Donor Optimisation

Although most efforts focus on increasing the number of donors, as many succesful transplants as possible is the true objective. In this regard, the role of the intensive care clinician in organ donation does not end in donor identification and referral or even collaboration in the family approach. Rather, it must also include a commitment to provide the highest number of donor organs in the best possible condition through optimisation of donor physiology. To do otherwise might be regarded as a betrayal of the trust that a donor and their family place in the healthcare professionals who propose donation as a component of end of life care.

Organ retrieval from DBD donors in the UK Rates of retreival and utilisation of organs from DBD donors in the UK are shown in the figure below.

Figure 1 Use of organs from DBD donors in 2015-16 (numbers are organs transplanted as a % of total actual organ donors)

In the UK, an actual DBD donor donates an average of 3.9 organs, with the number of organ transplants being retrieved and transplanted – particularly the thoracic organs - falling sharply in donors over the age of 50 years. There is now considerable evidence that the application of standardised donor management protocols increases the number of retrieved organs, with a particular impact on retrieval of cardiothoracic organs.

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