Organ Donation Flashcards
What is the law regarding organ donation?
- Decision of the deceased takes precedence
- Lawful to remove organs for transplantation where deceased has consented before death
- Clinical practice ensures appropriate people are consulted
- Should ideally be part of all end of life care where appropriate
How do the donor and recipient benefit from organ donation?
DONOR - the idea of being responsible for an increase in a patient’s quality of life
RECIPIENT - Best treatment for ESRF and treatment is life saving
What is the deemed consent approach?
Conversation begins the same
* Doctor often not present for the full end of life care planning and
donation approach
* Leading with the benefits of donation-GIFT of LIFE!!!
* It’s not about us, it’s about the patient and their family
* Deemed Consent empowers and allows for a positive approach
* Conversation is unique for every family.
Which patients may be fast tracked and identified as potential donors very early on?
- Patients with severe brain injury
- Patients with anticipated circulatory death following decision to withdraw or limit life sustaining treatment
What are the ABSOLUTE contraindications to organ donation?
Creutzfeldt-Jakob disease (CJD)
* HIV disease
* Ebola
* Certain cancers
In rare cases organs from donors with HIV and Hepatitis C have been used to help other’s with the same condition.
What are the 3 stages of the family approach?
- Planning
- Confirming understanding and acceptance of loss
- Discussing donation
Research suggests that families should be
approached by a clinician with whom they are familiar with and an expert in the field of organ donation.
What are the types of donation?
- Donation after brain death - determined using neurological testing. Applies when brain injury is suspected to have caused irreversible loss of the capacity for consciousness and irreversible loss of the capacity for respiration
- Donation after circulatory death
Give four cases of brain stem death.
Tumour
Trauma
Ischaemia
Intra-cerebral haemorrhages
What are the signs of brain stem death?
Fixed and dilated pupils
* No response to painful stimuli
* Loss of cough and gag reflex
* Apnoea
* Hypertension followed by hypotension
* Tachycardia/Bradycardia
What steps should be given importance before brain stem death diagnosis?
- Diagnosis consistent with irreversible brain damage with the patient being apnoeic, unresponsive on ventilator
Reversible causes of apnoeic coma must be excluded
- Drug intoxication
- Hypothermia
- Metabolic & Endocrine disturbance
Who tests for brain stem death?
Two medical practitioners with one being a consultant - always 2 sets of tests with both doctors acting together
What is checked during brain stem tests?
- Pupils are fixed and dilated and don’t react to light
- No corneal reflex
- No vestibulo-occular reflexes
- No motor response to pain within cranial nerve distribution
- No gag reflex or reflex response to tracheal stimulation
- Positive apnoea test
What can be done in potential donor management?
IV Access
* Inotropes – Vasopressin
* DDAVP
* Fluids
* Ventilation
* Actrapid
* Temperature management
What happens in donation following circulatory death?
Invasive arterial monitoring continues once patient extubated
* Death is pronounced by a doctor 5 minutes after irreversible loss of cardiac output.
* Body is transferred into theatre - knife to skin can commence
* Incision is made to cannulate aorta and commence perfusion with a preserving solution.
* Organs are removed after cold perfusion
* Team on standby for 3-4 hours in theatre
* If patient stable after 3-4 hours- team can stand down
How would you ask a family about tissue donation?
“There is a possibility that xxxx may able to help others by becoming a tissue donor. They may be able to give the gift of sight, or help those with burns or other serious injuries. If this is something you would like to know more about, I can phone a specialist nurse who
will phone you at home, later in the day, to discuss it with you.”
What are the main principles behind tissue donation?
Can occur up to 24 hours after death
* Patients who die outside of critical care can
donate (Do not have to be I&V) or those that
may have been declined for organ donation
* Need to ask the family about wishes before
referring
* Consent is taken over the phone
* Donation occurs in the mortuary
What are the main principles behind bone donation?
Bone is removed from the hip to just below the knee.
- The bone is replaced with a specially designed prosthesis and the leg fully reconstructed
- One donation can enable up to thirty
people to undergo surgery such as:-
*Revision joint replacement
*Spinal fusion
*Trauma surgery
*Major bone replacement
What are the main principles behind skin donation?
Skin is donated from the back of the
body and the thighs.
- Donated skin is not full thickness. Used in the early, life-saving treatment of major
burns to:-
*Reduce interference with the wound from dressings
*Stimulate underlying tissues
*Prepare a good dermal bed for later cosmetic grafting
What are the main principles behind tendon donation?
Achilles and patella tendons may be donated by younger donors.
- Used to repair the anterior and posterior cruciate ligaments of the knee.
- Inserted into the knee through an arthroscope.
What are the main principles behind heart valve donation?
Used to replace defective heart valves
- No need for long term anticoagulation
What are the main principles behind cornea donation?
Donation may restore or greatly improve the sight of up to two people.
- Occasionally the sclera of the eye is also used in orbital reconstruction surgery.
- Eye is carefully reconstructed to appear
anatomically normal.
