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Situation in Europe: legislation/consent modali; Mihaly Sandor

Which is the most common legal system in European countries regarding or-gan donation from deceased?

Presumed/deemed consent (Opting-out).

Explicit consent (Opting-in).

Mixed system with both type of registries.

There is no legislation in place in most countries.

Situation in Europe: legislation/consent modali; Mihaly Sandor

Main characteristics of public knowledge and attitude about organ donation in Europe:

40% of Europeans have raised the issue of organ donation and transplantation with their family.

28% of Europeans are aware of laws governing the dona-tion and transplantation of organs in their country.

55% of Europeans are willing to donate their organs after their death.

Situation in Europe: legislation/consent modali; Mihaly Sandor

Regardless of the law applied for organ donation from deceased, the role of the health care professionals who are responsible for the com-munication with the donor family is:

to ensure that the patient’s wish will be respected,

to ensure that family members understand the situation and the pro cess, and their wishes are also considered, meanwhile the patient’s wish have to be respected as first,

to ensure that the family members understand the situation and the process, and only the relatives’ wishes will be respected.

Situation in Europe: legislation/consent modali; Mihaly Sandor

What is the most common reason for failure of organ donation among identified and reported potential donors?

Medical unsuitability

Legal reason

Organizational reasons and lack of capacity

Family refusal

Situation in Europe: legislation/consent modali; Mihaly Sandor

Some main roles of family conversations:

We need to have hospital level standpoint agreed in ad-vance how we handle the family protest.

We should talk about donation after we made sure the family understood death.

The conversation and the family should be guided as part of our support.

We have to provide information and do not ask for consent directly.

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

Autonomy of the person is essential for voluntary consent in organ donation. Which of these characteristics is not associated to a voluntary consent?

Consent must be given freely

Consent must be a deep emotional decision.

Consent must be given by a competent person.

Consent must be informed.

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

One of the following aspects is no related to Declaration of Istanbul

The Declaration of Istanbul expresses the determination of dona-tion and transplant professionals and their colleagues

The Declaration of Istanbul try to maximize the number of organ donors all over the world

Declaration of Istanbul refuse on unethical and exploitative prac-tices that have harmed poor and powerless persons around the world.

It is aim of Declaration of Istanbul to provide ethical guidance for professionals and policymakers who share this goal.

The Declaration of Istanbul complements efforts by professional societies, national health authorities to support the development of ethical programs for organ donation and transplantation

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

Regarding living donation one of the following asseveration is not right.

Organ donation from the related donor never requires a review by the Ethics Committee.

In the case of unrelated living donor donation, it is ethical to eval-uate the donor's freedom in decision-making.

The living donor must have the option to withdraw consent till the moment of donation.

Altruism is the main driver of living donor donation.

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

Regarding living donor donation, points out that the right answer.

Genetically/emotionally related donation is ethical correct.

Paired/pooled Exchange donation is ethically correct.

Non-directed altruistic donation is ethically correct.

All of the answers above are correct.

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

In an ethical analysis of organ donation with expanded criteria, point out which of the following statements is incorrect.

Organ donation with expanded criteria is ethically correct even though it is associated to Medically or immunologically higher risk.

Transplantation with expanded criteria kidneys is not ethically cor-rect because is worse option than dialysis.

Transplantation with organs from donors with expanded criteria requires specific and detailed informed consent.

Organ donation with expanded criteria, is ethically correct if insuf-ficient the number of optimal organs donated

Donor Detection - Ignacio Martin Loeches

The most important part in organ donation is

The number of hospitals in the country

The figure of transplant coordinator team

The religion

The media support

Donor Detection - Ignacio Martin Loeches

Regarding family consent

It should be started as soon as possible

It should be signed

It should be discussed in friendly manner

It should be carried out by a trained team/person

Donor Detection - Ignacio Martin Loeches

Which of the ones is NOT an extended donor criteria?

Age

Gender

Comorbid conditions

Previous hypertension

Donor Detection - Ignacio Martin Loeches

Which of the following is NOT important regarding improvement in organization process?

Detection of potential donors

Family consent optimization

Organ donation census

Adequate training and motivation in staff.

Donor Detection - Ignacio Martin Loeches

Which of the following is NOT a basic principle in improving organ donation?

Transplant coordinators inside the hospitals

Quality Assurance Program in the Deceased Donation Pro-cess

Prioritising donation after circulatory death (DCD)

Close attention to the mass media with special communica-tion policy

Family approach I consent – Danica Avsec

About telling bad news. Please circle uncorrect answers.

Prepare quiet, comfortable room with round table

If you dont have time just inform relatives in front of the entrance of department

Use a huge specter of verbal and nonverbal communication tools

Dont allow gloomy silence

Advise the relatives not to visit their beloved due to situation in the ICU( still mechanically ventilated, warm, active ECG monitor)

Family approach I consent – Danica Avsec

The grief reaction could be? Please mark correct answers

Denial and displacement of the reality, when the family thinks that something was wrong during treatment

Bargaining based on a hope that still better exit is possible

The relatives protect themselves against having to deal with reality

Various display of unexpected emotions and behaviours

Acceptance of death after some time

Family approach I consent – Danica Avsec

When asking for consent for organ donation, we should ask for:

The opinion of the relatives on organ donation

If they know anyone living with a transplanted organ

The opinion of the deceased on organ donation

What kind of person the deceased was

What was the way of life of the deceased related to health, social habits, travelling, etc

Family approach I consent – Danica Avsec

When two parents have different opinions about organ donation of their child:

We explain useful facts why donation is important

We say the decision has to be taken by the head of the family

We try to help the doubtful parent, and ask what we can do for him/her

We suggest speaking with a priest if there is a need

bd

Family approach I consent – Danica Avsec

In a case of disagreement to donation. Please mark correct answers:

It is recommended to ask family for additional explanation for circumstances in which deceased person expressed disagreement

It is recommended to offer consultation with priest or other religious leader when there opposition is based on religion

It is recommended to the family to find somebody from their closest to donate the organs

It is recommended to suggest a break or bedsite visit and then ask again for the donation

a, b, d

SNODs The UK concept to family approach – SusanLee & John Stirling

Which of these are the functions of NHSBT in relation to organ donation?

Maintaining the Organ Donor Register. Matching and allocation of organs. Maintaining a transplant registry. Development of standards, performance indicators and protocols. Auditing and analysing results .

Central point for information and support. Raising public awareness. Development of standards, performance indicators and protocols. Auditing and analysing results. Retrieving organs for research.

Central point for information and support. Raising public awareness. Ensuring organ recipients are correctly consented. Development of standards, performance indicators and protocols. Matching and allocation of organs.

Maintaining the Organ Donor Register. Advise on transplantation techniques. Matching and allocation of organs. Maintaining a transplant registry. Central point for information and support.

SNODs The UK concept to family approach – SusanLee & John Stirling

What is the role of the Specialist Nurse Organ Donation

Supporting clinical staff. Advocate for the potential donor. Support the family. Perform bronchoscopies. Donor characterisation.

Participate in donation from referral to retrieval. Potential donor audit. Hospital engagement. Teaching. Advise on stabilisation and optimisation of the donor.

Hospital engagement. Teaching. Advise on stabilisation and optimisation of the donor. Nurses organ donors on ITU. Potential donor audit.

Consent for donation. Potential donor audit. Advocate for the potential donor. Perform Neurological death tests. Supporting clinical staff.

SNODs The UK concept to family approach – SusanLee & John Stirling

What order is seen as best practice in the UK when contemplating a family approach?

Breaking bad news, confirming understanding and acceptance of loss. Planning. Approaching donation .

Planning. Approaching donation. Breaking bad news, confirming understanding and acceptance of loss .

Planning. Breaking bad news, confirming understanding and acceptance of loss. Approaching donation .

SNODs The UK concept to family approach – SusanLee & John Stirling

In the UK when opt out legislation is in place what is the order in which to approach consent / authorisation

Person in the highest qualifying. First person consent via ODR (Organ Donor Register), written or verbal. Nominated/ appointed representative. Deemed if inclusion criteria met, (need to ascertain last known decision or duty to enquire) relationship.

Person in the highest qualifying. First person consent via ODR, written or verbal. Nominated/ appointed representative. Deemed if inclusion criteria met, (need to ascertain last known decision or duty to enquire).

First person consent via ODR, written or verbal. Nominated/ appointed representative. Deemed if inclusion criteria met, (need to ascertain last known decision or duty to enquire). Person in the highest qualifying.

Deemed if inclusion criteria met, (need to ascertain last known decision or duty to enquire). Person in the highest qualifying. First person consent via ODR, written or verbal. Nominated/ appointed representative.

SNODs The UK concept to family approach – SusanLee & John Stirling

What background is it vital that Specialist Nurses Organ Donation have prior to this role?

Senior / leadership nursing background. Excellent communication skills. Critical Care background (or willingness to undertake education in this). Qualified nurse.

Senior / leadership nursing background. Excellent communication skills. Critical Care background (or willingness to undertake education in this). Student nurse.

Excellent communication skills. Critical Care background (or willingness to undertake education in this). Qualified nurse. Personal experience of donation.

Excellent communication skills. Senior / leadership nursing background. Student nurse. Personal experience of donation.

Management of the potential donor - Rafael Badenes

Which is the most common physiological derangements during the potential donor management:

Disseminated Intravascular Coagulation

Pulmonary Oedema

Metabolic Acidosis

Hemodynamic Instability

Management of the potential donor - Rafael Badenes

During the hemodynamic management of the potential donor after brain death, which of the following is a false:

If Hypovelemia, treatment is fluid loading.

If myocardial dysfunction, treatment is Norepinephrine and fluid loading.

If vasoplegia, treatment is Norepinephrine and fluid loading.

If hypovolemia, consider diabetes insipidus.

Management of the potential donor - Rafael Badenes

During the management of potential donor after brain death, the target range of basic monitoring is:

Invasive Mean Arterial Pressure (20-40 mmHg).

Urine Output (0.2-0.4 ml/kg/h)

Na (135-145 mmol/L)

Platelets > 15 G/L

Management of the potential donor - Rafael Badenes

In the management of polyuria in the potential donor after brain death:

Polyuria is > 2 ml/kg/h

Should not exclude secondary polyuria

In diabetes insipidus, urine specific gravity below 1.005 g/mL

The goal diuresis target using Desmopressin is 0.2-0.4 ml/kg/h

Management of the potential donor - Rafael Badenes

Interventions for a lung protective strategy don´t include:

Avoid any decrease in oxygenation

Closed circuit for tracheal suction

PEEP 0 cm H2O

Bronchoscopy

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

In 2021 in every donor following investigations should be done during evaluation? 

Coronary Angiography 

Collection of 24h Urine for protein diagnostics 

SARS-CoV-2 NAT from nasopharyngeal swab and/or BAL (lung: must) 

Whole body CT-scan.

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

In which donor is a coronary angiography most likely with a pathological result? 

59 yrs, male, ICB, smoker 30 pack years, alcohol 1.5l vine/d, untreated hypertension, ECHO: LVH IVSd 16mm, plaque in aorta ascendens & descendens 

62 yrs, male, SAH Hunt-Hess V, 100 km bicycle/day, ECHO 6 hrs after SAH: LVF good EF 60%, IVSd 10mm, no wall motion irregularities, no plaques, good RVF, non-smoker, no alcohol, no hypertension, CT scan thorax without calcification in coronary artery, neurosurgery hospital without Coro-facilities. 

1 year old baby with multiple heart surgery  

49 years female, head trauma at 50 km bycicle tour, no CVR risks reported

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

A donor with death confirmed by neurologic criteria and legal authorization / written consent to organ donation is reported to you. The ICU physicians tells you: 59 years old, 170 cm, 100 Kg, heavy smoking, heavy drinking, arterial hypertension may not have been treated well; SAH two days ago, on abdominal ultrasound: liver edge blunt, liver parenchyma echo-inhomogenous, pancreas lipomatosis, aorta plaques, both kidney 11cm*6cm (2cm Parenchyma) & otherwise normal morphology; echo-heart two hours after admission two days ago: LVF EF 30%, LVH IVSd 13mm, wall motion abnormality (apical akinesia). 5 years ago he was admitted for pancreatitis (after swollowing a tooth pick with perforation form stomach into pancreas after consumtion of ethanol). Which one of the following is false: 

reject liver regardless of finding during procurement 

consider liver for inspection during procurement after checking all other medical data & perform biopsy to confirm macroscopic assessment –then decide to use graft or not 

pancreas and intestine may not be of perfect quality, confirmation by expert to exclude 

nothing is said about the lung except smoking history. Needs more data. 

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

In the above case regarding the heart following statement is not correct/inappropriate: 

reject the heart because of bad echo findings 

check whether hemodynamics is optimized and then repeat echo 

consider Coro after b) has been checked and resolved 

check valves, and if ok and if heart is not used for transplantation -> consider tissues: heart valves

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

For donation of an intestinal graft following considerations are an inclusion criteria for donation 

recovery from previous hypotensive periods and/or cardiac arrest events do not preclude donation. 

parenteral nutrition during donor management is desirable 

positive anti-EBV-IgG-VCA. 

a+b+c is correct.  

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

A 4 year old boy was found unresponsive in a private pool and received 30min CPR. 48hours later the child has fixed dilated pupils and diabetes insipidus. Which of the following statements is correct (one applies)

Clinical brain death testing in pre-school children is not sufficient to establish a diagnosis of brain death without imaging

Criteria for brain death testing in this age group are identical to those of adults

A EEG should be performed to establish a diagnosis of brain death

Due to the ischemia of organs during CPR, the child is unlikely to become a suit-able donor

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

A term born girl is resuscitated in delivery room after severe perinatal asphyxia for 25min. On day 3 of life, she is unresponsive. Parents inquire about the option of her to become an organ donor. Which of the following statements is wrong (one applies)

You have to check with the guidelines and legal framework of your jurisdiction as neonatal organ donation may not be allowed

Organs from neonates are too small to be implanted successfully to re-cipients.

In preterm infants, brain death cannot be established using clinical criteria.

Brain ultrasound is not an accepted imaging modality to confirm brain death.

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

A 14 year old child victim of a motor vehicle accident with severe traumatic brain injury develops signs compatible with brain death. Which of the following statements about family care is correct (multiple apply)

Where feasible, a trained organ donation specialist should be present in family meetings.

If brain death testing is performed, the family should be given the op-portunity to be present if they wish.

It is not recommended to explore whether the child had previously expressed views on organ donation in school or at home, as at that age the child would not be able to consent anyway.

If the child does not meet brain death criteria, the same rules for po-tential donation after cardiac death apply as in adults.

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

A 18month old child with severe cerebral palsy has a severe aspiration event which had required 30minutes of CPR. Attempts at extubation failed and the family is inquiring about organ donation. Which of the following statements about organ donation are correct (multiple apply)

Donation after cardiac death should be explored with the family.

Different ischemia times apply for children for DCD compared to adults.

Congenital conditions usually preclude clinical brain death testing.

Deaths in young children <2 years of age represent about half of PICU deaths, but only a small minority of pediatric organ donations.

Infants should not be considered for organ donation as donor-recipient allocation in this age group is extremely hard.

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

You are asked to establish a pediatric organ donation program at your institution. Which of the following statements about pediatric organ donation are correct (multiple apply)

Overall, while there are age-specific criteria, the same principles as in adult donation apply.

Pediatric organ donations are associated with worse transplant outcomes.

Consent rates of parents from potential pediatric donors are much lower com-pared to family members from potential adult donors.

If establishing a pediatric donation after cardiac death program at a pediatric in-stitution is not possible, you will explore partnership with an adjacent adult insti-tution..

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