Guidelines

1
Organ Tissue Donation in Australia
Guidelines
2
Ethical and professional standards

• Clinicians are guided by detailed ethical and
  professional standards and guidelines some of
  which include
• National Health and Medical Research Council
  (NHMRC) Guidelines, Organ and Tissue Donation
  After Death, for Transplantation Guidelines for
  Ethical Practice for Health Professionals (2007)
• Australian and New Zealand Intensive Care
  Society, Statement on Death and Organ Donation
  (1998 currently under review)
• The Transplantation Society of Australia and New
  Zealand Organ Allocation Protocols (2002, updated
  2004)
• Australasian Transplant Coordinators Association
  National Guidelines for Organ and Tissue Donation
  (2006)

3
Organ Tissue donation in Australia

• In 2007 there were
• 198 donors 9.4 donors per million population
  dpmp
• 349 kidneys (342 recipients)
• 133 livers (147 recipients)
• 62 hearts (including six heart/lungs)
• 150 lungs (65 double, six heart/lungs and eight
  single lungs)
• 28 pancreas
• 5 pancreas islets transplanted into recipients.
• In addition there were
• 125 corneas
• 42 heart valves
• 11 bone donations from these donors

4
Organ Tissue donation in Australia

• The mean age of donors was 43.4 years, median
  45.2 years with a range of 0.7 - 80.4 years
• In 2007, the major cause of death in 53 of
  donors was (CVA) cerebrovascular accident, while
  road trauma caused 15 of all donor deaths
• The donation of more than one organ occurred in
  82 of donors.
• The average number of organs transplanted per
  donor was 3.3

5
Cause of Donor Deaths in Australia2001 2006
6
General Organ Donor Medical Criteria

• Patients who have suffered irreversible loss of
  brain function (brain death) but still have an
  intact cardiovascular system, are potential
  donors of heart, lungs, liver, pancreas and
  kidneys
• Organ donation after brain death can only occur
  when the patient has died in the intensive care
  or emergency department setting and is still
  maintained by mechanical ventilation
• Organ donation cannot take place until death has
  been confirmed and authorisation has been
  obtained

7
General Organ Donor Medical Criteria

• All potential donors are considered individually
• but the patient must have
• Suffered irreversible loss of brain function
  brain death
• Been maintained on a ventilator with intact
  circulation
• No current malignancy except primary brain tumour
  or minor skin lesions

8
Exclusion Criteria for Organ Donation

• Human Immunodeficiency Virus (HIV)
• Current neoplastic disease other than primary
  brain tumour and non-malignant skin cancers
• Systemic viral infections/uncontrolled sepsis
  (eg measles, rabies, adenovirus, enterovirus,
  parvovirus and herpes encephalitis)

9
Definition of Death

• In the States and Territories of Australia, with
  the exception of Western Australia, the two legal
  definitions of death are
• Irreversible cessation of circulation of blood in
  the body of a person
• OR
• Irreversible cessation of all function of the
  brain of a person
• (In Western Australia organs and tissues
  may be removed for the purposes of
  transplantation if two medical practitioners
  certify that irreversible cessation of all
  function of the brain has occurred.)

10
Certification of Brain Death

• The confirmation of brain death must be certified
  by two medical practitioners, each of whom has
  carried out a clinical examination, to confirm
  cessation of function and demonstrate
  irreversibility
• Each State and Territory has legislation that
  prescribes the legal requirements necessary for
  the removal of organs or tissues for
  transplantation including the required status
  of the two
  medical practitioners who are to
  perform the
  certification of brain death

11
Clinical Certification of Brain Death

• Prior to clinical testing all preconditions must
  be satisfied
• Diagnosis of severe brain injury usually
  confirmed by neuroimaging
• Exclusion of coma caused by drugs or poisoning
• Exclusion of metabolic causes for coma (eg
  severe electrolyte or endocrine disturbances)
• Exclusion of hypothermia- core temp gt35C
• Confirmation of intact neuromuscular conduction
• Minimum of four hours mechanical ventilation and
  observation of GCS 3, non-reactive pupils, absent
  cough and gag reflexes and no spontaneous
  respiratory effort

12
Cerebral Angiogram
Carotid siphon
Normal Cerebral Bloodflow Absent
Cerebral
Bloodflow
13
Cerebral Perfusion Scan
Normal Cerebral Bloodflow Absent
Cerebral
Bloodflow
14
Medical Management Of the Potential Donor

• In response to brain death a cascade of complex
  physiological changes occur, resulting in
  haemodynamic instability, which at times can be
  profound
• Medical management of the potential donor in the
  ICU is aimed at maintaining normal physiology and
  the usual spectrum of monitoring and
  interventions should be employed
• Management is designed at optimal organ perfusion

15
Allocation of Organs

• Kidneys are allocated by
• Blood group compatibility, tissue typing and
  cross-matching
• National Organ Matching System (NOMS) computer
  system, best match
• Multiple possible recipients
• Allocated after retrieval surgery

• Heart, lungs, liver pancreas are allocated by
• Blood group compatibility, size match and
  cross-matching
• Allocated to home state recipients first then
  offered on rotation interstate
• Transplant units have 20 mins to respond to offer
• Allocated prior to retrieval surgery

No suitable recipient for an organ then the organ
is NOT removed
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The Retrieval Surgery

• Always performed in the operating theatre at the
  donor hospital by specialist transplant surgeons
• There is a midline incision from the sternal
  notch to the pubic bone with a neat, meticulous
  closure of incision with no disfigurement to the
  donor
• Family always given opportunity to
  view loved one
  post retrieval surgery
• There is no delay for the family in
  making
  normal funeral arrangements

17
Care of the Donor and Donor Family

• CARE OF THE DONOR FAMILY
• STARTS WITH
• CARE AND RESPECT
• OF THE DONOR

18
Donor Family Follow Up

• Initial phone call within 24 hours
• 7 -10 days follow up letter of donation
  outcomes, In reflection and Coping with
  Grief booklets sent
• 6 weeks Information regarding donor family and
  recipient
  correspondence, thanksgiving services, counseling
  services, reflection rose bush
• 1 year anniversary card

19
Cost of Donation

• Over 1,800 Australians are waiting for an organ
  transplant at any given time. The wait for a
  transplant can extend to many years and comes at
  a significant cost to the health system. For
  example, hospital based kidney dialysis costs an
  average of 83,000 per person per annum. In
  contrast, a kidney transplant costs 65,000 per
  recipient for the first year, and 11,000 a year
  thereafter.
• There is no cost to the family for the donation
  of organs or tissues.

20
The Australian Organ Donor Register

• The Donor Register ensures that an individuals
  consent (or objection) to donating organs and/or
  tissue for transplantation can be verified 24
  hours a day, seven days a week by authorised
  medical personnel, anywhere in Australia. In the
  event of an individuals death, information about
  their decision will be accessed from the Donor
  Register, and provided to their family.

21
The Australian Organ Donor Register

• Only persons who are aged 18 years or over can
  register consent (or objection) on the Donor
  Register.
• A signature is required to record legal consent
  (or objection) to organ and/or tissue donation
  for transplantation.
• If registration is done online, a form will be
  mailed to the registered address to obtain a
  signature.

22
The Australian Organ Donor Register

• To register
• Call 1800 777 203
• or
• Visit your local Medicare Office
• or
• Complete the self sealing pamphlet at your GP
  surgery and send to the pre paid address

23
Further Information

• State Based Agencies

• Other websites

• Australian Organ Donor Register
• Ph 1800 777 203
• Email aodr_at_medicareaustralia.gov.au
• Website www.medicareaustralia.gov.au/public/serv
  ices/aodr
• Australasian Donor Awareness Programme
  ADAPTPh [phone]Website
  www.adapt.asn.au
• Australian Transplant Coordinators Association
• Email Info_at_atca.org.au
• Website www.atca.org.au
• The Australian and New Zealand Intensive Care
  Society (ANZICS)
• Ph [phone]
• Email anzics_at_anzics.com.au
• Website www.anzics.com.au
• Transplantation Society of Australia and New
  Zealand
• Ph [phone]
• Email tsanz_at_racp.edu.au
• Website www.tsanz.com.au
• The Australia and New Zealand Dialysis
  Transplant Registry (ANZDATA)
• Website www.anzdata.org.au/v1/index.html
• Kidney Health AustraliaPh 1800 682 531Email
  vic_at_kidney.org.auWebsite www.kidney.org.au

• NSW/ACT LifeGift NSW/ACTPh (02) 9229
  4003Website www.organdonor.com.au
• ACT ACT Organ and Tissue Donation ServicePh
  [phone]Email organ.donation_at_act.gov.au
• Vic/Tas Victorian Organ Donation Service
  LifeGift Australian Red Cross Blood ServicePh
  1300 133 050 (number restricted to Vic / Tas
  callers) Email lifegift_at_arcbs.redcross.org.auWe
  bsite www.organdonor.com.au
• Queensland Queenslanders Donate
• Ph [phone]Email queenslanders_donate_at_he
  alth.qld.gov.auWebsite www.health.qld.gov.au/que
  enslandersdonate
• South Australia South Australian Organ Donation
  AgencyPh [phone]Email
  organ.donation_at_health.sa.gov.auWebsite
  http//www.organdonation.sa.gov.au
• Northern Territory LifeNet NTPh (08) 8922
  8786
• Western Australia Donate WestPh (08) 9222
  0222Email donatewest_at_health.wa.gov.auWebsite
  www.donatewest.health.wa.gov.au