More than 1500 people are waiting for organ transplants in Australia while only a small fraction of potential donors in emergency departments are identified. One organ donor can save or improve the lives of many patients. While the majority of Australians support organ donation, current practices are missing opportunities to increase the donor pool. Careful screening can allow organs from donors once considered unsuitable, such as those with diabetes, hepatitis, or a history of smoking, to be donated.

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

3. Causes of Donor death

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

7. Donation after Brain Death

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

10. Identification in ED
Patient intubated& palliated
Referral
Donor Coordinator is notified via switchboard

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