It would be interesting to hear the protocol with regards to discussion about organ donation once a critically injured person arrives.
At what stage is the organ donation team advised of a possible donor?
At what stage is the family asked if they know their relative's wishes with regards to organ donation?
How long is life support allowed to continue once a family has agreed to donation?
Clearly the life support machinery remains on so the relative seems to be still "alive" when they are then left to say goodbye. That could be confronting and difficult. Perhaps people need the closure of seeing that breathing has stopped?
Just random thoughts.
Protocol
It's not about the patient arriving, but more to do with determining the extent of injuries. Princess Fiona may be able to expand on this. But there are some types of injuries and some physical signs that might indicate that the patient is brain dead. Once it's determined that the injury/illness is not survivable, then organ donation might be considered. Sometimes family members raise it and discussions may commence.
Remember not every death in hospital is suitable for organ donation - the vast majority, in fact, are not.
When patients are dying in hospital, it's standard care to ask family members what the patient would want. It's about respecting the patient's wishes and these questions are asked about a whole range of things, not just organ donation.
Sometimes many people haven't thought about it, or discussed it. And the opinions here on this board, it's been interesting to see how little people actually understand regarding organ donation which makes me think that we have to redirect our efforts in terms of raising awareness of the issues involved.
Organ donation team notification
Only notified when consent is given. Which is after determination of death.
Family questions
See above (fairly early on, because it's pretty easy to tell who's going to do badly and who's not). Like I said, I've been surprised by the situations in which family members have raised it themselves. I'm not going to go into details, but it's truly inspiring and humbling all at once.
Life support continuation
Continued for as long as it takes to determine patient unsurvivability. Family are given an estimate of how long they "have left".
Testing donors is done very quickly.
Finding an organ donation team can be the tricky part (usually done overnight so as not to upset the elective surgery operating lists). Donation is done in the home hospital, so this may mean that the organ donation team has to be flown in. Various state Government aircraft are used for this purpose (so if you see the Qld Premier's jet arriving at a regional airport at 2am...). This allows time for family to say their goodbyes, allow distant relatives to travel, to make funeral arrangements.
Turning off the machine
For donation after cardiac death, the rules are different in each state, but the breathing tube is removed and the patient's heart will stop beating in its own time. Once there is no heart beat, family have 5 minutes before the patient is taken to the operating theatre. (Perfusion of organs is a time-critical issue).
With brain death, the patient is taken to the theatres still on life support. Life support is removed at a certain point in the donation operation.
I'm not sure that there's much comfort in seeing a loved one lying still on the bed, without their chest rising and falling. It can be very confronting to see a recently deceased person.
I must stress that at all points along the organ donation pathway, the patient is given every treatment and opportunity to improve. Sometimes organ donation doesn't proceed because the patient doesn't meet the strict criteria for donation.
Even in the operating theatre, the donor is treated with the utmost care and respect. It's generally a fairly sombre theatre, and there are some time-critical issues to deal with as well (not to mention you as the surgeon are sleepless!). We see some horrible stories leading to death and operate on many young people whose lives have been tragically cut short. Don't think we're not affected by what we see or do - organ donation surgery is quite emotional.
Most of what I've said here is a fairly inarticulate summary of some very complex medical/ethical issues - my apologies for this, but I can't summarise all these issues into a few lines.
