Once the potential for DBD or DCD has been recognised by the ED specialist, the next step is to determine the feasibility of donation and the patient’s medical suitability. This will take into account:
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current illness
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past medical history and comorbidities
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the condition of potentially transplantable organs.
There are few absolute contraindications to organ or tissue donation, (e.g. haematological malignancy). All other contraindications are relative. For example, a past history of treated cancer, smoking or heavy alcohol intake require discussion with the transplant services.
ODNZ recommends that the ED specialist consults the local ICU specialist about the possibility of ICU admission for organ donation as soon as the potential is recognised. ICU specialists are responsible for admission decisions to ICU.
ODNZ recommends that either the ED or the ICU specialist consult ODNZ about the feasibility of DBD or DCD and the patient’s medical suitability for donation as soon as the potential for organ donation is recognised, and before donation is discussed with the family.
ODNZ can advise on:
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the likelihood of brain death developing
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the likelihood of death occurring after withdrawal of treatment within a time frame that might permit DCD
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the suitability of organs
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liaison with the transplant teams as appropriate.
ODNZ recommends that the possibility of ICU admission for organ donation should not be discussed with the family before discussions with the ICU specialist and ODNZ. There may be circumstances where donation is not possible (e.g. because of medical unsuitability), or not feasible, (e.g. because there is insufficient ICU resource).
It is unfair on families to offer the option of ICU admission solely for organ donation if donation isn’t a realistic possibility.