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ED give presentation
1.
2. More than 1500 people are waiting for an organ transplant
Opportunity to offer organ donation in only one of 100 ED deaths
but
One organ and tissue donor can change the live of many patients
Majority of Australians are willing to become organ donors
4. Diagnosing Death
Cardiac no body circulation Absent pulse
Vascular
"Cardiac/ Circulatory Death"
Cerebral no blood flow to brain Four-vessel angiography or
Vascular Radionuclide imaging
"Brain Death"
no brain function Unresponsive &
Absent brain-stem reflexes &
Apnoea
Death
5. Pathways to Organ donation
Circulatory criteria:
Absent body blood flow
Donation after Circulatory Death
(DCD)
Brain criteria:
Absent brain blood flow
Donation after Brain Death
(DBD)
Diagnosis of Death
by
6. Potential Organ Donors in the ED
likely to become pulseless
after extubation
Potential for DCD
likely to become brain dead
Potential for DBD
Intubated & palliated
8. Donation after Circulatory Death
• Category 1 Dead on arrival (uncontrolled)
• Category 2 Failed resuscitation (uncontrolled)
• Category 3 Withdrawal of life support (controlled)
• Category 4 Arrest following brain death (uncontrolled)
9. Missed Request
Mrs. A.B. 55 years, nil comorbidities
Massive brainstem bleed 28/7/2014 with GCS 3 at scene
Intubated on arrival in ED at 15:50
Pupils 3, nonreactive, corneal& gag reflex present
E1 VT M2 (extending with UL)
nil organ dysfunction
“Not for surgical intervention given extend of hemorrhage…
Plan: Palliation. Comfort care.” NSx 17:40
Extubated at 20:30
RIP 21:30
11. Identification in ED
Patient intubated& palliated
Referral
Donor Coordinator is notified via switchboard
Confirmation no
Coma with GCS <6, intubated and ventilated
Diagnosis of irrecoverable brain injury documented
End of life care accepted by patient`s family
Assessment of Suitability no End of
No medical contraindication and Life care
likely brain dead next 24hrs or continues
likely to die within 1hr of withdrawal in ED
Hospital/ State Medical Director for medical suitabilty as required
yes
Evaluation of Patient`s wishes no
State Donor Coordinator for databases check
yes
Request for Organ Donation no
Family is offered opportunity of Organ Donation
yes
End of Life care continues in ICU
ED to contact primary team
ICU SR to notify Intensivist and to organise transfer
Clinical management as by Intensivist and primary team
Organ donation will be further discussed
12. “Contra-indications” in 2012
• 27 donors with Type II DM provided 36 kidneys, 11 livers, two hearts, four double
lungs, 23 corneas, three sets of heart valves, two bone donations and one tissue
donation
• 37% Australian donors were recorded as current smokers
• A past history of hypertension was recorded in 26% in Australia
• There were seven Hepatitis C positive donors
• 4% of Australian donors were Hepatitis B positive
• 43% of donors were subject to coronial inquiry
• 16% of donors were >65 years of age
Editor's Notes
In order to be an organ donor you need to die in a specific way. In ICU on a ventilator about 1.2 % of all hospital deaths.
Of that figure we loose about half, if family members don’t know their loved ones wishes they are more likely to refuse OD.
Surprising figures however as when we survey the population about 90 % are in favour of OD.
BD – irreversible cessation of brain function
DCD – irreversible cessation of circulation
DCD categories – NSW using categories 3 and 4
Spain uses categories 1 and 2 - it is illegal to withdraw treatment in Spain so category 3 is not possible
