VOL: 98, ISSUE: 28, PAGE NO: 32
Judith Stewart, RGN, is cardiothoracic recipient transplant coordinator, Wythenshawe Hospital, Manchester
Donor hearts are a scarce resource, and we have a duty to donor families to ensure that they are transplanted into recipients who will gain the most benefit. Prospective recipients are, therefore, carefully assessed before being accepted on the waiting list.
- Cardiopulmonary exercise test;
- Lung function tests;
- Abdominal ultrasound;
- Dental assessment;
- 24-hour urine collection for creatinine clearance;
- Blood for biochemistry, haematology, immunology and tissue typing;
- Microbiology screening;
- Virology screening.
The time patients wait for a heart depends on finding a suitable donor. Some may only wait a few hours or days, while others may have to wait months or years. Because there are not enough donor organs to meet demand, many patients die before a suitable heart becomes available.
In cardiac transplantation there is usually insufficient time to perform a prospective tissue-typing crossmatch. This is done only if there is evidence that the recipient has antibodies that may aggressively attack the donor organ. In most cases, the decision is made by matching blood group and assessing the size by comparing the height and weight of the donor and the recipient. Donor and recipient can be of both different ethnic origin and gender, provided the organ is of a suitable size.
After discussion with the family, the donor transplant coordinator assesses the donor in ICU, giving staff both practical and psychological support and advice. If the death was reported to the coroner, his or her consent may also be required (for example, in cases of industrial disease, sudden or unexplained death, or if death occurred during surgery). Information is collated from the donor's notes and family or GP, to ensure no medical or social contraindications to donation. Blood samples are obtained for virology screening to ensure minimal risk of transference of disease. The donor is then registered with UK Transplant.
Part of the extended remit of UK Transplant is to increase the number of organ donors. Extra funding of £4m has meant that more donor transplant coordinators could be employed across the country. A transplant coordinators advisory group was set up at UK Transplant and task groups have examined all aspects of transplant coordination such as standards, education, research and job descriptions.
- If not, why not?
- If consent is given, does donation proceed?
- If not, why not?
- If consent is refused, what reason is given?
- Live related donors: kidneys, liver lobe, lung lobe, small bowel;
- Live unrelated donors: kidneys;
- Non heart-beating donors: kidneys, liver.