Page 778 - ACCCN's Critical Care Nursing

Organ Donation and Transplantation 755

CULTURAL COMPETENCE
With large cultural mixes in the Australian and New TABLE 27.7 ATCA referral information 58,76,87
Zealand populations, best practice for approaching a
family includes openness and awareness of what Section Details
information the family member(s) may need to make Personal details Address, phone number, sex, age,
their decision. As significant differences also exist within height, weight, race, religion, build,
various cultural groups, expectations of responses cannot occupation
be stereotyped. When healthcare professionals are unsure Current admission details Dates and time of hospital admission,
of how a family may perceive a situation it is best to ask, intubation, critical care admission
as acknowledgment of expectations and needs can lead Other trauma or significant event
63
to improved communication. Importantly, the most sig- Declaration of brain death Cause of death, time, date, method
nificant differences between potential donor families are of testing
socioeconomic and educational factors, rather than cul- Consent details Which organs, designated officer
tural or racial background. Therefore, individual assess- details, coroner’s details, police
64
ment must guide the approach by health professionals. details, who gave consent, which
databases accessed
ORGAN DONOR CARE Donor history Family, medical, surgical, travel, social
and sexual history
Time is critical in the management of a potential organ Blood results Blood group, biochemistry and
donor. Those patients who have sustained traumatic haematology on admission and
brain injuries deteriorate rapidly following brain death, within past 12 hours, microbiology,
exhibiting severe physiological instability requiring vigi- gas exchange
lant monitoring and specialised treatment to maintain Test results Chest X-ray including lung field
organ perfusion. This is a time of great distress for fami- measurements, ECG,
lies with the patient’s death usually the result of a sudden, echocardiogram, bronchoscopy,
unexpected illness or injury and therefore discussion sur- sputum
rounding organ and tissue donation must be undertaken Haemodynamics BP, MAP, HR, CVP, temperature
in a sensitive manner by skilled requestors who possess Admission history Cardiac arrest, temperature, renal
a strong professional commitment to the quality of the function, nutrition, drug and fluid
process. 13,36 administration
Ideally, the time between brain death and organ retrieval Physical examination Scars, trauma, needle marks, etc.
should be minimised to ensure an optimal outcome for
transplant recipients. Therefore the focus of medical man-
agement changes from ensuring brain perfusion to main-
36
taining good organ perfusion for transplantation. Early
referral, application of recognised management protocols Practice tip
and collaboration between the donation centre and
retrieval teams is paramount. Donor family care forms a All brain dead patients should be referred to the relevant
crucial part of the process, with up-to-date and accurate State DonateLife agency for advice regarding medical suita-
information essential to ensure the bereavement process bility. Contacting the State DonateLife agency for advice does
is managed appropriately. not constitute an obligation or formal referral for organ
donation. 58
REFERRAL OF POTENTIAL DONOR
If consent is granted, the referral process usually com-
mences immediately. To ensure organ viability for trans- TISSUE TYPING AND CROSS-MATCHING
plant, the time from brain death confirmation to retrieval
of organs is kept to a minimum. The longer the time delay, A vital component of the assessment and referral process
the more likely that organ failure-related complications is tissue typing, cross-matching and virology testing of the
will occur. In 2009, the median time from brain death potential donor’s blood. Blood is taken from an arterial
65
confirmation to the commencement of organ retrieval or central line of the potential donor and sent to the
was 16 hours in Australia and 12 hours in New Zealand. 17 relevant accredited laboratory (see Table 27.8). Tissue
typing identifies the human leucocyte antigen (HLA)
The referral process begins with the donor coordinator phenotype from the genes on chromosome 6. The HLA
collating the past and present medical, surgical and social molecules control actions of the immune system to
history of the potential donor, and relaying this infor- differentiate between ‘self ’ and foreign tissue, and initiate
mation to the relevant transplant units (see Table 27.7). an immune response to foreign matter. As a transplanted
Using this information, transplant teams allocate the organ will always be identified as foreign tissue by the
organs to the most suitable and appropriate recipient/s. recipient’s body, the use of immunosuppressive drugs
If the transplant team does not have a suitable recipient, suppress the immune response. A crossmatch is routinely
the offer is extended to another team in Australia or New used to predict the level of this response. Lymphocytes
Zealand on rotation using TSANZ guidelines. 23 from the potential donor are added to the potential