Practice Guidelines

Donor identification and consent for deceased organ donation: summary of NICE guidance

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e341 (Published 12 January 2012) Cite this as: BMJ 2012;344:e341
  1. K Chamberlain, project manager1,
  2. M R Baker, clinical adviser1,
  3. P Kandaswamy, technical adviser, health economics1,
  4. E J Shaw, technical adviser1,
  5. G McVeigh, professor of cardiovascular medicine2,
  6. F Siddiqui, assistant technical analyst1
  7. On behalf of the Guideline Development Group
  1. 1National Institute for Health and Clinical Excellence, Manchester M1 4BD, UK
  2. 2Department of Therapeutics and Pharmacology, Belfast BT9 7BL, UK
  1. Correspondence to: Professor G McVeigh g.mcveigh{at}qub.ac.uk

Organ donation plays a major role in the management of patients with single organ failure of the kidneys, liver, pancreas, heart, or lung, or with combined organ failure of heart and lung (such as in cystic fibrosis) or of kidney and pancreas (such as in diabetes). A shortage of transplant organs has resulted in long waits for transplantation. Currently about 500 people in the United Kingdom die each year because of a shortage of donated organs,1 and at 31 March 2011 almost 7000 patients were waiting for a kidney transplant1 and would be having costly dialysis with serious morbidity and impact on quality of life. This shortage of organs is partly the result of relatively low numbers of road traffic deaths (lower than in many countries) but is also the result of inefficiencies in the donor identification and consent processes. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on improving donor identification and consent rates for deceased organ donation.2

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Identifying patients who are potential donors

  • Consider organ donation as a usual part of planning for “end of life care.”

  • Identify all patients who are potentially suitable donors as early as possible, through a systematic approach. While recognising that clinical situations vary, base this identification on either of the following criteria:

    • -Defined clinical trigger factors in patients who have had a catastrophic brain injury (namely (a) the absence of one or more cranial nerve reflexes and (b) a Glasgow coma scale score of ≤4) unless …

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