Introduction:

Donor management is a foundation of organ transplantation. It requires professionalism, compassion, and collaboration between intensive care unit (ICU) staff, organ procurement organizations (OPOs), and a patient's next of kin. In the absence of first-person consent, authorization for organ donation is obtained by OPOs and intricate donor management protocols are initiated under the OPO's medical direction. There are no clear guidelines on withdrawal of consent or continuation of donor management protocols in such circumstances.

Case Description:

A 55 year old woman suffered a massive hemorrhagic stroke and presented to the hospital comatose, with severe anoxic brain damage and Glasgow Coma Score of 3. She did not improve during her ICU stay and was pronounced dead by neurologic criteria on hospital day 3. The local OPO obtained authorization for organ donation from the patient's sister, with several relatives being unreachable abroad. Standard donor management protocols were initiated for fluid management, hormone replacement, and lung-protective ventilation. Recipients were identified for lungs, liver, and kidneys within 36 hours. When informed of the OR time for procurement, the family stated they were not ready to allow organ donation and wanted to reconsider. Organ procurement was cancelled and the donor case was closed by the OPO. ICU staff was faced with questions of appropriate management of the donor during this period of reconsideration. This was further complicated by ICU staff managing this patient's imminent demise in a hospital with active transplant programs and candidates being cared for in the same unit. Donor management protocols from the OPO were continued overnight under the direction of critical care staff. The next morning, after discussion between ICU staff, hospital administration, and the donor's family, donor management and organ support was discontinued, resulting in immediate cardiorespiratory arrest.

Discussion:

Preserving options for organ donation is a fundamental component of critical care, with management of deceased organ donors often transferred from critical care staff to OPOs. The role of critical care staff is unclear in the difficult case of withdrawn consent. Critical care staff familiarity with organ donor management can allow safe and ethical management of organ donors in cases of uncertain consent status. Increased ICU familiarity with OPO protocols can enhance the process of organ donation and procurement, especially in difficult ethical situations.

CITATION INFORMATION: Varma M., LaRosa J. Critical Care Management of Organ Donors with Uncertain Consent Status Am J Transplant. 2017;17 (suppl 3).

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