Organ donation
- Establish brainstem death
- A local transplant co-ordinator should be contacted early once the potential for organ donation is recognised.
- Respiratory support should be continued, maintaining normal blood gas parameters but minimising the harmful effects of positive pressure ventilation (e.g. avoidance of excessive positive end-expiratory pressure and excessive FiO2).
- Hypotension is common following brain stem death and can compromise the perfusion of transplantable organs.
- It may occur as a result of decreased sympathetic tone, diabetes insipidus, cold diuresis or cardiac dysfunction. It should be treated with fluids, vasopressors or inotropes as appropriate.
- Normothermia should be maintained as per standard critical care management,
- As it may contribute to coagulopathy, acidaemia, cardiac arrhythmias and diuresis.
- Endocrine support may also be required to reduce the need for inotropes and delay cardiac arrest.
- Vasopressin, insulin, tri-iodothyronine and methylprednisolone may all be used.
Contra-indications to organ donation
- Positive HIV, Hepatitis B or C, HTLV, syphilis or malaria tests
- Untreated systemic sepsis
- Evidence of Creutzfeldt-Jakob disease
- Progressive neurological disease of unknown cause (e.g. Alzheimer’s, Parkinson’s, motor neurone disease)
- Uncontrolled hypertension or end-organ damage from hypertension or diabetes mellitus
- Malignancy
- A previous transplant recipient who has received immunosuppressive treatment.
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