GIVE trigger: GCS under 5, intubated, ventilated, and with end-of-life discussions in progress.
In NSW, the two doctors determining brain death cant be involved in the tissue removal or the care of the organ recipient, and must have practiced medicine for at least 5 of the last 8 years. Furthermore, one of them must be a designated specialist in that hospital.
Things that disqualify you from being a donor:
- HIV infection
- Creutzfeldt-Jacob Disease
- Metastatic or “incurable” cancer
- Malignancy which has a high risk of metastasis no matter how log the disease-free period, eg. melanoma or choricarcinoma
Try to avoid calling it “organ harvesting”. This has agricultural connotations.
The decision to withdraw treatment must be made INDEPENDENTLY of the decision to donate organs.
Kidney, lung and pancreas grafts survive as often as with braindeath donation, but the function of the organ takes longer to establish (eg. the kidneys don’t start working until several days after grafting) Liver grafts don’t do as well WARM ISCHAEMIA TIME: from treatment withdrawal until cold perfusion of the organs.
- No greater than 30min for liver
- No greater than 60min for kidney/pancreas
- No greater than 90 minutes for lung
Only Maastricht criteria 3 and 4 patients are eligible
Category 1 are “dead on arrival” – unknown warm ischaemia time, organs are probably useless. Category 2 failed resuscitation in ED – also unknown warm ischaemia time. Category 3 have treatment withdrawn in ICU – controlled, known warm ischaemia time Category 4 have an unexpected cardiac arrest during or after the determination of brain death. Once treatment is withdrawn, death is expect to follow quickly (because if it doesn’t, the warm ischaemia time is exceeded, and the organs are of no use) Nothing disqualifies you from being a donor
…but what if you aren’t brain dead, but you wanted to donate organs?
Donation after cardiac death
Ventilated, and treatment is about to be withdrawn
You can still donate organs even if…
You have hepatitis B or C You had cancer, and it has been treated successfully a long time ago You are in your early eighties