Donor identification and referral
Any successful deceased donation programme has a fundamental reliance on the identification and referral of all potential donors.
Deceased donation also benefits from referrals of potential donors being made as early as practicable and responded to as efficiently as possible. This is because the benefits of timely referral of potential donors are largely to be realised through earlier involvement of the Specialist Nurse - Organ Donation (SN-OD) team, and include:
- access to expert clinical advice, for example on the neurological determination of death (brain-stem death testing).
- prompt application of the donor care bundle to support the physiological optimisation of potential DBD donors.
- identification and resolution of potential Coronial/Procurator Fiscal issues.
- more rapid screening and assessment of donor eligibility, particularly DCD donors.
- early tissue typing and virology screening (a source of considerable delay)
- involvement of SN-OD team in the planning and conduct of the approach for consent/authorisation.
In it's guidance on end of life care, the General Medical Council have emphasised the duties of a doctor caring for a potential organ donor:
|81||If a patient is close to death and their views cannot be determined, you should be prepared to explore with those close to them whether they had expressed any views about organ or tissue donation, if donation is likely to be a possibility.|
|82||You should follow any national procedures for identifying potential organ donors and, in appropriate cases, for notifying the local transplant coordinator. You must take account of the requirements in relevant legislation and in any supporting codes of practice, in any discussions that you have with the patient or those close to them. You should make clear that any decision about whether the patient would be a suitable candidate for donation would be made by the transplant coordinator or team, and not by you and the team providing treatment.|
In December 2011 the National Institute for Health and Clinical Excellence (NICE) issued a clinical guideline on organ donation. The guideline applies to practice in England, Wales and Northern Ireland and recommends that hospital staff initiate discussions with a SN-OD when one of the following criteria are met:
- an intention to use brain-stem death tests to confirm death
- an intention to withdraw life-sustaining treatment in patients with a life-threatening or life-limiting condition which will, or is expected to, result in circulatory death
- admission of a patient with very severe brain injury (defined as a Glasgow Coma Score of 3-4 with at least one absent brain-stem reflex) that cannot be attributed to the effects of sedation.
The UK Donation Ethics Committee in their 2011 guidance Ethical Framework for Controlled Donation after Circulatory Death considered that:
"There is no ethical dilemma if the treating clinician wishes to make contact with the SNOD at an early stage, while the patient is seriously ill and death is likely, but before a formal decision has been made to withdraw life-sustaining treatment."
To achieve these ambitions, NHS Blood and Transplant published in 2012 a Strategy Guide for use by Organ Donation Committees and SN-OD teams to ensure that all potential donors are identified and referred in a timely fashion. The objectives of such policies should be that:
- All potential organ donors are identified.
- All potential donors are identified and referred in a timely fashion.
- SN-ODs are deployed in a way that best meets the needs of referring hospitals, thereby minimising any subsequent delays in the donation pathway.