Red Bood - Donation After Circulatory Death

Question 1

Ethical principles of DCD prior to withdrawing care

Answer 1

No treatment aimed at organ donation should be done PRIOR to decision to withdraw confirmed

You CAN maintain life sustaining treatment in the best interests if pt wanted to be a donor

AND it facilitates donation
AND it causes them no furhter distress/harm

Examples - increasing FiO2, chaning vent settings, putting a cannula in, maintaining MAP

DO NOT start treatment against famiyt wishes

Question 2

Process of controlled organ donation

Answer 2

Retrieval team in theatre and ready to go.

Family ready

Withdraw tx.

Following loss of cardio-resp function - 5 minute observation of monitored asytole

Certify death, doctor independent of retrieval.

family have 5 minutes.

If lung donation - re-intubate and give 1 single breath when retriaval team ready.

CPAP maintained on 100%.

DO NOT VENTILATE UNTIL CHEST OPEN AND AORTA CLAMPED

Question 3

Define Functional Warm Ischaemia

Answer 3

Time from when sys BP < 50 or SpO2< 70%

Liver 30 min
Pancreas 30 min
Lung 60 min (from onset of FWI to inflation)
Kidney 2 hours

Question 4

Define DCD

Answer 4

Retrieval of organs for the purpose of tranplantation whoe death is diagnosed and confirmed by cardio-resp criteria

Question 5

Types of DCD

Answer 5

Controlled and uncontrolled

Uncontrolled - arrest was unexpected

Controlled - after planned withdrawel of treatment

Question 6

Describe the Maastricht class

Answer 6

1 Uncontrolled Dead on Arrival ED

2 Uncontrolled Failed Resus ED

3 Controlled Arrest after withdrawel - ICU

4 Eitehr Arrest in brain death - ICU

5 Uncontrolled Cardiac arrest - inpatient - Hospital

Question 7

CI to organ donation

Answer 7

No age limit

Absolute
Variant CJD
HIV disease (not infection)

Relative
		Active invasive cancer in 3 years (not non-melanoma skin)
		Primary intracerebral lymphome
		Secondary brain tumours
		Haem cancer
		Active TB
		West Nile Virus
		History of Ebola