Background:
Active malignancy is generally a contraindication to organ donation. The Transplantation Society of Australia and New Zealand (TSANZ) guidelines stipulate that donors with primary CNS malignancies are eligible.[1] However, since the Australian Organ and Tissue Authority (OTA) was established in 2009, only 26 deceased organ donors had primary brain cancer.[2] This represents 0.2% of patients who died from brain cancer during this time.[3]
Deceased organ donation in patients with terminal brain cancer is a unique situation for transplant protocols, which typically involve patients in ICU with sudden and unexpected events such as trauma.
Aims:
To describe two cases of patients in a tertiary metropolitan hospital with high grade gliomas who successfully donated their organs with an elective ICU admission for organ retrieval. Barriers and facilitators were addressed.
Results:
Two male patients aged 33 and 35 with heavily treated high-grade gliomas were on average 6 years from diagnosis. Extensive discussions about organ donation occurred in the outpatient setting. Both were admitted to the palliative care unit pre-emptively before death to facilitate timely ICU transfer, and both progressed to successful organ retrieval which were able to benefit five and three recipients respectively.
|
Barriers |
Facilitators |
|
Inadequate experience or knowledge by the healthcare staff |
Incorporating discussions about organ donation in to advance care planning |
|
Ethical considerations such as the timing of elective intubation and withdrawal of life-sustaining treatments |
Clear communication with family members during the donation process |
|
Difficulty coupling end-of-life care to organ harvesting |
A multidisciplinary approach with clear communication between treating teams |
Conclusions:
By incorporating discussions about donation in to advance care planning we were able to fulfil these patients’ altruistic wishes to donate their organs. With careful coordination and involvement from a multidisciplinary team involving palliative care, intensive care, oncology and an external organ donation organiser, successful outcomes were achieved.