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PPS - trauma > Death and organ donation > Flashcards

Death and organ donation Flashcards

1
Q

Why are kidney donations from cadavers so much larger than from living donors?

A

Can take both kidneys from cadaveric donors

Double the amount of transplants since can only take one kidney from a living donor

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2
Q

What is the trend in the amount of living donors over the years?

A

Increased

Due to transplantation between family members/ friends/ altruistic donors

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3
Q

What is the trend in the amount of dead donors over the years?

A

Donors that have undergone cardiac death have increased

Donors that have undergone brain death have remained stable

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4
Q

What are the two types of donors?

A

Living donors

Deceased donors

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5
Q

What are the two types deceased donors?

A

Those that died following brain death - heart beating

Those that died following cardiac death - non-heart beating

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6
Q

What are examples of living donors?

A

Friends

Relatives

Altruistic

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7
Q

What are the two types of deceased donors?

A

Those that died following brain death

Those that died following cardiac death

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8
Q

What are causes of brain death?

A

Stroke

Tumours

Accidents

No longer able to maintain life

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9
Q

When are organs extracted from cardiac death donors?

A

Cardiac arrest

Predicted to die after withdrawal of therapy in the ICU

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10
Q

What is the definition of death?

A

Simultaneous and irreversible loss of both the capacity for consciousness and the capacity to breathe

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11
Q

What are the 3 main causes of death?

A

Neurological determination of death

Somatic determination of death

Cardio-respiratory determination of death

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12
Q

Why is brainstem death equal to death?

A

Brainstem is a very important organ for life

The effect of this organ failing is equivalent to death

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13
Q

What are the functions of brainstem?

A

Control of respiration

Integrative control of the cardiovascular system

Conduit for almost all ascending and descending neural pathways

Maintenance of the capacity for consciousness

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14
Q

When was the brainstem death criteria devised in the UK?

A

1976

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15
Q

What are examples of brainstem criteria?

A

Fixed pupils which do not respond to sharp charges in the in the intensity of incident light

No corneal reflex

No response to supraorbital pressure

No cough reflex to bronchial stimulation or gagging response to pharyngeal stimulation

Caloric test

Disconnection of the ventilator

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16
Q

How does disconnection of the ventilator act as a good test to check for brain death?

A

No observed respiratory effort in response to disconnection of the ventilator for long enough to ensure elevation of the arterial partial pressure of CO2 to at least 6.0 kPa

17
Q

What is the caloric test?

A

Absent oculovestibular reflexes

No eye movements following the slow injection of at least 50 ml of ice-cold water into each ear in turn

18
Q

What are the conditions needed to be followed to appropriately determine brain stem death?

A

Two independent physicians, not involved in transplant team - no bias

Exclude the confounding factors to appropriately determine brain stem death

19
Q

What are confounding factors that could affect determination of brain stem death?

A

Drugs

Hypothermia

Metabolic conditions that could influence the action of the brainstem

20
Q

What is the most common source of organ donation?

A

Brain dead donors

21
Q

How are non-heart beating donors classified?

A

Maastricht classification

22
Q

What is the Maastricht classification of non-heart beating donors?

A

Group I - brought in dead

Group II - unsuccesgul resuscitation

Group III - awaiting cardiac arrest

Group IV - cardiac arrest after having brainstem death

Group V - cardiac arrest in a hospital inpatient

23
Q

What are groups I and II in the Maastricht classification called?

A

Uncontrolled

24
Q

What is group III in the Maastricht classification called?

A

Controlled

25
Q

What are group IV and V in the Maastricht classification called?

A

Uncontrolled or controlled

26
Q

What is the uncontrolled group characterised by?

A

Long period when the organs are not produced

Warm ischaemia can be detrimental to the subsequent function of the organs

27
Q

What is the controlled group characterised by?

A

High likelihood of death whilst in care by the doctors

When the heart stops beating, the organs are cooled and then removed

Waiting cardiac arrest

28
Q

What is the controlled and uncontrolled group characterised by?

A

Don’t fulfill criteria for brain death and then undergoes cardiac death

Would have to die within 4 hours of withdrawing therapy

29
Q

Why do patients who do not fulfill criteria for brain death have to die within 4 hours of withdrawing therapy?

A

Ethical

So the medical team don’t stand around waiting for a long period of time for the patient to die

30
Q

What are the graft outcomes for non-heart beating vs heart beating donors?

A

No difference in 5 year outcome if use organs from

< 70 years
< 12 hours
Not re-transplant

31
Q

Where are most donated organs lost in the transplantation process?

A

Obtaining consent

Approaching family - may not want to donate

Doctors don’t believe they are suitable for donation

32
Q

What are ways in which organ donations have increased?

A

Target social or religious groups

People not considered before due to old age, comorbidities, marginal donors

33
Q

What are examples of marginal donors?

A

Older population

Increased over the last 10 years

Older donors to treat older patients in the waiting list

34
Q

What is an important factor to consider when donating a kidney?

A

Matching the nephron requirements of a recipient with the potential nephrons in the organs

35
Q

What is the nephron dose?

A

Think of kidney as nephron dose

36
Q

What are ways to match nephron doses between donor and recipient?

A

Age

Size

Comorbid conditions

37
Q

What is a way to match the nephron dose between the donor and recipient?

A

Two kidneys from donor into one recipient to double the nephron dose

38
Q

What are the two things that need to be matched to carry out a kidney transplant?

A

Blood group

Tissue type

39
Q

What is a way to increase the organ donation pool?

A

Cross donations

PPS - trauma (4 decks)

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