Organ Donation

Question 1

What types of living donors are there?

Answer 1

• Blood relative
• Relative by marriage
• Friends
• Paired/altruistic

Question 2

What is the criteria fro determining brain 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 considerations are there for 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

What solid organ donation is available?

Answer 4

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

Question 5

What tissue donation is available?

Answer 5

• Eyes (cornea and sclera)
• Bone
• Heart valves
• Tendons
• Skin
• Islets
• Hepatocytes

Question 6

What are the steps in the donation process?

Answer 6

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

Question 7

How are donors identified?

Answer 7

• Brainstem death criteria/planned withdrawal of care
• Contra-indications ruled out
• Current/PMH
• Procurator fiscal/coroner

Question 8

What contra-indications are there to become a donor?

Answer 8

• Known HIV - have transplanted in past

- Known or suspected vCJD

Question 9

How can you find out if someone wishes to donate?

Answer 9

-Check the Organ -Donor Register
-Check if carried a Donor Card
-Check if verbalised wishes
-Check if noted in a will
In unknown family approached for authorisation

Question 10

What is the family hierarchy when it comes to organ donation wishes?

Answer 10

• Adults spouse or civil partner
• Living with as husband and wife/civil partnership 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 the above available authorisation cannot be given

Question 11

How are donors screened?

Answer 11

• Haematology: Cross match, FBC, clotting
• Tissue typing
• U+Es, LFTs, amylase and phosphate
• Virology: HIV, HTLV, Hep B, Hep C, CMV, Toxoplasmosis, Syphilis

Question 12

What virology test is carried out in paediatrics specifically?

Answer 12

EBV

Question 13

What virology test is carried out on tissue only

Answer 13

vCJD

Question 14

What core donor data must be collected?

Answer 14

• Blood Gasses on current O2% & 100%
• All drugs on and given
• Fluid status/haemodilution
• Evidence of brain stem death on clinical records
• Haemodynamic status
• Physical examination

Question 15

What are the haemodynamic goals?

Answer 15

• 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 16

What hormone resuscitation may be required?

Answer 16

• 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 17

What considerations must be made when preparing theatre?

Answer 17

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

Question 18

What follow up is there for donor families?

Answer 18

• 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