Lecture 12

Question 1

What are the 3 potential donor pools?

Answer 1

• Organ donation (heart, lungs, liver, etc.)
• Tissue donation (skin, heart valves, bone)
• Eye donation (corneas, sclera)

Question 2

What are the pathways to tissue/organ donation?

Answer 2

• Brain death (heart, lung, liver, kidney, pancreas)

- Circulatory death (lung, liver, kidneys, eye, bone)

Question 3

What are the legal requirements of tissue/organ donation?

Answer 3

• Human Tissue and Transplant Act 1982
• Certificate of death
• AODR - donor consent (no objection recorded)
• Coroner’s consent
• Next of kin consent
• Designated/delegated officer authority

Question 4

What are the 2 definitions of death?

Answer 4

1. Irreversible cessation of circulation of blood in the body of the person
2. Irreversible cessation of all brain function of the person

Question 5

What are the causes of death in DBO donors?

Answer 5

• 53% stroke
• 25% hypoxia
• 14% trauma
• 7% other

Question 6

What are the causes of death in DCD donors?

Answer 6

• 42% hypoxia
• 37% stroke
• 18% trauma
• 5% other

Question 7

Causes of brain death in donors (5)

Answer 7

1. Spontaneous Intracranial Haemorrhage
2. Cerebral Oedema
3. Trauma
4. Hypoxic Injuries
5. Tumours

Question 8

Spontaneous intracranial hemorrhage

Answer 8

–> subarachnoid or intercerebral haemorrhage

Question 9

Cerebral Oedema

Answer 9

Meningitis, acute hyperthermia/hypothermia

Question 10

Trauma

Answer 10

Motor vehicle accidents, gun shot wounds, falls

Question 11

Hypoxic Injuries

Answer 11

Cardiac arrest, drowning, hanging, asthma

Question 12

Tumours

Answer 12

Primary brain tumours, astrocytomas

Question 13

How to determine brain death?

Answer 13

1. Clinical testing
2. Radiological Imaging
   o 4 vessel angiography
   o Radionuclide scanning

–> to demonstrate that irreversible injury is not localised to brainstem

–> declared by 2 medical practitioners

Question 14

What must designated officers demonstrate

Answer 14

That:
- Death has been diagnosed, including correct documentation

• donor has consented to, or not objected to, donation prior
• senior NOK has made decision on deceased behalf
• coroner has been informed and consent obtained

Question 15

Serology & Tissue Typing of donation

Answer 15

Serology

• Viruses (HIV, Hep B/C, EBV, HTLV, CMV)
• syphillis
• toxoplasmosis

Tissue Typing & Cross-matching
- immunology at FSH

Nucleic Acid Testing
- HIV & Hepatitis B, C

Question 16

Organ referral & allocation

Answer 16

• urgent listing
• donor info discussed & forwaded to transplant units
• potential recipients have tissue typing & immunology
• organ offers:
  o Compatible blood type
  o Size match
  o Whoever is sickest

Question 17

Tissue donation post OR

Answer 17

Corneas = 5-100 yrs
Bone Tissue = 15-65 yrs
Skin Tissue = <70 yrs
Heart Valves = <60 yrs

Question 18

What % of organ donations come from hospital deaths?

Answer 18

1-2%

Question 19

Organ age suitability;

Heart

Answer 19

< 60yrs CIT 4 hrs

Question 20

Organ age suitability;

Liver

Answer 20

< 80yrs CIT 12hrs

Question 21

Organ age suitability;

Lungs

Answer 21

5yrs < 70yrs CIT 6hrs

Question 22

Organ age suitability;

Intestines

Answer 22

< 50yrs 6-10 hrs

Question 23

Organ age suitability;

Kidneys

Answer 23

< 80yrsup to 24hrs

Question 24

Organ age suitability;

Pancreas/ Islet cells

Answer 24

Pancreas 3yrs < 50yrs Islet cells 10yrs < 70yrs 12 hrs