University Hospital of Wales Paediatric Intensive Care Unit Guideline Printed on Wed 23-jul-08
Search Site

Last updated August 17, 2017 10:37 AM

Referrals
0300 0300 789

PCCU
02920 744622

External links

Fax

029 2184 7322

logo

Noah's Ark Childrens Hospital for Wales
Heath Park
Cardiff
CF14 4XW
02920 747747


PCCU Organ Donation Pathway


Organ donation should be considered as a usual part of “end of life care” planning.

All patients who are for withdrawal of treatment or are potentially brain stem dead should be identified and referred to the SNOD (Senior Nurse for Organ Donation) as early as possible.

There are two types of deceased organ donation:-

Donation after brain stem death (DBD)
Donation after brain stem death can only occur when a child has been diagnosed as brain stem dead. The child will need to be intubated and ventilated for this to happen. Donation after brain stem death allows the following organ to be retrieved:- heart, lungs, liver, pancreas, bowel, kidneys and tissues.

Donation after circulatory death (DCD)
Donation after circulatory death is when donation occurs after the heart has stopped beating naturally, following the withdrawal of life sustaining treatment. The following organs can be obtained:- lungs, liver, pancreas, kidneys and tissues. However in order to avoid hypoxic organ damage the process of death needs to occur reasonably rapidly and asystole needs to occur within two to four hours after withdrawal.

Pathway

  1. Every child that is potentially brain stem dead with the possibility for organ donation should undergo brainstem death (BSD) tests in accordance with national guidelines. Please note the recent inclusion by RCPCH of brain stem testing in infants as young as 37 weeks gestation.
  2. Every child with fixed dilated pupils in whom BSD testing is being considered should be referred to the SNOD.
  3. Every case where there is the intention to withdraw life sustaining treatment and where death is thought likely to occur within a short period of time should be discussed with the SNOD. It can be difficult to accurately predict the time of death so the “cover all” option in this case is to refer all patients where withdrawal of life sustaining treatment is being considered.
  4. In both the above scenarios the SNOD will identify cases that are obviously not suitable to be organ donors; in which case discussion need not progress any further.
  5. Discussions between PCCU consultant, SNOD and the family regarding organ donation should take place at a different time to those between the PCCU consultant and the family about withdrawal of life sustaining treatment or brain stem testing.
  6. It is useful to remember that parents need to have accepted that death will inevitably occur before they are willing/ able to move forward with discussions on organ donation. The timing of when the parents are approached is crucial and should not be done too early.
  7. The discussion about organ donation with the parents should occur with experts in donation. Collaborative discussion with both the PCCU Consultant and the SNOD should occur. There should be an agreed plan between the PCCU Consultant and SNOD regarding any approach.
  8. If the family is considering organ donation and the child is approaching end of life where death is imminent the SNOD will contact the coroner (if they need to be involved after death) to inform them of the situation and to check they have no objections/ restrictions to donation. This may instigate discussions with the pathologist regarding further investigations. The coroner is supportive of donation and there are no coronial absolute circumstances that restrict donation.
  9. Consent for organ donation will then be taken from the parents by the SNOD.
  10. Investigations needed include Arterial blood gas, FBC, U+Es, clotting, group and save, Amylase, Magnesium, GGT, AST and glucose. The SNOD will advise on tissue typing and virology. CXR, ECG and ECHO will also be required.
  11. Donor optimisation must occur following advice from the SNOD. Aim for the following parameters in DBD patients:-

BrainStem Death Documentation

2 months - 18 years of age

2 months - 18 years (abbreviated)

Under 2 months

Under 2 months (abbreviated)

Pre-condition: in post-asphyxiated infants, or those receiving intensive care after resuscitation, whether or not they have undergone therapeutic hypothermia, there should be a period of at least 24 hours observation during which the preconditions for assessing death by neurological criteria should be present before the clinical testing of DNC. If there are concerns about residual drug-induced sedation, then this period should be extended.

Apnoea test: a stronger hypercarbic stimulus is used to establish respiratory unresponsiveness. Specifically, there should be a clear rise in the arterial blood partial pressure of carbon dioxide level > 2.7 kPa above a base-line of at least 5.3 kPa to > 8 kPa with no respiratory response at that level.

 

 

 

References

  1. Paediatric Intensive care society standards for organ donation, Jan 2014
  2. NICE clinical guideline 135-Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation, Dec 2011
  3. UK DEC position statement on paediatric donation, Jan 2015

 

Dr Michelle Jardine,   June 2016    
(For review June 2019)