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Code of practice 2

Donation of solid organs for transplantation

Appendix B

Guidelines for transplant teams and coroners in cases of potential uncontrolled non-heart beating donation requiring steps to be taken for organ preservation

B1. The following steps in the process are recommended:

  1. The potential donor should be identified by emergency department staff. The coroner must be informed and advised whether a medical practitioner will issue a Medical Certificate of The Cause of Death (MCCD) or that the death is sudden and of unknown cause or unnatural, traumatic or violent.
  2. The donor coordinator should be contacted to attend, in order to determine likely suitability based on history and duration of warm ischaemia, and liaise with the coroner’s officer or court staff.
  3. Any requirements of the coroner should be met to enable determination of the cause of death. This may mean that the coroner requires a post-mortem examination and that perfusion and organ retrieval cannot proceed. If the coroner exercises discretion in favour of permitting perfusion subject to further investigations, then the local memorandum of understanding agreed with the coroner should be adopted, in order to obtain blood samples for potential toxicology as well as samples required for potential organ retrieval and donation.
  4. Certain criteria may mean that this could proceed without immediate coroner notification in some situations. It is possible that when death is verified in the emergency department and then certified by a registered medical practitioner who is able to issue a MCCD for a natural cause of death, then the death does not need to be reported to the coroner. If in doubt then the case should be reported.
  5. The Organ Donor Register (ODR) should be searched in order to ascertain wishes of the patient.
  6. If the patient is registered on the ODR, this should be communicated to the nominated representative or person in a qualifying relationship if they are available, and subject to coroner approval, perfusion should commence. In the case of a child the person with parental responsibility must be consulted in the first instance.
  7. If the patient is not registered on the ODR and their wishes relating to donation are not known, consent should be sought from the nominated representative or person/s in a qualifying relationship, and subject to the coroner’s approval, perfusion should commence.
  8. If the wishes of the deceased are unknown and no nominated representative or person/s in a qualifying relationship can be contacted, perfusion may be instigated, subject to the coroner’s approval, while attempts to contact the nominated representative or person in a qualifying relationship continue.
  9. Subject to the coroner’s approval as discussed above, and where they are contactable, the consent of the nominated representative or person in a qualifying relationship, the femoral vessels should be cannulated. Blood specimens for both the coroner and organ donation purposes must be taken before perfusion is started.
  10. Where the deceased wishes are unknown and the nominated representative or a person/s in a qualifying relationship is not available before perfusion being instigated, consent or refusal to consent to organ donation should be confirmed/ obtained when they arrive. In any event, it should be advised that the death may still remain the subject to the jurisdiction of and investigation by the coroner.
  11. If consent for organ donation has been established or obtained, the patient may be transferred to theatre for removal of organs.
  12. All conversations and discussions including operative findings, should be documented in the patient’s notes for reference by other healthcare professionals and the coroner.