Organ donation and ethics

  • Created by: z
  • Created on: 04-03-16 16:22

Issues with donation

  • need to undertake interventions that do not benefit pt (only donor)
    • e.g. bloods, ventilation, cannulation, time and place of withdrawal of treatment
  • answer: in best interests of pt if it is their wish to donate
  • family veto
    • patient has joined ODR and is known to want to donate, family can refuse consent 
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Increasing donation and approach

  • ways to increase donation
    • incentivise donation
    • coerce donation
    • force donatrion
    • remove barriers to donatin
  • approach
    • MDT must discuss approach
    • pt must be identified as potential donor and elicit statu son organ donor register (ODR)
    • only approach family once they understand that death has occurred/is inevitable
      • use positive language, open ended qus, avoid being apologetic or coercion 
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Diagnosis and confirmation of death

  • legal responsibilty of a medical practitioner
  • death= irreversible loss of capacity for consciousness + irreversible loss of capacity to breathe
  • neurological, somatic and circulatory criteria
  • must demonstrate loss of capacity for consciousness
    • absence of pupillary response to light
    • absence of corneal light
    • absence of motor response to supre-orbital pressure
  • demonstration of loss of capacity to breathe
    • in CR arrest: 5 min observation of maintained CR arrest
    • in coma: 5 minut apnoea test to demonstrate no spontaneous respiratory effort
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Criteria for death

  • neurological criteria
    • established aetiology capable of causing structural damage to brain which has led to irreversible loss of capacity for consciousness and breathing
    • exclusion of reversible conditions capable of mimicking or confoundong the diagnosis of death by these criteria
    • clinical examination of the patient which demostrate profound coma, apnoea and absent brainstem reflexes
  • somatic criteria
    • pallor mortis
    • livor mortis (bruising colour on lowest areas of body)
    • algor mortis (coldness of death)
    • rigor mortis
    • decomposition
  • circulatory criteria
    • clear intention not to attempt/continue CPR
    • observation period (5 minutes) to confirm cont apnoea, absent circ and unconsc
    • prohibition of intervention at any time that might restore cerebral blood flow by any means
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