e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Elective ICU admissions for organ donation in patients with terminal brain cancer: two cases illustrating barriers and facilitators (#362)

Shohei Waller 1 , Sue-Anne McLachlan 1 , Yvette O'Brien 1 , Jo-An Seah 1 , Anthony J Dowling 1
  1. St.Vincent's Hospital Melbourne, Fitzroy, VICTORIA, Australia


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.


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.


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.



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


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.






  1. [1] The Transplantation Society of Australia and New Zealand. (2020) Clinical Guidelines for Organ Transplantation from Deceased Donors. Version 1.4, p33-36
  2. [2] Australia and New Zealand Organ Donation Registry. (2020) Annual Reports. Viewed 14th August 2020.
  3. [3] Cancer Australia. (2020) Brain Cancer in Australia Statistics. Viewed 14th August 2020.