Page 777 - ACCCN's Critical Care Nursing

754 S P E C I A LT Y P R A C T I C E I N C R I T I C A L C A R E

Donatelife Organ donor coordinator Role of Designated Officers
The ‘Donatelife’ organ donor coordinator acts as a Under Australian law, a ‘designated officer’ is appointed
resource and is invited into critical care when appro- by the governing body of the institution to authorise a
priate. 1,58 A professional who is an expert in donation non-coronial postmortem and the removal of tissue from
and has the time to spend with the family may be the a deceased person for transplant or other therapeutic,
best person to undertake an approach to a potential medical or scientific purposes. The designated officer
13
49
donor family. A large US study found that consent rates must be satisfied that all necessary inquiries have been
improved when conversations about brain death and made and any necessary consent has been obtained
organ donation were separated, were held in a private before granting authority. Medical, nursing and adminis-
setting and when an organ donation professional/trained trative staff can be appointed to the role, but they must
requestor was involved. 48 not act in a case if they have had clinical or personal
involvement in the donor’s case. 13
DOCUMENTATION OF CONSENT The term ‘designated officer’ is not used in New Zealand
Consent is sought for individual organs and tissues, legislation. A person with equivalent authority under the
rather than making a ‘global’ approach. If granted, the Human Tissue Act 2008 is the person lawfully in posses-
individual tissues are written on the consent form or sion of the body. In the case of a hospital, this person
59
named if the consent is being recorded over the tele- is specified as the medical officer in charge. In practice,
13
phone; only those tissues granted will be retrieved. the treating clinician undertakes this consultation with
the family.
Definition of Next of Kin
In Australia the definition of next of kin for adults and Role of Coroner and Forensic Pathologists
children is listed in strict order (see Table 27.5). In New
Zealand there is no hierarchy of next of kin, with the Because of the nature of their death, many donors are
definition including a surviving spouse or relative. In subject to coronial inquiry. In this case, permission to
13
both countries, the next of kin can override the known undertake organ and tissue retrieval is sought from the
wishes of the deceased regarding consent, but experience respective forensic pathologist and coroner according to
shows that the family rarely disagree if the wishes of the local policy and procedure as part of the consent-seeking
deceased are known. 13 process. The coronial system is very supportive of dona-
tion for transplant, and in 2009, 43% of the Australian
and 44% of New Zealand multiorgan donors were
coroner’s cases. 17
TABLE 27.5 Definition of next of kin for children and
adults in Australian legislation 13 CONSENT INDICATOR DATABASES
Donor Order of seniority Relationship The most influential variable that an individual may
have on family unit decision-making is the existence
Child 1 Parent of an advance care directive or prior indication of
2 Adult sibling (over 18 years) consent, as this information has made decision-making
‘easier’ 60,61 and preserved patient autonomy, 50,62 enabling
3 Guardian (immediately before
death) wishes of the patient to be followed even when family
decision makers would have made the opposite deci-
Adult 1 Spouse or de facto (at time of sion. Conversely, if the family members were opposed
death)
to donation despite the presence of an indication of
2 Adult offspring (over 18 years) consent from the potential donor, the retrieval would
40
3 Parent not occur on ethical grounds. Table 27.6 lists prospec-
tive donation databases available in Australia and New
4 Adult sibling (over 18 years)
Zealand.

TABLE 27.6 Consent indicator databases in Australia and New Zealand 8,65,66,86
Country Database name Host Access to database information Availability to join
Australia Australian Organ Medicare Australia Limited to coordinators nominated by state Via Medicare offices, internet
Donor Register Donatelife agencies and tissue banks or phone (1800 777 203)
Driver’s licence State roads & transport Limited to coordinators nominated by state Driver’s licence application and
authorities donation agencies and tissue banks renewal form
New Zealand Driver’s licence Land Transport New Limited to coordinators nominated by the Driver’s licence application and
Zealand database National Transplant Donor Coordination Office renewal form