discussion beyond intensive
care: lessons from specialist
Joanne Wells, Delyth Hughes and Parul Mistry
With an increasing gap between the demand for donated organs and tissues for transplantation and the available supply, there is a need to facilitate donation from clinical environments other than intensive care. In this chapter we draw mainly on UK data to highlight the potential for donation from alternative settings such as accident and emergency departments, general wards, the primary care setting and palliative care units. Initially we will discuss the possibilities and problems associated with non-heartbeating donation.1 We will then focus on non-heartbeating donation from the palliative care setting, examining the current literature, particularly studies by two of the authors (Wells and Hughes). Finally we will highlight the issues influencing donation from non-heartbeating donors who die outside the intensive care unit, and pinpoint the differences that exist between donation from this setting and the palliative care environment.
Prior to establishment of brain death criteria (Ad Hoc Harvard Committee 1968) non-heartbeating donors were the only source of organs and tissues. With the introduction of the legal definition of brain death, brain dead patients became a more preferred source of organs. Practical concerns regarding warm ischaemia, the amount of time the organ spends at room temperature without any oxygen supply and organ preservation were