Diagnosis

• Organ donation should be considered as a usual part of ‘end-of-life care’ planning
• Identify all patients who are potentially suitable donors as early as possible

Investigation

• Identification should be based on:
  • Absence of one or more cranial nerve reflexes and
  • Glasgow Coma Scale (GCS) score of 4 or less that is not explained by sedation

Management

• Healthcare team caring for the patient should initiate discussions about potential organ donation with the specialist nurse for organ donation at the time the above criteria are met
• Where patient has capacity, obtain their views on, and consent to, organ donation
• Where patient lacks capacity to make decisions about end-of life-care, establish whether taking steps, before death, to facilitate organ donation would be in the best interests of the patient
• Provided that delay is in the patient’s overall best interests, life-sustaining treatments should not be withdrawn or limited until the patient’s wishes around organ donation have been explored
• Consider:
  • Advanced directives
  • Patients belief, values
  • Whether patient registered and recorded consent on the NHS organ donor register
  • Explore with family friends whether patient expressed views about organ donation
  • Views of patients family and friends
• If consent not already gained: consent for organ donation should be sought from those in a qualifying relationship with the patient

Approach to those Close to the Patient

• MDT:
  • Medical and nursing staff involved in care of the patient, led by an identifiable consultant
  • Specialist nurse for organ donation
  • Local faith representative

Before approaching:

• Identify patient’s potential for donation in consultation with the specialist nurse for organ donation
• Check NHS organ donor register and advance statements, Lasting Power of Attorney
• Clarify coronial, legal and safeguarding issues
• Knowledge of the clinical history of the patient who is a potential donor
• Identification of key family members
• Assessment of whether family support is required: faith representative, family liaison officer, bereavement service, trained interpreter, advocate
• Identification of other key family issues
• Identification of cultural and religious issues
• Approach Those Close to Patient in a setting suitable for private and compassionate discussion
• Should only take place when clearly established they understand death is inevitable or has occurred
  • Discuss with them that donation is a usual part of the end-of-life care
  • Open-ended questions ‘how do you think your relative would feel about organ donation?’
  • Positive ways to describe organ donation
  • Avoid the use of apologetic or negative language
  • Assurance that primary focus is on the care and dignity of the patient
  • Explicit confirmation and reassurance that the standard of care received will be the same whether they consider giving consent for organ donation or not
  • Rationale behind the decision to withdraw or withhold life-sustaining treatment and how the timing will be coordinated to support organ donation
  • Clear explanation of, and information on the process of organ donation
• Discuss withdrawal of life-sustaining treatment or neurological death before and at a different time from, discussing organ donation

NICE Source: CG135 Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation. Summary compiled by Dr D P Sheppard MBBS.