Organ donation after death in the community or emergency department

Traditionally, organs are donated from in-hospital donors. There are two types of donor: those who donate after brain death or after cardiac death. Donation after brain death (DBD) subjects, who are intubated and ventilated, must meet rigorous criteria confirming the absence of cerebral function. Once brain stem death criteria are met, the person can be confirmed legally dead. If the family or next of kin consent to organ donation, the person is transferred to the operating theatre where a multi-organ retrieval team removes the organs accepted for transplantation.

With this technique, the heart is beating throughout the operation until the point when organs are removed. This maintains organ perfusion preserving their function. Just prior to organ retrieval, the patient is exsanguinated via incisions in the inferior vena cava and right atrium with simultaneous perfusion of ice cold preservation fluid directly into the arterial system. There is a short period of warm ischemia when the organs are not perfused with blood but are cooling down. The body cavities are packed with ice and the organs allowed to cool before finally being removed. They are then packed in a cold environment and transferred to the receiving transplant centre for implantation. The cold ischaemic time is defined as the period from the organs being cooled to re-implantation in the recipient.