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Organ donation for transplantation
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Introduction
This pathway covers the improvement of donor identification and consent rates for deceased organ donation.
A significant proportion of people in England and Wales would wish to donate their organs after death for the purpose of transplantation. This guideline recognises the complexities that arise owing to the majority of potential organ donors lacking the capacity to be directly involved in decision making at the time of their death. It seeks to promote the identification and fulfilment of these wishes through:
- more effective identification and referral of potential organ donors
- a more informed, considered and timely approach to consent for donation which is based primarily on identifying the wishes of the individual whenever known and however recorded.
Source guidance
The NICE guidance that was used to create the pathway.
Organ donation. NICE clinical guideline 135 (2011)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
8 February 2013 Minor maintenance updates
17 April 2012 Clinical case scenarios and educational resource added.
Supporting information
Glossary
A set of instructions given in advance by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. It does not always have to be written down, although most are.
Death diagnosed after irreversible cessation of brainstem function and confirmed using neurological criteria. The diagnosis of death is made while the body of the person is attached to an artificial ventilator and the heart is still beating.
Death diagnosed and confirmed following cardiorespiratory arrest.
A set of clinical criteria used to indicate a high probability of death, which is used to define a standard point in care when the hospital is expected to initiate referral.
Family, friends, partners and anyone who knows the patient who can be, but is not necessarily, in a qualifying relationship.
A Lasting Power of Attorney (LPA) is a legal document that enables a person who has capacity and is over 18 to choose another person or people (attorney[s]) to make decisions on their behalf. A health and welfare LPA is for decisions about both health and personal welfare, such as where to live, day-to-day care or having medical treatment.
Multidisciplinary team
A nominated representative is a person appointed by the patient to represent the patient after their death in relation to consent for organ donation. The appointment may have been made orally or in writing.
The following are qualifying relationships for the purposes of the Human Tissue Act 2004. Consent should be obtained from the available person ranked highest in the following list:
- spouse or partner (including civil or same sex partner)
- parent or child (in this context a 'child' can be any age)
- brother or sister
- grandparent or grandchild
- niece or nephew
- stepfather or stepmother
- half-brother or half-sister
- friend of long standing.
A healthcare professional with specific expertise in the promotion and facilitation of the entire donation process through working with all staff in critical care areas to support and maximise organ/tissue donation and providing support and information to families of potential donors.
Organ donation for transplantation
Organ donation for transplantation
Early identification of potential organ donors
View the 'Organ donation for transplantation: early identification of potential organ donors' pathPatients who have capacity
Patients who have capacity
Patients who have capacity
Where a patient has the capacity to make their own decisions, obtain their views on, and consent to, organ donationIf the potential donor is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children..
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeAssessing the patient's best interests
Assessing the patient's best interests
Assessing the patient's best interests
If a patient lacks capacity to make decisions about their end-of life-care, seek to establish whether taking steps, before death, to facilitate organ donation would be in the best interests of the patient.
Consider:
- the patient's known wishes and feelings (in particular any advance statement or registration on the NHS organ donor registerSee the NHS Blood and Transplant organ donation website. and views expressed to those close to the patient)
- the beliefs or values that would be likely to influence the patient's decision
- any other factors they would be likely to consider
- the views of the patient's family, friends and anyone involved in their care as to what would be in the patient's best interests
- anyone named by the patient to be consulted about such decisions.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeSeeking consent to organ donation
Seeking consent to organ donation
Seeking consent to organ donation
If a patient lacks the capacity to consent to organ donation seek to establish the patient's prior consent by:
- referring to an advance statement if available
- establishing whether the patient has registered and recorded their consent to donate on the NHS organ donor registerSee the NHS Blood and Transplant organ donation website. and
- exploring with those close to the patient whether the patient had expressed any views about organ donation.
If the patient's prior consent has not already been ascertained, and in the absence of a person or persons having been appointed as nominated representative(s), consent for organ donation should be sought from those in a qualifying relationship with the patient. Where a nominated representative has been appointed and the person had not already made a decision about donation prior to their death, then consent should be sought after death from the said nominated representative(s).
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeDiscussions with those close to the patient
View the 'Organ donation for transplantation: discussions with those close to the patient' pathOrganisation and policy
View the 'Organ donation for transplantation: organisation and policy' pathPaths in this pathway
- Organ donation for transplantation: early identification of potential organ donors
- Organ donation for transplantation: discussions with those close to the patient
- Organ donation for transplantation: organisation and policy
Pathway created: February 2012 Last updated: February 2013
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