Update : What is involved in the end to end process of assessing a potential deceased organ donor?

Following on from an earlier post in this blog on this particular topic, the time has come to provide an update as to what is involved in the end to end processes around the world  of undertaking a full medical/surgical assessment of a potential organ donor. This process extends from the initial identification of a potential organ donor in hospital through to the surgical recovery of the organs that are then deemed suitable for transplantation. In particular this information applies to deceased donors whether it be that they proceed via the donation after circulatory death (DCD) pathway or whether it be following the neurologic determination of death (otherwise known as brain death - DBD).

A number of professional organizations and statutory organ donation organizations also have relevant up to date information which can be accessed via the relevant web sites. This includes NHS Organ Donor , the United Network of Organ Donation in the United States ( UNOS ), and the Australian Organ and Tissue Authority via it's DonateLife website

However the best practice principles of assessing each and every organ donor are the same regardless of either the location or the circumstances. This involves putting together the relevant data and information for every point of interest as summarized in each of the pieces of the jigsaw in the following graphic-

One particular point of note and that is that along the way, from the beginning of the assessment process through to the end of the organ retrieval/recovery surgery being performed on an actual donor, as new information comes to hand this may rule out some or all of the organs for transplantation purposes. For example testing for infectious disease involves a battery of tests being performed the results of which are not available for a number of hours. As each year goes by the tests either become more sophisticated for eg the nucleic acid testing (NAT) for viruses. In addition as new blood tests are developed these are added to the battery of tests being undertaken, depending on the circumstances.

At times additional tests such as echo cardiograms, ultrasound scans and even computerized tomographic imaging may be performed if there are concerns that the donor may have additional medical problems which may need to be investigated further. On occasion more sophisticated tests are also performed on tissue obtained from undertaking a biopsy of one or more of the donor organs. These biopsies may also be undertaken during the organ retrieval/recovery surgery if the surgeons are concerned that there are specific abnormalities which need to be investigated further.

Acknowledgements: Lesley Logan NHS Scotland for providing feedback on this updated graphic prior to this blog post going live.