Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Introduction
- Withholding or Withdrawing Treatment
- Presumption in Favour of Prolonging Life
- Decisions Need to Be Informed by Multidisciplinary Team Assessment
- Put Patients at the Heart of the Decision-Making Process
- When a Treatment Is Deemed to Clearly Offer no ‘Clinical Benefit’
- When the Overall Benefit of a Treatment Is Less Clear
- Clinically Assisted Nutrition and Hydration
- Disagreement
- Care of the Patient during Withdrawal of Life-Sustaining Treatment
- Introduction
- Treat Your Patient as an Individual
- Capacity
- Confidentiality
- Rapport
- Know All the Relevant Information
- Optimise the Setting
- What Does the Patient Already Know?
- What Does the Patient Want to Know?
- Warning Shot
- Speak Honestly and Directly
- Allow the Expression of Emotions
- Listen to Concerns and Answer Questions
- Agree New Goals
- Summarise
- Pitfalls to Avoid
- Tricky Cases
- Introduction
- ‘Good Death’
- Recognising the Dying Patient
- The Decision-Making Process
- Decisions and Care at the End of Life
- Recognising Symptoms
- Involving Family Members
- Religion and Spirituality
- Communication
- Definition of Death
- The Personnel
- Brainstem Reflexes
- The Apnoea Test
- Ancillary Tests
- Introduction
- Pathophysiological Changes after Brainstem Death
- Stabilisation of a Brain-Dead Donor to Optimise Organ Function
- General Management
- Introduction
- Controlled and Uncontrolled Donations
- The Process of Controlled DCD
- Ischaemia Times
- Patients from Emergency Department
- 8.1 How to Manage the Process of Withholding or Withdrawing Treatment with the Multidisciplinary Team
- 8.2 How to Discuss End-of-Life Care with Patients and Their Families/Surrogates
- 8.3 Managing Palliative Care of the Critically Ill Patient
- 8.4 Brainstem Death Testing
- 8.5 Physiological Support of the Organ Donor
- 8.6 Management of Organ Donation Following Circulatory Death
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
8.5 - Physiological Support of the Organ Donor
from Section 8 - End-of-Life Care
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Introduction
- Withholding or Withdrawing Treatment
- Presumption in Favour of Prolonging Life
- Decisions Need to Be Informed by Multidisciplinary Team Assessment
- Put Patients at the Heart of the Decision-Making Process
- When a Treatment Is Deemed to Clearly Offer no ‘Clinical Benefit’
- When the Overall Benefit of a Treatment Is Less Clear
- Clinically Assisted Nutrition and Hydration
- Disagreement
- Care of the Patient during Withdrawal of Life-Sustaining Treatment
- Introduction
- Treat Your Patient as an Individual
- Capacity
- Confidentiality
- Rapport
- Know All the Relevant Information
- Optimise the Setting
- What Does the Patient Already Know?
- What Does the Patient Want to Know?
- Warning Shot
- Speak Honestly and Directly
- Allow the Expression of Emotions
- Listen to Concerns and Answer Questions
- Agree New Goals
- Summarise
- Pitfalls to Avoid
- Tricky Cases
- Introduction
- ‘Good Death’
- Recognising the Dying Patient
- The Decision-Making Process
- Decisions and Care at the End of Life
- Recognising Symptoms
- Involving Family Members
- Religion and Spirituality
- Communication
- Definition of Death
- The Personnel
- Brainstem Reflexes
- The Apnoea Test
- Ancillary Tests
- Introduction
- Pathophysiological Changes after Brainstem Death
- Stabilisation of a Brain-Dead Donor to Optimise Organ Function
- General Management
- Introduction
- Controlled and Uncontrolled Donations
- The Process of Controlled DCD
- Ischaemia Times
- Patients from Emergency Department
- 8.1 How to Manage the Process of Withholding or Withdrawing Treatment with the Multidisciplinary Team
- 8.2 How to Discuss End-of-Life Care with Patients and Their Families/Surrogates
- 8.3 Managing Palliative Care of the Critically Ill Patient
- 8.4 Brainstem Death Testing
- 8.5 Physiological Support of the Organ Donor
- 8.6 Management of Organ Donation Following Circulatory Death
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Any patient likely to progress to brain death is a potential organ donor.
2. Severe raised intracranial pressure and brain death are associated with various organ system consequences.
3. Optimising the physiological status of a potential donor is an active process and may require escalation of monitoring and therapies.
4. Donor management improves the quality of donated organs.
5. Care bundles for the management of brain-dead organ donors are available.
Keywords
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 683 - 685Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Gordon, JK, McKinlay, J. Physiological changes after brain stem death and management of the heart-beating donor. Contin Educ Anaesth Crit Care Pain 2012;12:225–9.CrossRefGoogle Scholar
McKeown, DW, Bonser, RS, Kellum, JA. Management of the heartbeating brain-dead organ donor. Br J Anaesth 2012;108(Suppl 1):96–107.CrossRefGoogle ScholarPubMed
NHS Blood and Transplant. Donor optimisation – guidance around selecting potential DBD donors. www.odt.nhs.uk/deceased-donation/best-practice-guidance/donor-optimisation/Google Scholar
NHS Blood and Transplant. 2012. Organ retrieval from donation after brain-stem death (DBD) donors in the UK. Donor Optimisation Extended Care Bundle. www.odt.nhs.uk/deceased-donation/best-practice-guidance/donor-optimisation/Google Scholar
Office of the Chief Health Officer, Ministry of Health NSW. 2016. Management of the adult brain dead potential organ and tissue donor. www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2016_008.pdfGoogle Scholar