Tag: organ donation

Winter’s Wrap: Registrar Training 19.04.2017 – Organ donation, contrast nephropathy and paracetamol overdose

Organ Donation – Dr Forbes McGain (Intensivist)


Brain Death vs Circulatory Death

Clinical Testing – normothermic

– Sedating drugs excluded – *Baclofen mimics brain death

– cranial nerve testing

– Apnoea test

Imaging – if inappropriate for clinical test, unstable, spinal reflexes present


ED responsibility:

Contact Donor Coordinator – ICU registrar or Consultant, or Donate Life via switchboard

Initiate conversation but ensure family aware ICU attendance is NOT too prolong life but for consideration of organ donation


consider for donation if:  Brain death or imminently dying and withdrawal of cardiorespiratory support planned

Intubated and Ventilated

BP adequate for organ perfusion

No Malignancy or HIV

Age 1-80 years



Contrast Nephropathy – Dr Jamie MacGilivray

Limited evidence

Variable definition of nephropathy

Jamie’s audit showed 16 patients actually had improvement in renal function!!


In summary – understand the clinical indication for the scan requested and the timeframe within which results are needed. Renal function should not delay an appropriate CT.

Paracetamol Overdose – Dr Deb Maher




Guidelines for writing SAQs…for registrars presenting at Footscray to incorporate into their presentation:

Guidelines for Writing the Fellowship SAQ Examination Paper


GIVE – Organ donation



Key points:

  1. remember the trigger – GIVE – GCS <5; Intubated, Ventilated, End of life care
  2. Acute intracerebral catastrophe (eg bleed) is the most likely ED scenario wherein donation may be considered
  3. patient’s wishes regarding donation can be unknown to their family and must be broached sensitively
  4. discussions regarding donation may be appropriately deferred to the ICU team or the on-call Donation co-ordinator (phone number found via ICU) to maintain separation between ED care-givers and the Donation team
  5. Brain death testing is usually deferred to ICU
  6. Donation after circulatory death is an extremely unlikely ED outcome
  7. observe the fewer absolute contraindications to donation eg. active malignancy, HIV, age > 80