ICM - Donation after Circulatory Collapse

Question 1

Ethical principles of DCD prior to withdrawing care

Answer 1

No treatment aimed at organ donation should be done PRIOR to decision to withdraw confirmed
You CAN maintain life sustaining treatment in the best interests if pt wanted to be a donor AND it facilitates donation AND it causes them no furhter distress/harm
Examples - increasing FiO2, chaning vent settings, putting a cannula in, maintaining MAP
DO NOT start treatment against famiyt wishes

Question 2

Process of controlled organ donation

Answer 2

Retrieval team in theatre and ready to go.
Family ready
Withdraw tx.
Following loss of cardio-resp function - 5 minute observation of monitored asytole
Certify death, doctor independent of retrieval.
family have 5 minutes.
If lung donation - re-intubate and give 1 single breath when retriaval team ready.
CPAP maintained on 100%.
DO NOT VENTILATE UNTIL CHEST OPEN AND AORTA CLAMPED

Question 3

Define Functional Warm Ischaemia

Answer 3

Time from when sys BP < 50 or SpO2< 70%
Liver 30 min
Pancreas 30 min
Lung 60 min (from onset of FWI to inflation)
Kidney 2 hours

Question 4

Define DCD

Answer 4

Retrieval of organs for the purpose of tranplantation whoe death is diagnosed and confirmed by cardio-resp criteria

Question 5

Types of DCD

Answer 5

Controlled and uncontrolled
Uncontrolled - arrest was unexpected
Controlled - after planned withdrawel of treatment

Question 6

Describe the Maastricht class

Answer 6

1 Uncontrolled Dead on Arrival ED
2 Uncontrolled Failed Resus ED
3 Controlled Arrest after withdrawel - ICU
4 Eitehr Arrest in brain death - ICU
5 Uncontrolled Cardiac arrest - inpatient - Hospital

Question 7

CI to organ donation

Answer 7

No age limit
Absolute
Variant CJD
HIV disease (not infection)

Relative
Active invasive cancer in 3 years (not non-melanoma skin)
Primary intracerebral lymphome
Secondary brain tumours
Haem cancer
Active TB
West Nile Virus
History of Ebola