Organ Donation

Question 1

What are some OFTF recommendations?

Answer 1

• UK wide organ donation organisation (ODO) should be established, which is responsible for NHSBT
• Each trust should have an identified clinical donation lead and an NHS board donation committee to help achieve this
• BSD testing should be carried out in all patients where BSD is a likely diagnosis
• Donation activity must be monitored by potential donor audit
• Electronic on-line donor registration and offering systems
• UK wide network of dedicated organ retrieval teams for timely high quality organ removal

Question 2

What does ODTF stand for?

Answer 2

Organ donation task force

Question 3

What does ODO stand for?

Answer 3

Organ donation organisation

Question 4

Living donors can be who?

Answer 4

• Blood relative
• Relative by marriage
• Friend
• Human tissue act 2004/06
  
  • Paired
  • Altruistic

Question 5

What are the different donor criterias?

Answer 5

• Donation after brain death
  
  • Patient confirmed brain stem dead
  • Criteria for determining brain stem death
    
    • Irreversible brain damage
    • Exclude reversible causes
    • Exclude depressant drugs
    • Core temperature >34
    • Exclude metabolic, circulatory and endocrine disorders
    • Exclude reversible causes of apnoea
• Donation after circulatory death
  
  • Significant brain injury, not able to meet brain stem death testing criteria
  • Planned withdrawal of care
  • Offered the option of organ donation to the family

Question 6

What is the criteria for brainstem death?

Answer 6

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

Question 7

What does ODR stand for?

Answer 7

Organ donor register

Question 8

What must be check prior to approaching relatives for authorisation to harvest organs?

Answer 8

Prior to approaching relatives ODR must be checked

If no entry on ODR approach nearest relative for authorisation removal of organs

Question 9

Who dictates the ethics of organ donation?

Answer 9

GMC

Question 10

Solid organ donation can be done with?

Answer 10

• Kidney
• Liver
• Heart
• Lung
• Pancreas
• Small bowel
• Multi-visceral

Question 11

Tissue organ donation can be done with?

Answer 11

• Eyes
  
  • Cornea and sclera
• Bone
• Heart valves
• Tendons
• Skin
• Islets
• Hepatocytes

Question 12

How does the waiting list compare to the amount of organ donors?

Answer 12

Massive gap

Question 13

Roughly, what percentage of population are on organ donor list?

Answer 13

33%

Question 14

Describe the process of organ donation?

Answer 14

1. Donor identification
   
   1. Brainstem death/planned withdrawal
   2. Contra-indications
      
      1. HIV, known or suspected vCJD
   3. Organ donor register access
      
      1. Check the organ donor register
      2. Check if carried donor card
      3. Check if verbalised wishes
      4. Check if noted in will
      5. If unknown approach family for authorisation
2. Approach to relatives
   
   1. Patients wishes paramount
   2. Family hierarchy
      
      1. Adult spouse or civil partner -> living with as husband and wife for not less than 6 months -> adults child -> parent -> brother/sister -> grandparent -> adults grandchild -> uncle/aunt -> cousin -> niece/nephew -> friend of longstanding
      2. If none available then authorisation cannot be given
3. Screening
   
   1. Haematology
      
      1. Cross match, FBC, clotting
   2. Tissue typing
   3. U&Es/LFTs, amylase and phosphate
   4. Virology
      
      1. HIV, HTLV, Hep B, Hep C, CMV, Toxoplasmosis, Syphillis
      2. EBV
      3. vCJD
4. Core donor data
   
   1. Blood gases
   2. All drugs on and given
   3. Fluid status/haemodilution
   4. Evidence of brain stem death on clinical records
   5. Haemodynamic status
   6. Physical examination
5. Electronic offering
   
   1. Super urgent offering or national offering
6. Donor management
7. Follow-up
   
   1. Phone call following day family
   2. Meet with them for visit to mortuary
   3. Phone retrieval centres over next few days for recipient uptakes
   4. Letter to donor family
   5. Letter to all who participated in retrieval

Question 15

Explain the family hierarchy for authorising organ donation?

Answer 15

1. Adult spouse or civil partner -> living with as husband and wife for not less than 6 months -> adults child -> parent -> brother/sister -> grandparent -> adults grandchild -> uncle/aunt -> cousin -> niece/nephew -> friend of longstanding

Question 16

What is done for screening a donor?

Answer 16

1. Haematology
   
   1. Cross match, FBC, clotting
2. Tissue typing
3. U&Es/LFTs, amylase and phosphate
4. Virology
   
   1. HIV, HTLV, Hep B, Hep C, CMV, Toxoplasmosis, Syphillis
   2. EBV
   3. vCJD

Question 17

What core donor data is looked at before accepting a donation?

Answer 17

1. Blood gases
2. All drugs on and given
3. Fluid status/haemodilution
4. Evidence of brain stem death on clinical records
5. Haemodynamic status
6. Physical examination

Question 18

What are the different kinds of electronic offerings?

Answer 18

Super urgent offerings

National offerings

Question 19

What should be done for the follow up part of organ donation?

Answer 19

1. Phone call following day family
2. Meet with them for visit to mortuary
3. Phone retrieval centres over next few days for recipient uptakes
4. Letter to donor family
5. Letter to all who participated in retrieval

Question 20

What should be checked to see if a patient is a donor?

Answer 20

1. Check the organ donor register
2. Check if carried donor card
3. Check if verbalised wishes
4. Check if noted in will
5. If unknown approach family for authorisation

Question 21

What are some contraindications to organ donation?

Answer 21

1. HIV, known or suspected vCJD

Question 22

What are haemodynamic goals for organ donation?

Answer 22