Corpses are not warm, they are not pink, they do not move, they are not pregnant – but a person who is brain dead can be all of these things. To all appearances, there is little difference between a person who is brain dead and a person who is asleep. At the same time we ask people if it is OK to remove a beating heart or other living organ from their loved one. (Kellhear 2007)

Taking part in an organ retrieval procedure will involve liaising closely with donor transplant coordinators. Part of the role of the transplant coordinator is to ensure that the best possible management of the donor and their family is provided throughout the donation process. A collaborative approach between the coordinator, critical care staff and perioperative staff is required once the diagnosis of brainstem death has been ­confirmed. The Coroner is consulted and permission from the Coroner gained before the retrieval process begins.

A crucial point that may sometimes be overlooked by staff new to perioperative practice is that the donor patient will have been diagnosed as brain dead before arrival in the perioperative suite. The time of death will have been recorded as whenever the first brainstem diagnosis was carried out.

This may be difficult to come to terms with as often the patients are transferred from critical care units in a ‘warm, pink and well perfused state, in sinus rhythm ­without any visible marks or trauma’. The use of a neuromuscular blocking agent is sometimes used to prevent spinal reflexes from occurring intraoperatively, but their use does not constitute a part of an anaesthetic. To put it bluntly, patients who are brainstem dead do not require an anaesthetic. The role of the perioperative team in this instance then is to help provide support for the organs while maintaining the dignity of the donor.

Restrictions to the organ retrieval may be imposed by the Coroner, such as insisting that a police officer and/or police photographer (taking detailed photos) is present ­during the organ retrieval.

In all Coroner’s cases the lead surgeon should make detailed notes as he or she may be summoned to court at a much later date. Good practice dictates that all ­perioperative practitioners will also need to be scrupulous with their record-keeping and ­documentation (Medical Protection Society 2005).

Death of a Child

If intraoperative death of a child looks likely to happen, then parents of a Christian faith may ask for an emergency baptism to be carried out while the child is still alive. Ideally this service should be completed by the hospital chaplain. If the child looks likely to die before the attendance of a chaplain then a member of staff (preferably, but not exclusively Christian) can complete an emergency baptism. It is inappropriate to baptise a child after it is dead but baptism during resuscitation can help to provide pastoral support to family members.

If the child dies in the perioperative area then the ward and Coroner need to be informed as soon as possible. The child’s body should then be transferred to an ­appropriate area following discussions with the Coroner. The child’s death must be recorded in the appropriate system.

If a newborn baby dies before being registered at birth then both birth and death can be registered at the same time.

Stay updated, free articles. Join our Telegram channel

Join