Page 781 - ACCCN's Critical Care Nursing

758 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

retrieval. Death is determined by cessation of circula- with eye caps. 77,78 Support requirements for families of
tion, with recommendations that the ECG is not moni- tissue-only donors share many aspects of programs
tored (electrical activity can persist for many minutes provided for families of multi-organ donors. A sensitive
following cessation of circulation), but an arterial line approach, provision of adequate information to assist
is used to determine the time of cessation of circula- informed decision making, offers of bereavement
13
tion. If withdrawal occurs in critical care, an intraab- counselling and follow-up information of recipient
dominal catheter may be inserted via the femoral artery outcomes are evidence-based strategies of successful
after cardiac standstill to infuse cold perfusion fluid programs. 1,79
into the abdominal cavity. If the lungs are to be retrieved,
perfusion fluid is infused via bilateral intercostal cath-
69
eters. The patient is then transferred to theatre for SUMMARY
organ retrieval. When withdrawal of treatment occurs
in theatre, a catheter is not required and retrieval may Australia and New Zealand have an opt-in system of
commence after the patient is declared deceased (ces- giving consent for organ and tissue donation. After death
sation of circulation for greater than two minutes). If has been confirmed, the option of organ and tissue
the patient does not die during the window of time donation is given to the next of kin, or information
available for organ retrieval, they are transferred back from a consent indicator database is sought to determine
to ICU. 74 the wishes of the person. Each person is assessed on a
case-by-case basis to determine medical suitability for
organ and tissue retrieval for transplant. The treating
TISSUE-ONLY DONOR clinicians are not expected to make this decision and
their involvement and care is vital. Support and informa-
People confirmed as dead using cardiac criteria can be
tissue donors. Eyes (whole and corneal button) are tion is available around the clock from the respective
retrieved for cornea and sclera transplant. Musculo- donor agencies and tissue banks. Donor family care
skeletal tissue is used for bone grafting (long bones of commences at the time of the family member’s admis-
arms and legs, hemipelvis), urology procedures and treat- sion and continues as required with structured bereave-
ment of sport injuries (ligaments, tendons, fascia and ment programs specific to donor family care. In Australia
meniscus). Heart valves (bicuspid, tricuspid valves, aortic and New Zealand, consent to be an organ and tissue
and pulmonary tissue) are used for heart valve replace- donor can be indicated by people when alive or by the
ment and cardiac reconstruction. Skin (retrieved from the next of kin after death.
lower back and buttocks) is used for the treatment of There are three ‘types’ of organ or tissue donor:
burns. 75
1. multiorgan and tissue donor: after brain death has
been confirmed
IDENTIFICATION OF POTENTIAL 2. donor after cardiac death: controlled withdrawal
TISSUE-ONLY DONOR of treatment in critical care/operating suite
The most influential aspect for tissue donation is early 3. tissue-only donor: after cardiac death.
notification of the potential donor’s death to the relevant Four factors directly influence the number of multiorgan
tissue bank, ideally within hours of the person’s death. donations:
All deceased persons can be considered potential donors,
with assessment for clinical suitability on a case-by-case 1. incidence of brain death
basis. As noted earlier, there is no expectation that treat- 2. identification of potential donors
ing clinicians will be required to make that decision or 3. brain death confirmation and informed consent
make the approach to the next of kin. In general, once for donation
the death notification has been received, the determining 4. donor management after brain death.
factors are age, cause of death, time elapsed since death, There is evidence in the literature to address and guide
virology results, and presence of infection. The legal each factor, but each needs to be approached on a case-
requirements of the consent-seeking process mirror those by-case basis:
of the multiorgan donor.
l Medical suitability for every potential donor is
After checking medical suitability and the relevant asse ssed individually at the time of the person’s
consent indicator database, a coordinator from the tissue death.
bank or other trained personnel approach the next l Support and guidance from donor agencies and tissue
of kin with the option of tissue retrieval. Eyes can be banks in Australia and New Zealand are available at
retrieved up to 12 hours, and heart valves, skin and all times.
bone up to 24 hours after death. Of note, eye donors l Care and support of the potential and actual donor
can be up to 99 years old, donors of heart valve up family is a high priority for all donor agencies and
76
to 60 years and musculo skeletal up to 90 years of age. tissue banks in Australia and New Zealand.
After tissue retrieval, every effort is made to restore l Regular, routine follow-up and debriefing oppor-
anatomical appearance. Wounds are sutured closed and tunities for critical care and operating theatre staff
covered with surgical dressings, limbs given back their are important to manage stress reactions or other
form, and eye shape is restored with the lids kept closed concerns.