Organ Donation

What follows is a curated distillation of the ANZICS Statement on Death and Organ Donation.

Donation after Circulatory Determination of Death (DCDD)

Maastricht classification – only 3 & 4 used in Aus/NZ

CategoryContextWarm ischaemic timeDegree of control
Category 1Dead on arrivalUnknownUncontrolled
Category 2Failed resuscitation (ED or ICU)KnownUncontrolled
Category 3Withdrawal of treatment in ICUKnown and limitedControlled
Category 4Unexpected cardiac arrest following NDDKnown, potentially limitedUncontrolled*
Category 5Unexpected cardiac arrest in ICUKnownUncontrolled
* controlled in circumstances where the person is determined to be dead by neurological criteria and and the family wish to be present at the time of withdrawal of cardiorespiratory support.

Stages

Period/timeframeCommencesConcludes
AgonalWithdrawal of Cardiorespiratory SupportCirculatory arrest
Warm ischaemic timeVaries by organCold perfusion
Functional warm ischaemic timeSBP <50mmHgCold perfusion

Acceptable ischaemic times in Australia

  • Liver & pancreas: Agonal + FWIP <30 minutes
  • Heart: <30 minutes from SBP <90mmHg
  • Kidneys: FWIP <30 minutes
  • Lungs FWIP <90 minutes

or, visually (page 15, Best Practice Guideline for Donation after Circulatory Determination of Death in Australia, DonateLife)