitate face to face interviews in line with Government guidance, then that is a decision for them to make.
You should only undertake interviews in an environment you feel comfortable to do so. Please discuss any concerns you might have with the transplant centre.
Body language plays an important role and so whilst you may not be able to conduct face to face interviews, we hope that by seeing the people you are interviewing this will go some way in helping to provide some reassurance.
The decision as to which video platform to use will need to be decided in discussion with the transplant centre. Some factors you may wish to consider are:
Liaising with the transplant centre
The video conferencing facility used must be supported by local hospital protocol and security. Please discuss the practicalities with the transplant centre as they may have a preferred or existing local platform that they would need you to use.
How to access the video platform will need to be agreed with transplant centres i.e. account details and the use of personal equipment where applicable. Living Donor Coordinators will communicate details to donors and recipients prior to the interview to ensure they have access to the video platform that is agreed.
Identity, relationship and joint interviews
Please request to view relevant ID and evidence of relationship at the start of the interview, noting this in your report. We suggest asking for the documents to be held up to the camera so they can be seen clearly. Alternatively, the Living Donor Coordinator could securely email a scanned copy of the relevant documents to you prior to the interview, please ensure you securely dispose of these documents following the interview.
As usual, it is a requirement to interview the donor and recipient separately and together. Where donors and recipients share the same household, we advise when conducting separate interviews, you make it clear at the outset that there is an expectation to speak with each person alone and that you explicitly seek assurance from each individual during their interview, documenting this in your report. Alternatively, where the individual is comfortable to do so they may show you the room to demonstrate that they are alone.
Where the donor and recipient do not live in the same household, we advise using a platform that allows for more than one participant where possible to allow for a joint interview. This would allow both participants on the call to see each other and for you to observe body language.
Donor declaration form
During the interview, please confirm with the donor that they have signed the donor declaration form. The transplant centre may decide to facilitate this via post with the donor, once received they can either email the form to the HTA Transplant team or directly to you.
Young recipients or recipients that are too unwell to be interviewed
In instances where the recipient is young / pre-verbal or too ill to be interviewed please follow the same guidelines in place for face to face interviews. Where you have been unable to interview a recipient please clearly document the reasons for this in your report.
It is important that patients are aware of any additional risks relating to COVID-19.
Please kindly continue to address these risks during your interviews for the foreseeable future, clearly documenting the details of your discussion within your report. In particular, we ask that you cover the following areas:
- Confirmation that the donor and recipient have had a conversation with the clinical team surrounding COVID-19;
- Their understanding of these risks and measures; and
- Confirmation that the donor is still happy to proceed.
Transplant teams have been asked to confirm that the donor and recipient have had the risks explained to them within the referral letters.
To revisit consent in the context of COVID-19:
You may be asked to conduct a follow up call with donors and recipients that have received HTA approval prior to COVID-19, but where the transplant has not yet taken place. As circumstances have fundamentally changed since their consent was provided, a follow up call is necessary to ensure that all parties involved are happy to continue with the donation and that checks are put in place to protect living donors. The follow up call does not need to be conducted by the same Independent Assessor who conducted the original interview.
During future Independent Assessments and follow up calls, please ensure you cover the following with donors and recipients:
- Confirmation that the donor and recipient have had a conversation with the clinical team surround COVID-19;
- Their understanding of these risks and measures; and,
- Confirmation that the donor's consent remains in place and that they are happy to proceed.
Please note, we do not require you to educate the donor, recipient and person consenting on behalf of the donor on these risks. You should only be checking their understanding after the clinical team has had a discussion with them.
HTA approval over 12 months ago
As per our guidance (England, Wales and Northern Ireland / Scotland) there is no time limit on the validity of an approval, however where the period since approval being granted and the transplant going ahead has been more than 12 months, IAs will need to conduct a brief phone call with the donor and the recipient to ensure circumstances have not changed since approval.
It is important that the call revisits consent in the context of COVID-19 risks as outlined above, as well as the following:
- Any circumstantial changes (exploring any changes further); and,
- Confirmation that there is still no evidence of duress/coercion or reward.
To ensure we remain as proportionate as possible, it is acceptable to speak to donor and recipient on the phone and email details of your discussion to email@example.com. Please include the TXXXX number so that we can identify the relevant case. Please do not use patient names or details in your email. If you don’t have the TXXXX number, please call us to let us know which case the email refers to.
Note: please do not use patient names or include members of the clinical team in your email to the HTA as this breaches confidentiality.
We understand there will be ongoing questions about the changes we have outlined above however please be assured that we are here to support you. If you have any questions please don’t hesitate to contact the team on firstname.lastname@example.org.