Lecture - Organ Donation

Question 1

What are the different kinds of living donations?

Answer 1

Blood relatives
Relative by marriage
Friend
Paired
Altruistic

Question 2

What are the criteria for determining brainstem death?

Answer 2

Irreversible drain damage
Exclude reversible causes
Exclude depressant causes
Core temp >34C
Exclude metabolic, circulatory and endocrine disorders
Exclude reversible causes of apnoea

Question 3

What are the different types of organ donation?

Answer 3

Living donation
Donation after brain death
Donation after circulatory death

Question 4

What is the criteria for donation after circulatory death?

Answer 4

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

Question 5

What are the 3 categories of donation after circulatory death?

Answer 5

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

Question 6

How should you approach organ donation in a braindead patient?

Answer 6

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

Question 7

Can the nearest relative extend authorisation for transplant to include research, education, training or audit?

Answer 7

Yes

Question 8

What solid organ donations are there?

Answer 8

Kidney 
Lung
Liver
Heart
Pancreas
Small bowel
Multivisceral

Question 9

Give e.g.s of tissue donations

Answer 9

Eyes - cornea/sclera
Bone
Heart valves
Tendons
Skin
Islets
Hepatocytes

Question 10

Where is the Scottish transplant centre for liver, kidneys and pancreases?

Answer 10

Edinburgh

Question 11

Where is the Scottish transplant centre for hearts?

Answer 11

Glasgow Jubilee

Question 12

Where is the transplant centre for lungs?

Answer 12

Newcastle

Question 13

What is involved in the process of organ donation?

Answer 13

Donor identification 
Approach to relatives/families
Screening
Core donor data
Electronic offering
Donor management
Follow up

Question 14

What are contraindications to people being donors?

Answer 14

Known HIV
Prev. transplant
Known/suspected vCJD

Question 15

What ways might you be able to find out if someone wanted to be an organ donor?

Answer 15

Check organ donor register
Check if carried organ donor card
Check verbalised wishes
Check if noted in will

Question 16

What is the family hierarchy when it comes to a family member making a decision about organ donation on a patients behalf?

Answer 16

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

Question 17

What is involved in the screening for organ transplant?

Answer 17

Cross match, FBC, clotting
Tissue typing
UE, LFTs, amylase, phosphate
Virology: HIV, HTLV, hep B/C, CMV, toxoplasmosis, syphilis, EBV, vCJD for tissues only

Question 18

What is the necessary core donor data?

Answer 18

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

Question 19

What are the criteria for brainstem death testing?

Answer 19

Deep coma of known aetiology
Reversible causes excluded
No sedation
Normal electrolytes

Question 20

How do you test for braindeath?

Answer 20

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

Question 21

What is the oculo-vestibular reflex?

Answer 21

Eye movements following slow injection of at least 50ml of ice cold water into each ear in turn (the caloric test)

Question 22

Who should test for brainstem death?

Answer 22

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