See [cameron - organ and tissue donation](x-devonthink-item://10DC3BB1-027C-40D6-BDB3-4AF0C6B160E6?page=721) [ACEM Policy on Organ and Tissue donation](x-devonthink-item://F42649B3-3086-48E0-AFCE-ED98A199DB63) From Oh's : > [!quote] From Oh's Intensive Care Manual: >The rare *absolute contraindications* to organ donation are when there is an unacceptably high risk of *transmission of disease* to the recipient (usually because of malignancy or infection), or when the long-term function of all possible donated organs is likely to be *unacceptably poor*. > >*Tissue donation* (including eyes for corneas and sclera, heart valves and vascular tissue, skin and bone) is also frequently possible in most patients dying in ICUs, including from those who cannot donate organs. Because of the relative benefits and risks to recipients of donated organs and tissues, tissue donation may not be possible in some circumstances where organ donation is acceptable (e.g. low-risk possible food exposure to variant Creutzfeldt-Jakob disease). > > Although current haematological or metastatic malignancy remain *absolute contraindications to donation*, advanced age (e.g. over 80), most treated bacterial sepsis, treated herpes simplex virus encephalitis, positive hepatitis C virus (HCV), hepatitis B virus and even HIV serology, and ‘likely cured’ malignancies (even some melanoma) are ==no longer absolute contraindications.== > **identify potential organ donors** *mnemonic:* GIVE GCS ≤ 5, Intubated, Ventilated, End of Life Care - condition likely to cause irreversible cessation of all brain function (brain death) eg catastrophic intracranial bleed  - condition likely to cause irreversible cessation of the circulation of blood flow in body (circulatory death)  - prior expressed wishes or presence on organ donation registry  - age > 16y (A) patients with catastrophic brain injuries. (B) intubated patients considered for withdrawal of life-sustaining treatment. (C) patients in whom organ donation is being considered. # possible pathway - donation after brain death — most common eg [[traumatic brain injury|TBI]] - donation after circulatory death — rare to occur in ED ; usually ICU ==do not raise organ donation in ED== Given that the majority of potential organ donors are admitted through EDs, the management of these patients in this early phase has important implications. Although for some patients there is a high degree of prognostic certainty about futiity, it is increasingly appreciated that early prognostication is fraught with difficulty. Many centres now routinely support these patients in the ED to facilitate admission to the ICU. In the ED, clinicians should aim for normal physiological parameters. Early urinary catheterization as well as arterial and central venous access should be achieved to facilitate these aims. Restoration of normal physiology benefits both patients with prognostic uncertainty and patients who proceed to organ donation. # manage issues in TBI patients ![[Pasted image 20240909010401.png]]