ED give presentation

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

Causes of Donor death

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

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 Deathby

Potential Organ Donors in the ED

likely to become pulselessafter extubation

Potential for DCD

likely to become brain dead

Potential for DBD

Intubated & palliated

Donation after Brain Death

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)

Missed Request

Mrs. A.B. 55 years, nil comorbiditiesMassive brainstem bleed 28/7/2014 with GCS 3 at scene

Intubated on arrival in ED at 15:50Pupils 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 20:30RIP 21:30

Identification in EDPatient intubated& palliated

ReferralDonor Coordinator is notified via switchboard

Identification in EDPatient intubated& palliated

ReferralDonor 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 ofNo medical contraindication and Life carelikely 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 ICUED 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

“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