The potential organ donor

The source of most organs for transplantation is the brain-dead cadaveric donor. The realistic potential donor is one for whom mechanical ventilation and other support, to the point of brain death, is provided in the best interests of that patient, and not solely for the purpose of organ donation. Brain death secondary to spontaneous intracranial haemorrhage now exceeds traumatic head injury as a source of organ donors in Australia. There are now few medical exclusions to organ donation. Age limits rise constantly. No patient should be excluded without referral to the transplant coordinator. Adequate medical support of the potential donor is no more than should be provided to the severely brain-injured patient. Haemodynamic and other organ support are as logically appropriate as ventilation and must be continued until confirmation of brain death. Support should cease only if organ donation will not occur. Australian State laws define brain death as irreversible cessation of all function of the brain of the person, but do not dictate the methods of confirmation. The prospect of organ donation should not be raised until brain death is confirmed. The over-riding principle is that the family always has the right to be asked. There is no other way for the family's and patient's wishes about organ donation to be known and respected. It is vital that the person who will ask be experienced, competent and committed. A dedicated medical, nursing and allied health team providing care of the family throughout the period is essential.