tecnology.
That's all for this video.
Welcome, everybody. Welcome to this evening's presentation, When Are You Dead, Brain Death
and Organ Donation? I'm Sally Tiddemann. I'm the State Medical Director for Donate
Life in South Australia, and that's part of a national network of agencies and medical
and nursing staff, and there's one of us in each state and territory. Donate Life nationally
and in each state and territory has the job of putting in place the best practice and
the best approach to achieve a significant and long-lasting increase in the number of
life-saving and life-transforming transplants for Australians. The work of the network is
managed through the Organ and Tissue Authority based in Canberra, and that was established
on the 1st of January 2009 as part of a national reform package. The aim of the Commonwealth's
funded 151 million national reform package was to establish Australia on the world stage
as a world leader in organ and tissue donation and transplantation. Since 2009, the Donate
Life network has been involved in a dedicated national effort to make improvements to the
systems, and there is good progress. Organ and tissue donation rates and the number of
transplants are increasing. Tonight I'll be introducing you to a panel of experts,
two of whom I have sitting with me here, Steve and Orr, who is one of our organ donor coordinators,
so a senior ICU nurse who works coordinating organ donations, and Dr Stuart Moody, an ICU
consultant who works at the Queen Elizabeth Hospital and also at the Royal Adelaide Hospital.
So this panel will have some other members of the panel as well, and we are going to
be talking about a situation that most people don't even want to think about, and it's
really the possibility that you or someone close to you will become seriously ill or
injured and end up in hospital and intensive care. So serious is the situation that we
are discussing tonight, that brain death will be diagnosed and organ donation a real consideration.
But how did we get to this place? Tonight we'll be using a real case study to talk about
the process of brain death and organ donation. There will be time for questions throughout
the event. Before we begin, I'd really like to clarify that the focus of our discussion
is the donation of solid organs, not tissues. So solid organs are heart, liver, lungs, kidneys
and pancreas, whereas tissue, we refer to tissue and it covers eyes, heart valves, bone
and skin. So we're only concentrating tonight on the solid organs. Also it's important
to clarify that there are two ways to certify death, cardiac death and brain death, and
we're focusing just on brain death tonight. Before we start I'd like to put the story
of organ donation in context and I'll do that by firstly stepping through a slide that
really gives the bigger picture. So according to the ABS 2010 Australia had 22 million people.
Death then relates to the fact that we have about 145,000 deaths in Australia a year.
That then gives us about 78,000 deaths in hospital a year. So we've gone from a population
of 22 million, 145,000 deaths, 78,000 of those deaths are actually in hospital. Now to be
an organ donor you have to be recognised as a potential donor and you have to be confirmed
brain dead or you have to be confirmed cardiac death. And so you also need to meet some criteria
that make you be medically suitable or not. And so of that 78,000 that die in hospital
only 790 people qualify to be a potential donor. So that's 1%. So you can see the pool
of potential donors has diminished. When we actually get to the number of donors it then
drops again. Last year there were 309 organ donors out of 790 potentials and we'll be going
into the reasons for why we get that drop off, why there is that attrition between the 790
and the 309. And then from the donors we move to the transplant recipients. We usually see
about four organs per donor and last year there were 916 recipients of organs. So that's
the bigger picture. So just to reiterate only 1% of deaths in hospital give rise to potential
donors. In 2010 there were 790 potential donors. If we just go back to the step potential donors
to actual donors, so potential donors to actual donors, we can break that down further. Out
of those potentials there were 664 requests to families for confirmation of organ donation.
There were 379 consents, so we've dropped from 664 requests to families to 379 consents
and ultimately again there's another drop and there were 309 donors. If we go then again
to the final step I mentioned transplant recipients. There were 931 recipients of 978 organs across
Australia last year. So we're now going to move to the actual case study. The case study
we'll be using tonight concerns a 40 year old male who had complained of a headache.
It increased in severity over the day. That evening the man became unconscious at home
witnessed by his wife. An ambulance was called and he was taken to hospital where his conscious
state deteriorated further and he required mechanical ventilation. A CAT scan of his
head showed a large area of bleeding between the brain and the thin tissues that cover
the brain. There is extensive swelling in the brain. Due to the extent of the bleed
neurosurgical intervention was not a treatment option. After the CAT scan the patient was
transferred from the emergency department to intensive care for ongoing medical management.
The senior intensive care consultant caring for the patient had several meetings with
the family to discuss the poor outlook related to the severity of the swelling of the brain
that had occurred following the bleed. Due to the severity of the bleed and poor prognosis
the family themselves raised the option of organ donation with medical and nursing staff.
This discussion was deferred because the patient was still being actively managed. His neurological
condition continued to deteriorate and brain death was confirmed 24 hours after admission.
After confirmation of brain death the fact of death was conveyed to the family and support
provided. When the family clearly understood that their loved one was dead the ICU consultant
spoke with the family about the possibility of organ donation that the family themselves
had raised earlier. So we've got the 40 year old male, headache of increasing severity,
unconscious, taken to hospital by ambulance, extensive bleeding, neurosurgical intervention
not an option, transferred to the intensive care, diagnosis of brain death, family discussion
around the possibility of organ donation. At this stage I'd like to now open this up
to the panel and I'd like to firstly ask Stuart what actually is brain death.
Thanks Sally. Easy one to start off with. I'll take that. I think probably the best
place to start is with the legal definition of death and as Sally said there's two ways
you can die but a brain death definition is the irreversible cessation of all function
of the brain of the person. So there's two things there. There's the irreversibility,
the permanency of death and the loss of all function of the brain of the person. So they
also described in the legislation what they meant by all function of brain of the person
and what they said was that that person would never again experience consciousness, emotions,
knowledge, thought, feeling, sensation, speech and hearing. So what we have to understand
is that these individuals are not severely brain damaged but still alive like patients
in vegetative states or minimally responsive states. They have absence of all function
of the brain. The second thing that you need to have is permanency or irreversibility and
that ties up more with how brain death evolved which started back in the 1950s really with
the use of mechanical ventilators in intensive care units. Up until that point patients weren't
ventilated so when an individual had a catastrophic brain injury that would have resulted in brain
death they would have immediately stopped breathing, become hypoxic and their heart
would have stopped so there was no requirement for a brain death definition. What the practitioners
found around that time was there was a group of patients that were on mechanical ventilation
who showed no function at all of their brain and they looked at these individuals and what
they noted was there was no recovery from that point. Once there was loss of function
there was no recovery and inevitably these patients progressed to cardiac arrest with
normally within days to weeks and they described these patients as beyond coma and there was
a paper around that time that was published discussing that. We also know from looking
at countries where they haven't adopted the brain death standard until recently and an
example of that is Japan where they have continued to ventilate patients that we would recognise
as brain dead beyond that point and they have also experienced that once they've had an
individual lose all brain function there is no restoration of that function and the inevitability
of progressing to cessation of heartbeat. So those two facts then are tied together
and the other thing to say is that there's never been a documented case in the literature
of any individual meeting the criteria and preconditions of brain death and then having
any recovery of brain function. So Stuart why is it that some people and families struggle
with the concept of brain death in your experience why is that? I think that's the reason for
that is that a brain dead patient looks very similar to a lot of other patients in hospital
it looks the same as somebody about to have surgery they want a mechanical ventilator
their chest will go up and down their heart is still beating they are warm to touch and
they are pink and perfused so to an untrained eye they seem alive but there is absolute
loss a complete loss of all function of the brain and it's really trying to understand
where the essence of life is and as an experiment of the audience I guess is if you could be
part of some sort of Hollywood movie where you could transplant your brain into another
body and leaving your body behind but that body was being maintained on machines. Where
would your life be? Would you be alive again in that brain with that new body or would
your old body be alive? We know that life is indivisible or advanced life is indivisible
and I think what we find what we feel is that the essence of life is within the brain and
that's where we are. The second thing is that people say well how can you have a dead brain
but a body that's functioning because the organs still function obviously they go on
to be organ donors so the heart is still working the liver is still working they are still absorbing
nutrients despite the brain being dead and there are examples in the literature of women
who have carried babies when their brain dead carry fetuses to term and deliver it and how
can that happen? I think the answer to that is that cell death has never been a part of
death. We're all going to die and when we die our fingernails, our hair and our skin
will continue to grow for days and weeks after we are clearly dead and buried. It's also
a fact that in research labs around the world there's human cell lines which are traced
back to a lady called Henrietta Lacks who died in 1951 and her cells are continued to
be used all around the world for medical research purposes and those cells divide and they continue
to divide and those cells are being described as immortal and in a way the cells are immortal
they will continue to proliferate but Henrietta died in 1951 so it's separating cell death
and the brain which is the essence of who we are. So Stuart why do we need to diagnose
brain death at all? It's two reasons really and these are reasons which drove it in the
1950s and was that it was the ability to convey certainty to the family, to convey the certainty
that this individual had died and that it wasn't about withdrawing treatment or letting
somebody go, the fact of death that occurred and it was important to get that across to
the family. The second reason is the opportunity for organ donation. The first rule of organ
donation is that to be a category donor you have to be dead, it's called the dead donor
rule. We can't have a system where doctors go around intensive care units looking at
sick patients going, he's looking pretty ropey but good set of kidneys, we can maybe use
them better upstairs for the patient on dialysis or he's had a good innings, we can take that
from him. That cannot happen so the patient has to be dead so that is the reason we need
to diagnose brain death and do it properly. If that's the case there must be some pretty
strict criteria around the diagnosis of brain death, can you talk us through that?
In Australia the peak body which represents intensive care is ANZIC, the Australian New
Zealand Intensive Care Society and they give us a statement which is consistent with the
international guidelines and most countries have similar guidelines. It's a comprehensive
document about 66 pages and it takes the intensivist through how to diagnose brain death in somebody
they suspect that brain death is present. So this is the form that we have to look at,
you can see on the screen, you probably can't read it but the first and probably most important
thing is the intensivist needs to know the cause of the reversible loss of consciousness,
they need to know the cause of brain death and it needs to be something that is consistent
to progression to brain death and it needs to be affecting the whole brain and it cannot
be localised just to the brain stem because the brain stem is the only bit we can examine
clinically. The second thing is there need to be a period of observation and that period
of observation is four hours and that is to prove irreversibility and then we need to
exclude the preconditions. Now the preconditions are essentially things that could possibly
mimic brain death so we need to be sure that they are not present and that would be things
and they're there on the screen so somebody has to be warm because hypothermia can mimic
brain death so the patient has to be up to 35. They need to have adequate blood pressure
systolic above 60, sorry a map above 60 or systolic above 90. You need to exclude sedative
drugs so they can't be on any sedatives. Normal electrolytes, normal neuromuscular function
they can't have been given paralyzing agents if they have reversal agents is needed. You
need to be able to examine the patient and you need to examine the cranial nerves which
is what we're going to talk about shortly and then you need to perform an apnea test
and that's the test to prove that there is no breathing. The patient cannot breathe by
themselves. So after we've excluded those preconditions we then go on to perform the
clinical examination and the clinical examination is listed there where we go through. The patient
is unresponsive, there's no response to pain and there's no papillary response, no corneal
response, no gag, no cough, no vestibular ocula and the patient's apnea because they're
not breathing and we're going to go through each of one of these with a video so that's
why I've sort of rushed through them. So the first one is that there's no response to pain.
So this is a reaction. So this is a girl who's getting pressure over a super orbital nerve
which is very painful and stimulating and then she reacts to that and that would exclude
the diagnosis of brain death. In a brain dead patient there will be no facial movement,
there will be no cognition of the pain. We also do that in all four limbs to check that
there is no facial grimacing or movement of the limbs and that confirms the patient is
in coma, unresponsive coma at that point. The next test is we start examining the cranial
nerves. This is the pupillary response to light which tests the second and third cranial
nerves. So light is shining in the eye. The one on the left there shows no response and
the one on the right shows the constriction with the light. These pupils need to be at
least four millimeters so they need to be fixed and dilated. The next one is the corneal
effects or the blink reflex. Quite a stimulating test. This stimulates the fifth and seventh
cranial nerves and as you can see there in a brain dead patient there is no blink response
but in a patient who has got cranial nerve activity they blink. Then we go on to the
gag reflex which tests the ninth and tenth cranial nerves. It's done a little bit different
in clinical practice. We wouldn't have the tracheostomy, the patient would be intubated
and we often use a lingerscope but it's a touch to the posterior pharyngeal wall and
to see if they gag as she does there. So these would all exclude the diagnosis of brain death.
And then the cough reflex. We stimulate the corneal with a cuff and as you can see there
that's a very stimulating test and everyone would cough even if they're in a fairly deep
coma but if you're brain dead there will be no cough to that. The final test is the vestibular
reflex. That tests the vagus, the tenth cranial nerve. The vestibular reflex is 50 mills
of cold water, ice cold water into your inner ear and that causes circulation within your
semicircular canals and then that will cause your eyes to move in an astagma sort of way
if you're not brain dead as in there is cranial nerve activity. That tests the third, fourth,
and eighth cranial nerves. So they're all the cranial nerves that we can test. If there
is absent response to all of those then we proceed on to the apnea test which we don't
have a, we'll leave that on there. We don't have an example of the apnea test. The apnea
test is to prove that there's absence of breathing. So what we do is we pre-oxonate
the patient and then disconnect them for the ventilator, exposing their abdomen and chest
looking for any respiratory movement and then wait for their carbon dioxide level to rise
to a CO2 of 60 or a pH of 11.7.3 which is a maximal respiratory stimulus looking for
any respiratory effort. Normally it takes about five to ten minutes for that to occur
so they're apnea for five to ten minutes. If there's any desaturation we put them back
on the ventilator. Once all of those tests have been completed and confirmed that there
is no breathing and no response to any of those having met the preconditions and that
doctor will then sign the form and say in my view this person has satisfied conditions
of brain death. So just to recap when is the actual death, when is the time of death once
you've been through all of those tests? It's, the legislation for good reasons has a second
doctor perform a repeat examination so a second doctor performs exactly the same tests and
the legal time of death is when the second doctor has completed those tests. So that
will be when determination of death has occurred. We recognise that death has occurred in the
preceding hours but actual determination of death is the time of that second set of tests
so there's two doctors doing an identical exam. Okay and I mean those tests look like
they could be fairly confronting for a family, a family prison when this happens? You know
my practice is I do offer it to the family for the second set of tests. Anecdotally
a lot of families it adds reality to the concept of brain death particularly when they see
their loved one not breathing and I think then they find acceptance of brain death
slightly easier. If they don't want to come obviously we wouldn't push that but I do have
it as an offer. And does this take a long time all of this? I mean what's the sort of
time period of this observation and testing? The testing itself is fairly, fairly rapid
it can be done in sort of five to ten minutes but there is a four hour period of observation
at the start where we need to confirm that this is a continuous period of apnea and fixed
dilated pupils. So that four hour period starts from when the nurse would say to us well the
pupils are now fixed and dilated, the patient has stopped breathing and they have stopped
coughing and at that point we would say well they have likely progressed to brain death
because we know what the initial diagnosis was. That's changed slightly if the insult
was a hypoxic ischemic injury, that's an injury where there's lack of oxygen to the brain,
we extend that period 24 hours. Of observation? Of observation, yeah. Only because there has
been some dubious case reports of a return and function within a short time period. So
these guidelines have erred on the side of safety. So it's quite a long period, we're
looking at four hours, five, six, up to 24 hours sometimes. And what happens next? Once
you've got through that period of testing, what happens next? Once that patient's been
diagnosed as brain dead then the priority then is really to explain that fact to the
family and to look after that family and what is clearly an emotive and difficult time
for them. So our role then sort of goes into explaining the fact of death and making sure
they understand that fact of death because it's important particularly as the patient
still looks pink, warm, perfused and chest going up and down. And when we were talking
earlier we saw that distinguishing a patient to be a medically suitable patient is very
important. At what stage do you come to the decision or the discussion around medical
suitability, i.e. is this patient a possible organ donor? I think that's something that
the intensivist will be aware of. We never look at a patient with a severe bone injury
in their eyes as a potential donor. We're clearly always acting in their best interest
to try and reverse this terrible pathology. But you know, in all patients who come to
intensive care there is a high risk of them dying and if they're dying with a catastrophic
bone injury then there is a possibility for them to be an organ donor. So we would raise
the option of organ donation with the family once they've understood the fact of death
which can be a decoupled conversation. But often as in this example families now often
understand the option of donation prior to that and they will approach us about it.
What about the Australian organ donor register that we've got up here? How does that play
into this situation? Yeah, that's the AODR there on the screen. That's an intent register
which variably we can offer to use and look on. It will always be accessed in a patient
who has been certified brain dead. We will, as an intensivist, I will discuss with the
family after explaining that they have died that there is an option to be an organ donor
and then we will say somebody will be accessing the register to see if they offered an intent.
Generally the family would know the wishes of the loved one and the main use that I see
for the register is that when the family are uncertain about what the wishes would be we
can then say to them well if you're unsure what we can do is check the register. But
often they will know and they will come to us and say look he's always wanting to be
an organ donor. So it is a useful device in some circumstances. And do families know that
their loved one might be on the register, some of them? That's part of the campaign.
Obviously the Donate Life are running is that people communicate that wish and that the
final decision will be a question to the family. And we do encourage that they discuss that
they have been registered on the register. But some may not and if they do then obviously
that's information that they can use to make that final decision. And just stepping back
a step. I note you used the term mechanical ventilation in the newspaper today I see life
support. Perhaps Steve you could tell us about those terms and why there's some confusion
or there are two terms for one thing? Thanks Ali. There are a number of terms that we know
exist in the community in relation to organ donation and certainly within intensive care.
One of them I should say is life support. We see that sort of bandied about in the press
quite freely. That's a term we try to discourage within the organ donation sector because as
Stuart was talking about before often it's a hard concept for families to grasp that their
loved one is brain dead when they're actually pink and warm and their chest is moving up
and down. So we see that as really an ambiguous statement by suggesting that it's life support
because that sort of points to the fact that they may not be dead if we're actually supporting
their life. So we invariably use the term mechanical ventilation. There's a whole host
of different terms that come up that we try to discourage as well. One of them is organ
harvest which you often see in the press. And we try to use the term such as organ retrieval
and procurement. And one of the other terms that we try and discourage are terms such
as passed away because we really want to try and reinforce to the person that their loved
one has in fact died. And then given the, with some people with difficulty with them
grasping this concept, terms such as passed away really have a negative impact on them.
And your role as an organ donor coordinator, you'd have to be careful about these terms
and explain them to families and those sorts of things. But can you tell me as an organ
donor coordinator what actually, when do you get involved?
Well student through the process that he's involved in before and the intensivist spend
a considerable amount of time with families trying to get them to a point where they're
more accepting of the fact that their family member has in fact died. Once he's, well Stuart,
one of his colleagues have discussed the whole issue of organ donation and it's something
that the family want to explore further or are keen to progress. Then the intensivist
within the hospital normally call our agency. Just to put that in a bit of context, our
agency has probably about 6.5 FTEs of organ donor coordinators in this state. And we service
the five main large hospitals within Adelaide. There's two of us on call 24 hours a day,
every day of the year. So there's always somebody at the end of the phone of Intensive
King and it's one to actually contact us for the purpose of organ donation or just to get
some advice. So generally that's the point we'll be calling to talk to the family and
take the process from there.
And then you get called in. Could you explain to us what the actual role of the coordinator
is and how it all gets pulled together?
Sure. This diagram here really encapsulates the whole process. I'm just going to briefly
talk through this. If you look in the middle of this diagram, it's central to the whole
process as the actual donor themselves. There's a whole lot of logistical legal issues that
we have to look at, clinical issues. And we're really seeing the nexus between the donor
and these other parts of the process. So initially when we're called in, the first
point of call will be to talk to the Intensivist and to the Bedside Nurse to get a picture
of the patient's progress to date, their family situation and a whole lot of other issues.
As you can imagine, this is a fairly complex logistical issue that can take a fairly long
period of time. In fact, we know that a multi-organ donation in South Australia on average can
take up to about 19 and a half hours. So once we've talked to the Intensivist and the Nurse,
we'll then talk to the family and look at their needs and where they want to go and
what sort of information they require. First and foremost is that from our perspective as
all the donor coordinators, our process with them is extremely transparent and at all times
we've got full disclosure of information. And that's very important that we don't go
down the track at some later point. The family says, well, you didn't explain to me that
it's going to take so long and it's just getting emotionally too much and we don't want to
go on. So we find that it's a lot better for the families involved. It's a lot better
for the clinicians if we paint an accurate picture and have full disclosure from the
start. If the family do want to progress, we get a formal authority for them to proceed
and we talk about a whole lot of different issues and that could be which organs they're
willing to consent for their family member to donate. We can look at a whole lot of other
issues whether they want to viewing after the retrieval surgery. We talked to them about
follow-up and support because we provide written follow-up in six weeks. We also provide counselling
services and often we keep in touch with families over a longer period of time. There's a whole
lot of other issues like virology and serology because we want to make sure there's a lot
of transmissible diseases that donors don't have and we do this with everyone. We also
take bloods for tissue typing and that's really a diagnostic blood test to ensure that a donor
is compatible with a recipient. We look at all the clinical data and we actually liaise
with the transplant units and discuss this clinical data with them. We arrange which
organs are going to go where and it's based on a rotational basis and the kidneys and
liver will generally go to the clinics here in Adelaide. The thoracic organs will be exported
into state because we don't have a thoracic clinic here. There's also a legal aspect
with this. We have to ensure that we've got consent from the family or authority and if
it's a coroner's case that we liaise with the coroner and make sure that we've got
the OK to go ahead and we also, the final person to sign off on all this is the designated
officer of the hospital and they're really someone who's there to ensure that procedural
correctness has been followed and they seek a lot of information of the process from us
and once they're satisfied that everything has been completed to their level satisfaction
they'll give us a go ahead and we take it from there.
So it's a real matrix isn't it in terms of getting all of those things done in the most
timely way?
It certainly is. I mean I sort of look at it. When I show you this diagram it's not
really necessarily done in that chronology either because sometimes you have to keep
going back and forward. I sort of liken it to the man that spins the plates. You're always
just sort of going back to the beginning and continuing to keep those spinning. So it can
be a quite a complex task especially if you've got different clinics from interstate and
you're dealing with not only here but the interstate.
So it's really a complex procedure in terms of getting it all right. Just before we go
on Stuart I'd like to just question about what really determines the suitability for
organ donation. I know we've touched on it before but...
Actually the place and how you die, the majority of organ donors in Australia have to die of
brain death which as we've already shown is a rare event in hospitals. But in terms of
absolute exclusion criteria the four main ones are generally aged less than 80. Metastatic
malignancy obviously there's a risk of transmission of cancer so that's an exclusion. HIV and
any blood-borne diseases. Apart from that the decision about whether the organ is suitable
really comes down to the transplant groups about their need and assessment of the organ
and there's a fair number of relative contraindications depending on the match for the recipient.
And Steve again just stepping back I know in this case study that we're talking about
the process took about 11 hours. How long does it usually take? What's the sort of timeframe
you talk to families about? As I said before the average for a multi-organ donation is
generally about 19 and a half or 20 hours. That may vary if it's only organs are going
to be utilised locally and that may that's dependent on a lot of factors such as age
condition, medical condition etc. So in this situation that we're talking about the process
from talking to the family to actually getting the food it took 11 hours and that's pretty
well in part of this sort of scenario. And Stuart all of this is going on the organ donor
coordinator is moving all this legal and the tissue typing and those sorts of things forward.
The donor is still in intensive care what's actually happening to the donor? At that point
we are still continuing to manage the physiology of that donor. At that point death has been
certified and it's important then to look after the organs so that this person can be
the best organ donor that they can be if that's what they wished. So the medical staff on
the side as well as the nursing staff put a lot of time into optimising the organ function
as best they can by making sure the kidneys are in atropes and that there isn't a failure
of the physiology of the organs which around the time of brain death can be quite complicated
because of the changes of the physiology during brain death. So there's a lot of work going
on behind the scenes with the organ donor coordinator and a lot of work going on still
in the intensive care unit to make sure that you maximise the patient. It's a very busy
time for that patient we always make sure well at the big hospitals a senior nurse goes
to that patient and as the intensive care specialist I always identified the registrar,
the potential issues and what to watch out for. So it is a busy time to make sure that
they can be the best donor that they can be because that was their wish if the worst did
happen which it obviously has. So once we've got to the process where all of that's completed
or the bits that need to happen, how does the actual organ retrieval procedure take
place Steve? Can you just talk us through how that happens?
Well as I mentioned before, so in each hospital we utilise a designated officer who can give
the authorises a removal of organs for transplantation. It's important to realise this person is independent
of any of the clinics involved and often it may be depending on which hospital it is,
medical administrator or in some hospitals it may be an intensive care specialist. So
they're a very group but the important thing is that they're independent of the whole process.
During that time as Stuart said the donor is being maintained within ICU and once we've
arranged all the logistics in terms of the clinics that are actually going to carry
out the retrieval surgery, a time is arranged in the theatre and we take it from there.
Then it's transferred from intensive care to theatre for the procurement surgery.
And this means arranging times that suit interstate teams. You said before that the heart and
lung teams come from interstate. Anybody else come from interstate?
As I said, generally the kidneys and liver will be utilised in this state but that's
not to say that other states, if it's a better match or for any number of other reasons, may
not occasionally come here to retrieve those organs. But generally it's only the heart
and lung team that come from interstate.
And Steve, I think out of this case study there is a number of organs that actually went
to recipients. Can you just talk us through where they went and what the outcomes were?
We will if you see here in the screen, one thing I just want to point out is that normally
we on average will take about four to six hours for the fetal process depending on which
organ is it used. In this case it took ten and a half hours. The reason being there that
if we go through the number of people that received organs, the heart went to a 38-year-old
male, the lungs to a 52-year-old male. And you'll see here that the left lobe of the
liver went to an 8-year-old female. I shouldn't say often but what can happen occasionally
is that the liver will be divided in two and the smaller left lobe will be used for a child
with the right lobe being used for an adult. And that's what's happened here. If you look
at the fourth dock point, the left kidney and the right lobe of the liver went to a
50-year-old male with both renal and liver failure. And the right kidney to a 62-year-old
male with renal failure. And the pancreas ended up being used for research. It had been earmarked
for eyelid cell transplantation. The eyelid cells are cells within the pancreas that produce
insulin. And they can be used to be transplanted into brittle diabetics with the hope of getting
them off insulin. But as we know from experience, quite a number of those donations of the pancreas
doesn't have enough cells to facilitate that and often that's used for research. But that
is with the consent of the donor family involved.
So this donation was life-saving to five people. And assisted in research for the final eyelid
cells.
Correct.
Okay. Thank you. Well, I think there's been a lot of information that you've just heard
and we've worked through there. We're just going to move to the next phase. So thank
you, Steve.
Thanks, Stuart.
Thank you.
Thank you.
