Organ donation - a gift of life after death
Solid Organ Donation
If a patient dies within critical care, it may be possible for them to donate solid organs (e.g. Liver, Kidneys, Lungs, Heart, Pancreas) after their death. This will have a huge impact on the quality and length of life for other patients awaiting transplants for permanent organ failure (e.g. kidney failure).
For some patients, death will be unexpected, and rapid decline in health or development of multiple organ failure will preclude solid organ donation. Please ask if you are unsure.
For many patients, death will be an unfortunate but expected outcome following unsurvivable illness or injury (e.g. severe traumatic brain injury). The medical and nursing team will explain carefully when this is the case. We will talk to you as family members about the possibilities of organ donation, and where appropriate, check entries on the National Organ Donor Register.
Our medical and nursing teams and local / regional Specialist Nurses for Organ Donation (SNOD) are on hand 24 hours a day to discuss the possibilities for all our patients who may be able to donate solid organs or tissues. We will do our best to explain and answer questions about the processes involved, and allow time for families and loved ones to come to their own decisions. All donations are overseen by NHS Blood and Transplant (a special health authority separate to Newcastle upon Tyne Hospitals NHS Trust), and follow UK law and ethics regarding organ donation.
There are two ways in which a patient may be able to proceed to solid organ donation after death - dependent on the modality of death.
Donation after brainstem death (DBD)
Patients with severe brain injury of any cause (trauma, stroke, bleeding, low Oxygen levels) will sometimes progress to a situation in which the brainstem (centre for control of breathing and consciousness) within the brain is irreversibly damaged. In this setting, formal testing of the brainstem (by doctors on the unit) may define a patient as brainstem dead.
In this circumstance, death is of course permanent, but unusual - as the heart will continue to beat while the body continues to be ventilated (breathing machine).
This is the classical scenario whereby donation of solid organs can be considered and proceed in the operating theatre, provided that the patient and family had/have no objections. There is a high chance that donation will proceed, and a high chance that multiple patients awaiting organ transplants may benefit directly from this process.
Donation after circulatory death (DCD)
Patients whose brainstem remains (at least partially) intact, cannot be diagnosed as brainstem dead. This situation is common where there has been significant brain injury, or other cause of deterioration, and death is expected when life supporting therapies (e.g. ventilator or blood pressure medicines) that are no longer appropriate, are withdrawn.
In this circumstance, the heart will eventually stop beating, but predicting the timescale for this is difficult. Where possible, these patients may still become solid organ donors, but only if death occurs within a fixed timeframe, so that organs for transplant are in optimal condition. To this end, we will try to withdraw life sustaining therapies either in operating theatres, or on the critical care unit, with a view to proceeding to organ donation soon after the heart beat stops. It is common for donation not to proceed in this circumstance, as the dying process can be harmful to organs if it is prolonged.
Solid organ donation is not compulsory, and many families find both death of a loved one and organ donation very difficult subjects to talk about together and with health professionals. We will try our best to facilitate these discussions, and understand that not every patient, or family is ready for organ donation, but that those who are could change many others lives.
For those patients unable to donate solid organs either due to prior illness, or modality of death. Tissue donation may still be possible after death. This relates to heart valves, blood vessels, bone, skin and Cornea (eye) donation. These tissues can then be used for other patients and can be life changing for those who receive them in times of need. Donation usually needs to take place within 24-48 hours after a patient's death.