Lecture - Organ Donation Flashcards
What are the different kinds of living donations?
Blood relatives Relative by marriage Friend Paired Altruistic
What are the criteria for determining brainstem death?
Irreversible drain damage Exclude reversible causes Exclude depressant causes Core temp >34C Exclude metabolic, circulatory and endocrine disorders Exclude reversible causes of apnoea
What are the different types of organ donation?
Living donation
Donation after brain death
Donation after circulatory death
What is the criteria for donation after circulatory death?
Significant brain injury not able to meet brainstem death testing criteria
Planned withdrawal of care
Significant level of support to withdraw
Family discussion re plan to withdraw care
Offered option of organ donation
What are the 3 categories of donation after circulatory death?
1: dead on arrival to hospital (death mut be witnessed)
2: unsuccessful resus
3: awaiting cardiac arrest (death inevitable but don’t meet criteria for brainstem death)
4: cardiac arrest in brainstem dead cadaver
5: unexpected cardiac arrest in patient in ITU/critical care unit
How should you approach organ donation in a braindead patient?
Check ODR
No entry - approach nearest relative, establish whether pt carried donor card/expressed wish to donate
None of above - nearest relative can authorise donation
Can the nearest relative extend authorisation for transplant to include research, education, training or audit?
Yes
What solid organ donations are there?
Kidney Lung Liver Heart Pancreas Small bowel Multivisceral
Give e.g.s of tissue donations
Eyes - cornea/sclera Bone Heart valves Tendons Skin Islets Hepatocytes
Where is the Scottish transplant centre for liver, kidneys and pancreases?
Edinburgh
Where is the Scottish transplant centre for hearts?
Glasgow Jubilee
Where is the transplant centre for lungs?
Newcastle
What is involved in the process of organ donation?
Donor identification Approach to relatives/families Screening Core donor data Electronic offering Donor management Follow up
What are contraindications to people being donors?
Known HIV
Prev. transplant
Known/suspected vCJD
What ways might you be able to find out if someone wanted to be an organ donor?
Check organ donor register
Check if carried organ donor card
Check verbalised wishes
Check if noted in will
What is the family hierarchy when it comes to a family member making a decision about organ donation on a patients behalf?
Adults spouse/civil partner Living with as a husband/wife/civil partner for not less than 6 months Adults child Parent Brother/sister Grandparent Adults grandchild Uncle/aunt Cousin Niece/nephew Friend of longstanding If none of above available authorisation cannot be given
What is involved in the screening for organ transplant?
Cross match, FBC, clotting
Tissue typing
UE, LFTs, amylase, phosphate
Virology: HIV, HTLV, hep B/C, CMV, toxoplasmosis, syphilis, EBV, vCJD for tissues only
What is the necessary core donor data?
Blood gases on current O2 and 100% All drugs on and given Fluid status/haemodilution Evidence of brainstem death on clinical records Haemodynamic status Physical ex
What are the criteria for brainstem death testing?
Deep coma of known aetiology
Reversible causes excluded
No sedation
Normal electrolytes
How do you test for braindeath?
Fixed pupils which do not respond to sharp changes in the intensity of light
No corneal reflex
Absent oculo-vestibular reflexes
No response to supraorbital pressure
No cough reflex to bronchial stimulation/gagging response to pharyngeal stimulation
No observed resp effort in response to disconnection of the ventilation for 5 minutes
What is the oculo-vestibular reflex?
Eye movements following slow injection of at least 50ml of ice cold water into each ear in turn (the caloric test)
Who should test for brainstem death?
2 appropriately experienced doctors on 2 separate occasions
Both should be experienced in performing brainsteam death testing + have at least 5 years post-grad experience
1 must be a consultant
Neither should be a member of the transplant team
