Organ Donation Flashcards

1
Q

What types of living donors are there?

A
  • Blood relative
  • Relative by marriage
  • Friends
  • Paired/altruistic
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2
Q

What is the criteria fro determining brain death?

A
  • Irreversible brain damage
  • Exclude reversible causes
  • Exclude depressant drugs
  • Core temperature >34°C
  • Exclude metabolic, circulatory and endocrine disorders
  • Exclude reversible causes of apnoea
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3
Q

What considerations are there for donation after circulatory death?

A
  • 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
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4
Q

What solid organ donation is available?

A
  • Kidney
  • Liver
  • Heart
  • Lung
  • Pancreas
  • Small bowel
  • Multi-visceral
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5
Q

What tissue donation is available?

A
  • Eyes (cornea and sclera)
  • Bone
  • Heart valves
  • Tendons
  • Skin
  • Islets
  • Hepatocytes
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6
Q

What are the steps in the donation process?

A
  • Donor identification
  • Approach to relatives/families
  • Screening
  • Core donor data
  • Electronic Offering
  • Donor management
  • Follow - up
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7
Q

How are donors identified?

A
  • Brainstem death criteria/planned withdrawal of care
  • Contra-indications ruled out
  • Current/PMH
  • Procurator fiscal/coroner
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8
Q

What contra-indications are there to become a donor?

A
  • Known HIV - have transplanted in past

- Known or suspected vCJD

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9
Q

How can you find out if someone wishes to donate?

A

-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

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10
Q

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

A
  • 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
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11
Q

How are donors screened?

A
  • Haematology: Cross match, FBC, clotting
  • Tissue typing
  • U+Es, LFTs, amylase and phosphate
  • Virology: HIV, HTLV, Hep B, Hep C, CMV, Toxoplasmosis, Syphilis
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12
Q

What virology test is carried out in paediatrics specifically?

A

EBV

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13
Q

What virology test is carried out on tissue only

A

vCJD

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14
Q

What core donor data must be collected?

A
  • 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
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15
Q

What are the haemodynamic goals?

A
  • 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
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16
Q

What hormone resuscitation may be required?

A
  • 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)
17
Q

What considerations must be made when preparing theatre?

A
  • Arrange theatre time
  • Support theatre staff
  • Supply food for teams
  • Complete paperwork
  • Package retrieved organs
  • Dispatch retrieved organs
  • Perform Last Offices
18
Q

What follow up is there for donor families?

A
  • 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