1 | Introduction

Organ Donation New Zealand (ODNZ) is the national service for deceased organ and tissue donation in New Zealand. A donor coordinator and a medical specialist are available at all times to help with all aspects of organ and/or tissue donation.

Donor coordinators

The donor coordinators are senior registered nurses who organise the organ and tissue donation.

Please discuss all patients who could potentially donate organs or tissues with the donor coordinator on call who will provide advice and assistance. Phone 09 630 0935.

Medical specialists

The medical specialists are senior intensivists who provide advice and support. They are available 24 hours, 7 days through the donor coordinator on call.

How to contact ODNZ

The ICU doctor or nurse can contact ODNZ by calling the donor coordinator on call. The donor coordinator will:

• require information about the patient
• request contact details for the intensivist responsible for the patient
• discuss taking of donor bloods.

The donor coordinator will then contact the ODNZ medical specialist.

The ODNZ medical specialist will phone the intensivist responsible for the patient to discuss and provide support in the following areas:

• clinical situation and the intensivist’s overall plan
• physiologic support of the potential donor
• determination of brain death, including preconditions, criteria, procedures, timing and documentation
• medical suitability for donation and investigations that may be required to determine this
• likelihood of meeting the timeframes to allow donation after circulatory death (DCD)
• discussion of donation with the family
• discussion with the coroner
• further communication.

ODNZ contact details

For all donor referrals (24 hours) phone: 09 630 0935

Email: [email protected]

Website: www.donor.co.nz

Link Teams consist of intensive care doctors, intensive care nurses and operating theatre nurses. They are in all donor hospitals in New Zealand.

The members of the Link Team are your local resource for organ and tissue donation matters.

The Link role varies in each hospital. Some intensive care unit (ICU) and operating theatre (OT) Link Nurses are involved in all donations in their hospital, while others are available as a resource.

The ODNZ best practice guidelines are consistent with the Australian and New Zealand Intensive Care Society (ANZICS) Statement on Death and Organ Donation referred to here as the ANZICS Statement.

The main purposes of the Statement are to provide:

• a standard for intensivists and other health professionals in relation to the determination of death and the conduct of organ and tissue donation, including donation after circulatory determination of death;

and

• assurance to the Australian and New Zealand communities that determination of death and the conduct of organ and tissue donation are undertaken with diligence, integrity, respect and compassion, and in accordance with available medical evidence and societal expectations.

ODNZ requires the practice of health professionals involved in the determination of death and care of potential donors and families to be consistent with The ANZICS Statement.

ANZICS uses the terms Donation after Neurological Determination of Death (DNDD) and Donation after Circulatory Determination of Death (DCDD) to refer to what has previously been called Donation after Brain Death (DBD) and Donation after Circulatory Death (DCD). However, these terms are not yet in common use in intensive care and donation practice. Therefore, in this document ODNZ will continue to use the terms DBD and DCD.

In the context of both DBD and DCD, ODNZ requires that death be determined in accord with The ANZICS Statement and to be documented on the ANZICS Determination of Brain Death Form or the Determination of Death Form (for DCD).

The objectives of ODNZ are to develop, implement and monitor consistent processes and standards for deceased donation in New Zealand. ODNZ would like all opportunities where organ and tissue donation might be possible to be identified and discussed with ODNZ.

Guiding principles of ODNZ

Equity

Every opportunity for deceased organ donation should be recognised by hospital staff.

Every family should have donation discussed with them in a compassionate and respectful manner by a healthcare professional with the appropriate knowledge and skill.

Donation should be discussed with all families irrespective of whether the word “donor” is on the driver licence.

Respect

The family’s decision about donation should always be respected. All donors come out of human tragedy and donation by the family is voluntary.

Good process

The process of organ donation must accord with good medical practice, ethical standards, and the law. The Human Tissue Act (2008) requires both informed consent and a lack of informed objection before organs or tissues may be removed from a deceased person for transplantation.

Offering the option of donation

Organ and tissue donation are an inherent part of end-of-life care. Families should be offered the option of donation, given all the information they require, and be supported in making a decision which is right for them.

ODNZ believes that discussion of donation with families should be in accord with the principles of the Medical Council of New Zealand’s Standard for informed consent.

Determination of brain death

ODNZ supports the ANZICS recommendation that brain death be determined whenever it is suspected, irrespective of organ donation.

• This confirms that death has occurred and the family can be told this.
• Determination of brain death in all patients demonstrates that brain death occurs independently of organ donation.
• Physiologic support necessary for the determination of brain death preserves the option of organ donation.
• Determination of brain death in all patients provides the true incidence of brain death and potential for DBD.

Which ICU patients should be discussed with ODNZ?

• Any patient with severe brain damage who is likely to die.

• Any patient, irrespective of diagnosis, from whom intensive therapies are likely to be withdrawn.

Which Emergency Department (ED) patients should be discussed with ODNZ?

Some patients in NZ EDs with non-survivable injuries or diseases are admitted to ICU to provide end-of- life care. Others are admitted to enable consultation with other services, eg neurosurgery. Some of these patients may later donate organs.

However, there are some circumstances where patients with a non-survivable injury or disease are admitted to the ICU solely for possible organ donation. ODNZ recommends that ED staff discuss these patients with their intensivist and that ODNZ be consulted about the feasibility of donation before ICU admission is discussed with the family.

The ODNZ medical specialist can assist the intensivist in deciding whether donation should be discussed with the family and will discuss the following:

• likelihood of brain death developing

• likelihood of death occurring after withdrawal of intensive therapies within a time frame that might permit DCD

• patient’s medical suitability for donation

• condition of potentially transplantable organs

• feasibility of donation.

ODNZ recommends that family discussions in the ED about possible organ donation should be conducted by someone with experience in discussing donation.

Before families are offered the option of ICU admission solely for organ donation, it is crucial that they first understand and accept that:

• the injury or disease is non-survivable
• therapy (eg ventilation) is not for the therapeutic benefit of the patient and will not alter the ultimate prognosis but is solely to support the possibility of organ donation in the near future
• there is no certainty that organ donation will actually occur, eg contraindications to donation may be discovered.

Some families may accept admission to ICU to explore possible donation but decline the option of donation later.