Organ Donation

Question 1

who may a living donation be from?

Answer 1

• Blood relative
• Relative by marriage
• Friend
• Human Tissue Act 2004/6
• Paired
• Altruistic

Question 2

donation after brain death - Patient confirmed brain stem dead

what is the criteria for determining brain stem death?

Answer 2

Irreversible brain damage

Exclude reversible causes

Exclude depressant drugs

Core temperature >34°C

Exclude metabolic, circulatory and endocrine disorders

Exclude reversible causes of apnoea

Question 3

what is donation after circulatory death?

Answer 3

• Significant brain injury, not able to meet brain stem death testing criteria
• Planned withdrawal of care
• Significant level of support to withdraw
• Family discussion regarding plan to withdraw care
• Offered the option of organ donation
• Time to death governs what is able to be donated
• Tissue Donation

Question 4

GMC – What Treatment and Care Towards End of Life do you do?

Answer 4

“If a patient is close to death and their views cannot be determined, you should be prepared to explore with those close to them whether they had expressed any views about organ or tissue donation, if donation is likely to be a possibility”

Question 5

Solid Organ Donation may be what?

Answer 5

• Kidney
• Liver
• Heart
• Lung
• Pancreas
• Small bowel
• Multi-visceral

Question 6

tissue donation may be what?

Answer 6

• Eyes – cornea and sclera
• Bone – Woodend/Albyn
• Heart valves – 10 years
• Tendons – sportsmen/women
• Skin – 7/7 depleted supplies
• Islets – Edmonton, Canada
• Hepatocytes – Kings, London

Question 7

what is the process of organ donation?

Answer 7

• Donor identification
• Approach to relatives/families
• Screening
• Core donor data
• Electronic Offering
• Donor management
• Follow - up

Question 8

how is identification of a donor done?

Answer 8

• Brainstem death criteria/planned withdrawal
• Contra-indications:
• Known HIV - have transplanted in past
• Known or suspected vCJD
• everyone else assessed on an individual basis
• Current/Past Medical History - family, notes, GP
• Procurator Fiscal/Coroner

Question 9

what screening is done?

Answer 9

• Haematology - Cross match, FBC, Clotting
• Tissue typing
• U & E’s/ L.F.T.’s, amylase & phosphate
• Virology
• HIV, HTLV, Hep B, Hep C, CMV, Toxoplasmosis, Syphillis
• EBV - paediatrics specifically
• vCJD tissues only

Question 10

Haemodynamic Goals

Answer 10

• MAP 60mmHg
• Heart rate 70 – 120
• CVP 10 – 12cm H20
• UO 1ml/kg
• Lowest FiO2 compatible with PaO2 >10kPa
• Peep <10cm H20
• Tidal volume 6 – 8 ml/kg

Question 11

Hormone Resuscitation

Answer 11

• Methylprednisolone – 15mg/kg
• Tri-iodothyronine – 4 microgramme bolus, 3 microgramme infusion
• Insulin – minimum of 1 unit/hr irrespective of glucose (give to maintain if necessary)

Question 12

Theatre

Answer 12

• Arrange theatre time
• Support theatre staff
• Supply food for teams
• Complete paperwork
• Package retrieved organs
• Dispatch retrieved organs
• Perform Last Offices

Question 13

what follow up is done?

Answer 13

• Phone call following day to family
• Meet with them for visit to mortuary
• Phone retrieval centres over next few days for recipient updates
• Letter to donor family
• Letters to all who participated in retrieval