Management of the organ donation patient

OVERVIEW

Involves these steps:

  • Early identification
  • Establish rapport with family early
  • Non-coercive discussion with family regarding opportunity to donate
  • Initiate tissue typing, organ function testing and viral screening
  • Maintain extra-cerebral physiological stability
  • Facilitate family time at the bedside
  • Ensure aftercare of donor family
  • Management of staff who may require ongoing support and care

MANAGEMENT OF ORGAN DONATION PATIENT

Early identification

  • discuss with transplant co-ordinator early
  • close communication with organ donation co-ordinator and team is paramount

Establish rapport with family early

  • close and careful management of the family throughout the process

Non-coercive discussion with family regarding opportunity to donate

  • answer any questions and provide information

Initiate tissue typing, organ function testing and viral screening

  • echocardiography, biopsies, CT chest/ abdo, renal tract ultrasound, bronchoscopy
  • blood tests

Maintain extra-cerebral physiological stability

  • Ventilatory – oxygenation, lung protection, normocapnia, head up positioning, bronchoscopy, chest physiotherapy
  • Circulatory – initial sympathetic surge (e.g. hypertensive, dysrhythmias) then hypotensive (neurogenic/ hypovolemic/ cardiogenic shock); Rx: fluid, noradrenaline, vasopressin, monitoring, anti-arrhythmic agents
  • Neurological – normothermia (cold fluids, exposure, loss of shivering, decreased metabolic rate); Rx: external warming, humidification
  • Endocrine/ metabolic – loss of HPA axis: steroids (Methylprednisolone 15 mg/kg bolus), T3
  • Usual supportive care (glucose control, VTE prophylaxis, correct electrolytes and coagulopathy)

Facilitate family time at the bedside

Ensure aftercare of donor family

  • transplant co-ordinator
  • limited anonymous information available
  • further follow up offered

Management of staff who may require ongoing support and care

References and Links

LITFL

Journal articles

  • Bugge JF. Brain death and its implications for management of the potential organ donor. Acta Anaesthesiol Scand. 2009 Nov;53(10):1239-50. PMID: 19681785. [Free Full Text]
  • Mascia L, Mastromauro I, Viberti S, Vincenzi M, Zanello M. Management to optimize organ procurement in brain dead donors. Minerva Anestesiol. 2009 Mar;75(3):125-33. Epub 2008 Jan 24. PMID: 18636057. [Free Full Text]
  • McKeown DW, Bonser RS, Kellum JA. Management of the heartbeating brain-dead organ donor. Br J Anaesth. 2012 Jan;108 Suppl 1:i96-107. doi: 10.1093/bja/aer351. PMID: 22194439. [Free Full Text]

FOAM and web resources

  • ANZICS Statement on Death and Organ Donation – 3.2 (2013)

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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