Page 769 - ACCCN's Critical Care Nursing

Organ Donation and
27 Transplantation

Debbie Austen
Elizabeth Skewes

a report on the ‘hopelessly unconscious patient.’ The
Learning objectives committee members agreed that life support could be
withdrawn from patients diagnosed with ‘irreversible
After reading this chapter, you should be able to: coma’ or ‘brain death’ (terms they used interchangeably)
l differentiate between coma and brain death and that, with appropriate consent, the organs could be
13
l understand the process of donor identification and referral removed for transplantation. The committee’s primary
l be aware of best practice for the consent-seeking process concern was to provide an acceptable course of action to
l understand the principles of donor management permit withdrawal of mechanical ventilatory support for
the purpose of organ donation for human transplant. In
1981, a US President’s Commission declared that indivi-
dual death depended on either irreversible cessation of
circulatory and respiratory functions or irreversible cessa-
Key words tion of all functions of the entire brain. The consequent
Uniform Determination of Death Act referred to ‘whole
brain death’ as a requirement for the determination of
brain death brain death. 13
consent
coroner Legislation that defined brain death and enabled beating-
designated officer heart retrieval was enacted in New Zealand in 1964 and
Donatelife, legislation in Australia from 1982. This legislation heralded the
next of kin establishment of formal transplant programs. In Austra-
lia, the first heart and lung program commenced in 1983,
organ donation a liver transplant program in 1985, combined heart–lung
organ donor transplant in 1986, combined kidney and pancreas in
recipient 1987, single lung in 1990 and small bowel in 2010. In
2,3
retrieval New Zealand, bone was first transplanted in the early
tissue 1980s and the first heart transplant occurred in 1987.
transplant Skin transplantation occurred in 1991, lung transplanta-
tion in 1993, and liver and pancreas transplantation in
4
1998. The success of transplantation in the current era
as a viable option for end-stage organ failure is primarily
INTRODUCTION due to the discovery of the immunosuppression agent
cyclosporin A. 5
Transplantation is a life-saving and cost-effective form of
treatment that enhances the quality of life for many This chapter discusses the processes and clinical implica-
people with end-stage chronic diseases. Transplantation tions of cadaveric organ and tissue donation in Australia
surgery commenced in Australia in 1911, with a pancreas and New Zealand, within a critical care nursing context.
transplant in Launceston General Hospital, Tasmania.
Other tissue and solid organ transplantations followed,
retrieved from donors without cardiac function; the first ‘OPT-IN’ SYSTEM OF DONATION IN
cornea in 1941; kidney in 1956; and livers and hearts in AUSTRALIA AND NEW ZEALAND
1968. Transplantation in New Zealand began in the 1940s
with corneal grafting, and the first organ transplants were There are currently two general systems of approach to
kidney and heart valve transplantation in the 1960s. 1 seeking consent for cadaveric organ and tissue donation
in operation around the world. Some countries (e.g.
The first successful human-to-human transplant of any Spain, Singapore and Austria) have legislated an ‘opt out’,
kind was a corneal transplant performed in Moravia (now or presumed consent, system, where eligible persons
1
the Czech Republic) in 1905. In September of 1968 an are considered for organ retrieval at the time of their
746 ad hoc committee of Harvard Medical School produced death if they have not previously indicated their explicit