Organ and tissue donation - authorisation requirements: guidance

Chapter 4: Referral of potential donors

This chapter signposts health professionals not directly involved in the donation process to discuss the potential for referral of patients for donation to NHSBT or SNBTS.

67. There is a significant shortage of donor organs and some tissue in the UK, which means that many people are having to wait a long time for a life-saving or life-enhancing transplant. And some people are still dying while waiting. Therefore it is important to ensure that everyone who could potentially be a deceased donor is considered. NHSBT provides best practice guidance^[15] regarding referral and the key principles are set out below.

68. Where a patient in an Intensive Care Unit, Emergency Department or any other hospital area where patients may die could potentially donate, a referral should be considered and made if appropriate. The most important point to remember is that donation should start to be considered at an early stage where there is:

• an intention to use neurological criteria tests to confirm death;
• an intention to withdraw life-sustaining treatment in patients with a life-threatening or life-limiting condition which will, or is expected to, result in circulatory death;
• admission of a patient with very severe brain injury (defined as a Glasgow Coma Score of 3-4 with at least one absent brain-stem reflex) that cannot be attributed to the effects of sedation.

69. For tissue-only donation, donation should also be considered early.

70. A Specialist Nurse for Organ Donation (SNOD), Specialist Requestor (SR) or Tissue Donor Coordinator (TDC) should be contacted to see if donation may be possible, even if it may seem unlikely. The SNOD/SR or TDC will be able to advise often quickly by telephone if the patient could be a potential donor and this early screening call will help to ensure that no potential donor is missed.

Contact Numbers

71. If there is a patient who could be a potential organ (and tissue) donor i.e. if it is expected that life sustaining treatment will be withdrawn soon or brain-stem death testing will be carried out on the patient, the donor referral line should be contacted on the number below to arrange for a SNOD/SR to respond.

• Donor referral line (24 hours a day, 7 days per week) - 03000 20 30 40

Tissue only donation

72. If the patient has already suffered circulatory death, (in particular for Emergency Departments or general wards) a TDC should be contacted on the number below as tissue donation may still be possible (tissue, such as heart valves and tendons can be retrieved up to 48 hours after death, and eyes up to 24 hours after death).

• TDC Tissue services pager (24 hours a day, 7 days per week) - 07623 513987

Next Steps

73. If a patient could potentially be a donor, the SNOD/SR or TDC will guide the next steps. If the patient is a potential organ (and/or tissue) donor, a SNOD/SR/TDC will check the NHS Organ Donor Register. In the setting of organ donation, a SNOD/SR will arrange to attend and approach the nearest relative (or person with parental rights and responsibilities in the case of a child) about donation alongside the clinicians who have been caring for the patient. The topic of donation should not be raised with family members until the SNOD/SR arrives. Sometimes the patient's family might raise the issue of donation themselves with clinical staff; if so, it is normally best to suggest that it is too early to discuss donation, but that clinical staff will discuss further if and when end of life care options require to be considered.

Tissue only donation

74. For patients who could potentially donate tissues, but not organs (those who have already died, those not on ventilation who are not expected to die in a controlled manner, or patients with a history of cancer), the TDC will give guidance on approaching the patient's family. Clinical staff will be asked to speak to the family to ask them whether they would be willing for a TDC to contact them, almost always by telephone, at an appropriate time that suits the nearest relative (or person entitled to give authorisation on behalf of a child). If they are willing to discuss donation, the TDC will contact them and, if donation is authorised, will arrange the next steps.