ED give presentation
- 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
Editor's Notes
- #3: 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.
- #6: BD – irreversible cessation of brain function DCD – irreversible cessation of circulation
- #9: 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