organ donation Flashcards
who is involved in the process of organ donation?
Patient
Patient’s family
Specialist Nurse for Organ Donation (SNOD)
ICU staff
Transplant surgical team
In the case of tissue donation
Tissue Donation Co-ordinator
Mortuary staff
what organs can be donated?
Kidneys
Liver
Heart
Lungs
Pancreas
Small bowel
what tissue can be donated?
Corneas
Heart Valves
Tendons
Skin
Bone
Arteries
what is the exclusion criteria for organ donation?
Active invasive cancer in last 3 years
Haematological malignancy
Untreated systemic infection
Variant CJD
HIV disease (but not HIV infection)
Other exclusion criteria apply to individual organs
summarise the organ donation process?
what are the three ways adult autharisation can be obtained?
Express (self) Authorisation
Deemed Authorisation
Nearest Relative Authorisation.
what is deemed authorisation?
If a person has not recorded a donation decision in writing, the Act provides that authorisation for donation of their organs and tissue for transplantation may be deemed to have been given, subject to a number of safeguards.
Safeguards: 1. The healthcare professional is able to complete the duty to inquire adequately
2. No evidence of unwillingness to donate
3. The person is in not in an excepted category
4. Transplantation is not of excepted body part or for research
how is child authorisation aquired?
Authorisation for organ donation in children under 12 years old must be obtained from the person with parental rights and responsibilities for that child
Children aged 12-16 years can record their decision on the ODR, but parents should be consulted
In the case when the parents are incapacited, there is a hierarchy of nearest relatives who can provide authorisation
what are pre death procedures?
A pre-death procedure is a medical procedure carried out for the purpose of facilitating transplantation and is not a procedure that supports the patient’s health.
when are pre death procedures carried out?
The Act seeks to ensure that pre-death procedures aren’t carried out prematurely. They can only be carried out when death is considered to be imminent and after the decision to withdraw life sustaining treatment (where it is being administered) is made.
define Death by neurological criteria (DNC)?
When a patient has suffered irreversible loss of brain function so that they will not regain consciousness or be able to breathe independently, but is on artificial life support
Confirmed by neurological testing (previously known as brainstem testing)
define donation after cardiac death (DCD)?
When life sustaining therapy is withdrawn and the patient ceases to be alive confirmed by standard testing – heart stops, no respiratory effort
Timing is critical here
how is donation carried out following neurological death?
At time of confirming death to family, approach for organ donation made with SNOD –’what happens now?’
Authorisation
Donor optimisation and offering of organs to transplant centres (can take >24 hours)
Organ retrieval by transplant surgeons
Organs transported to transplant centres for recipients
how is donation carried out following cardiac death?
When continuing care is felt to futile by clinical team and patient is on organ support that can be withdrawn
Approach to family made with SNOD
Authorisation
Offering of organs
Transplant surgeons set up for retrieval in theatre
Withdrawal of life sustaining therapy
Patient allowed to die
Death confirmed after 5 minutes of asystole
Retrieval operation proceeds
why is timing in DCD critical?
Timing is critical in DCD as the quality of organs deteriorates rapid during warm ischemia
Warm ischemia is when systolic BP falls below 50mmHg (or oxygen saturations fall below 70%)
Different organs are more vulnerable, so the maximum tolerated warm ischaemic time varies
Kidneys – 120 minutes
Liver – 30 minutes
Pancreas – 30 minutes
Lungs - 60 minutes
Heart – New process
