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756 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

TABLE 27.8 Blood tests required for organ BOX 27.2 Medical management of
donation 58,72,87,88,89 the potential donor 76

Measurement required Test Referral:
l Refer all potential organ donors to the local State DonateLife
Serology l HIV I and II
l HTLV 1 antibody agency, even if uncertain of medical suitability. Criteria for
l Hepatitis B sAg suitability change over time and vary according to recipient
l Hepatitis B sAb circumstances.
l Hepatitis B Core Ab
l Hepatitis C sAb Medical management:
l CMV (IgG) l Maintain MAP > 70 mmHg: maintain euvolaemia, if required
l EBV (excluding NSW) administer inotropic agents (e.g. noradrenaline)
l Syphilis (excluding SA) l Maintain adequate organ perfusion (monitor urine output,
l Toxoplasma IgG and IgM (SA, NT
and WA only) lactate), consider invasive haemodynamic monitoring
+
+
l HSV (WA only) l Monitor electrolytes (Na , K ) every 2 to 4 hours and correct
to normal range
NAT screen (nucleic This is not routinely performed on
acid test) all donors. Testing is currently l Suspected diabetes insipidus (UO >200 mL/h, rising serum
only available through the sodium): administer DDAVP (e.g. 4 mcg IV in adults) and
Australian Red Cross Blood replace volume loss with 5% dextrose
Service. The State Donatelife l Treat hyperglycaemia (actrapid infusion): aim blood glucose
Coordinator facilitates the
process. 5 to 8 mmol/L
l HIV NAT Screen (VIC and NSW l Keep temp >35°C. Pre-emptive use of warming blankets
routinely test) etc is advised as hypothermia may be difficult to reverse
l HCV NAT Screen (VIC and NSW once it has developed
routinely test) l Provide ongoing respiratory care (frequent suctioning,
Tissue typing Crossmatching with the blood of positioning/turning, PEEP, recruitment manoeuvres)
potential recipients of relevant l Maintain haemoglobin >80 g/L
ABO
Hormone replacement therapy:
The use of hormonal replacement therapy remains controver-
sial. Some centres use it in the setting of persistent haemody-
recipient’s serum to test whether the recipient has an namic instability (despite volume resuscitation and low dose
antibody that is specific to the donor’s HLA antigens. inotropes) and/or if cardiac ejection fraction <45%. Typical regi-
A positive crossmatch reaction, where the recipient’s mens include:
serum destroys the donor’s cells, is a contraindication l triiodothyronine (T3): 4 mcg IV bolus, then 3 mcg/h by IV
for transplantation. 58 infusion
l arginine vasopressin (AVP): 0.5 to 4.0 U/h to maintain MAP
DONOR MANAGEMENT 70 mmHg
The fourth factor influencing the number of actual organ l methylprednisolone: 15 mg/kg IV single bolus.
donors is the clinical management that the donor and
family receive after confirmation of death. The aim of
donor management is to support and optimise organ
function until organ retrieval commences, while main- will bring most of their specialised equipment with them.
taining dignity and respect for the donor and support for An anaesthetist monitors haemodynamics, ventilation
the family. All aspects of ICU treatment, apart from brain- and administers medications, which may include a long-
oriented therapy, should continue until it is certain that acting muscle relaxant given prior to the surgical proce-
13
organ donation will not occur. Ideal parameters for dure, to prevent interference in the surgical process by
biochemistry, vital signs, and urine output and clinical spinal reflexes, only after consultation with the retrieval
58
management are detailed in Box 27.2. team. No other anaesthetic agents are administered. The
local scrub staff will work with the visiting surgical teams,
RETRIEVAL SURGERY and the Donatelife donor coordinator will be present
Organ retrieval surgery occurs in the hospital where the to document the procedure and outcomes, and act as
resource for all staff present.
donor is located, with the local operating theatre staff
integral to the process. The donor is transferred to theatre Surgery may take 4–5 hours depending on the extent of
after routine preoperative checks and documentation is the retrieval; cross-clamp will occur once the surgeons
completed, including death certification and consent for have identified all the various anatomical points. The
organ and tissue retrieval. All documentation, particu- aorta is cross-clamped with vascular clamps below the
larly consent, is viewed by all members of the retrieval diaphragm and at the aortic arch, the heart is stopped and
surgical team before surgery commences. Depending on ventilation is ceased. Retrieval teams administer a cold
which organs are to be retrieved, the retrieval teams will perfusion fluid with an electrolyte mix specific to the
be tasked to abdominal organs and thoracic organs, and organs being retrieved, and remove the organs. Organs