Organ Donation

Discussions around organ donation are complex and emotive, and occur at a particularly difficult and vulnerable time for families. The organ donation conversation is important as:

This covers considerations when discussing organ donation with the family. The entire process of organ donation is covered in Organ Donation.

Giving families information gives them the opportunity to have a choice. Not giving them information takes away that choice.

The Conversation

This assumes that the end-of-life conversation has already happened, and that the family is aware that their loved one is likely to die. A break should occur between these conversations.

In patients who are:

  • DBD
    Then this conversation should happen after brain death testing has occurred. This necessitates a preceding conversation to discuss the results of brain death testing.
  • DCD
    Then this conversation must happen before withdrawal of cardiorespiratory support.

Preparation:

  • Donor registry status
  • Family issues
    Best to know in advance and raise them, particularly if there are competing value systems.
    • Religious values
    • Other factors
  • Plan approach to the meeting

Conduct:

Principles:

  • Slow information delivery
  • Time to make decisions
  • Support to make decisions
  • Sensitivity
  1. Introduce the donation nurse if they have not yet met
  2. Raise organ donation
    • Emphasise that we are offering the family to choose what is right for them; not asking for or taking organs
    • If the patient has registered as an organ donor, it is relevant to mention that now
  3. Give important information
    Information that families have found helpful includes:
    • Organ donor registry status
    • Organ donation is rare
      <1% of patients who die in hospital can become organ donors.
    • There is a significant need for donor organs
    • The reasons other donor families feel that organ donation was the right decision for them include that:
      • Their loved one would have wanted to help others
      • It provided an opportunity for something positive to come out of tragedy
      • It allowed someone else to live a better life
  4. Answer questions

Discussing Concepts

This is a phrase library of concepts around transplant, organ donation, and the donation process.

Donation

Organ Donation:

  • People can donate organs if they pass away in very specific circumstances
  • Sometimes people register to do this while they are still alive, so that there is a record of it when they have passed
  • Other times doctors will ask the family if they wish to donate
  • It is always a very hard time to think about such a serious thing, but this is the only time it can happen
  • Family don’t have to decide immediately and have some time to talk and think about it, but the decision does have to be made within a couple of days
  • Organs that can be donated include heart, lungs, liver, kidneys, and pancreas

Tissue Donation:

  • Tissue donation is different to organ donation because almost anyone can become a tissue donor, irrespective of how they died
  • Tissues donation can occur some time after death and so is not as urgent
  • Tissues that can be donated include:
    • Cornea
      Outer layer of the eye used for those blinded from disease of their own cornea.
    • Heart valves
      To replace damaged heart valves.
    • Skin
      Used to replace skin in those with serious burns.
    • Bone
    • Tendons
      To help repair damaged joints.

Organ Donation Process:

  • Blood tests and sometimes x-rays or ultrasound is done to make sure the organs are healthy enough for transplant
  • Sometimes, the person will receive medicine to make sure the organs stay healthy enough to transplant
  • The organ will go to the next person on the waiting list who is a good fit
    • You can’t choose who the organs will go to
  • There’s a lot of organisation that has to happen before the organ donation goes ahead so it can take some time
    Need to arrange:
    • The team who removes the organs
    • The patients who need the organs have to come into hospital
    • The teams who put in the organs into each patient
    • The transport for all of these
  • The donation operation:
    • May take up to 6 hours, depending on how many organs are being donated
    • The cut is closed up afterwards and covered with a special dressing
    • The body is then taken to the hospital mortuary
    • They will look different afterwards as their heart will have stopped beating
    • The family can see the body afterwards if they want to
    • There are no problems having an open-casket funeral after this operation

After Organ Donation:

  • The family will get a call letting them know what was transplanted and how the recipients are doing
  • The family can’t contact the recipients directly, but can write to them through DonateLife
  • The recipients can also write to the family through DonateLife in the same way

Brain Death

Overview:

  • The brain is a soft and fragile organ that is protected in the skull
  • The brain keeps us alive by sending messages to all the other parts of the body to control them, and also lets us see, smell, hear, and think
  • If our brain very badly damaged then it can swell so much that blood can’t get to it
  • This can lead to death of the brain, even though the other parts of the body may not be as badly damaged

Brain Death Testing:

  • We test for brain death through a formal process that tests the vital functions of the brain, such as coughing and breathing
  • If these tests confirm what we think is going on, then it means that the brain has died, and that means that they have died
    • They have died even though their heart continues to beat and the breathing machine keeps giving air
  • You are welcome to watch these tests
    • Some people find it helpful to watch the testing
    • Other people find it distressing
    • If you want to watch, someone will be with you to support you and tell you what is going on
  • The time of death is the the time that the second set of tests are done
  • They will look the same after this set of testing as they are still on the breathing machine

Donation after brain death:

  • If they become an organ donor, they will look like this when they go to the operating room for the donation procedure

Circulatory Death

Overview:

  • Sometimes:
    • The brain is damaged very badly but some parts of the brain still work a little
      This does not meet the criteria for brain death, but is still not a recoverable injury.
    • The person may be very sick and cannot survive without the breathing machine
  • At this point, we no longer think the breathing tube is helping them
  • We are not sure how long they will survive without the breathing tube, but we will focus on their comfort during this time
  • This usually happens within 10-20 minutes, but sometimes takes hours or days

Donation after circulatory death:

  • Donation can only happen if death occurs within a specific timeframe
    • This is so the possible damage to organs is minimised, which happens when they are without blood flow
  • Medication will be given to relieve pain or distress
  • Predicting time between withdrawal of support to death is hard
    • Organ donation may not be possible
    • Tissue donation may still occur
  • You can withdraw consent at any time

Transplant

  • When someones organs - body parts - are healthy, they can live a normal life
  • When these organs get sick, then people are often very sick and it changes what they can do
    For example:
    • Someone with sick kidneys may need to go on a machine called dialysis
    • This means they have to spend several hours at hospital 3 days a week
    • They are often very tired and can’t do much or work much even when they are not at hospital
    • If they get a healthy kidney put in, then they don’t need dialysis anymore and can get back to a more normal life

References

  1. ANZICS. The Statement on Death and Organ Donation. Edition 4.1. 2021.
  2. Core Family Donation Conversation (FDC) Workshop. Course Notes. 2023.
  3. The Organ and Tissue Donation Story. DonateLife WA. 2023.
  4. The Brain Story. DonateLife WA. 2023.