Clinical Guidelines (Nursing)

Tissue Donation

  • Introduction

    Aim

    Definition of Terms

    Assessment

    Referral Process

    Standard Tissue Donation and Age Criteria

    Links

    References

    Evidence Table


    Introduction

    This guideline has been developed to provide staff with an overview of the tissue donation process. Many of the patients at RCH who are palliated on the wards or at home may be suitable for tissue donation. Ashkenazi and Cohen (2015) found that tissue donation was linked to a positive experience, as well as reducing the family’s grief and improving personal growth. Offering tissue donation to families of patients who will die is an important part of end of life care. Tissue donation has shown to be important to families who believe that donation honors the legacy of their loved one and believing that something good came from the death (Hogan et al, 2013). This guideline has been developed to provide staff with an overview of the tissue donation process.


    Aim

    • To provide an overview of the tissue donation process
    • To provide the contact details for people who can organize/facilitate tissue donation


    It is important to note that while information will be provided in this guideline for medical suitability to donate tissues, medical suitability should ultimately be decided by the Tissue Bank staff.


    Definition of Terms 

    Tissue donation: the donation of tissues such as eyes, heart valves, skin, bone and tendons for the purpose of transplantation into others. These can be retrieved within 24 hours of death. 

    Organ donation: the donation of whole organs such as heart, lungs, liver, kidneys, pancreas and intestines for the purpose of transplantation into others. Organs can only be donated by people who die in an intensive care unit on a ventilator.


    Assessment


    If organ or tissue donation is raised by a family:

    1. Acknowledge the request and show willingness to explore feasibilit
    2. Contact the RCH Organ and Tissue Donation Specialists (see contact details below), or a direct referral can be made to the Tissue Bank Victoria and/or Lion’s Eye Bank.


    The major barriers to tissue donation are:

    1. Age and size limitations (see below)
    2. Disease specific limitations
    3. Timing  (needs to occur within 24 hours of death)


    Referral Process

    To refer a patient for tissue donation, please call the Tissue Bank on (03) 9684 4444 (If no answer, please leave a message and phone back if there has not been a response within 30 minutes). For eye only donations, please phone Lion’s Eye Donation on (03) 9929 8708. For support in regards to tissue donation, please contact RCH Medical Donation Specialist Dr Ben Gelbart through switch, or  RCH Organ and Tissue Donor Coordinator Samantha Murphy on (03) 9345 6703 or 0452 223 768.

    For tissue donation to occur, the patient must be transferred to the Tissue Bank at the Coroner’s Court (65 Kavanagh Street, Southbank 3006). Transfer of the patient to the Tissue Bank will be arranged between the Tissue Bank and the funeral director. In some cases, the Tissue Bank may require a full autopsy to be performed, for example for bone donations. This allows for testing of “silent diseases” that may compromise a recipient. The Tissue Bank will explain this to families during the consent process. However, if such questions are raised by family members, it is recommended that the ANUM or medical staff are involved to facilitate conversations and communication between the family and the Tissue Bank.

    When referring a patient, the Tissue Bank will want to know:

    1. Patient’s intravenous fluid administration in the last 48 hours.
    2. Travel history is also important, particularly to areas affected by malaria. 
    3. Any history of cancers, sepsis and transmissible diseases (HIV etc)


    Please be aware that this information is important in determining medical suitability to donate.


    Standard Tissue Donation and Age Criteria

    Cardiovascular tissue 

    • Standard donation: Aortic valve, pulmonary valve and pericardium
    • Age: From 3 months of age (no weight criteria as long as babies were born at full term with no growth restrictions in utero).


    Skin

    • Standard donation: Superficial layer of skin from upper back, flanks, posterior upper/lower legs and anterior upper leg
    • Age: no specific age limit but depends on size. Very small body surface areas and bony prominences may be excluded.


    Bone

    • Standard donation: Femur, tibia, iliac crest and humerus
    • Age: From 18 years
       

    Tendon

    • Standard donation: Achilles, tibialis (anterior) and patella
    • Age: From 18 years 
       

    Eyes

    • Corneas- will consider donations from children between 2-6 years. Children older than 6 years of age are eligible for eye donation. Confirm with Lions Eye Institute
    • Sclera and eye research- May accept any age. Confirm with Lions Eye Institute


    Links


    References

    • Tissue Bank Victoria 2015. Available from <https://www.dbtv.org.au/>
    • Lions Eye Institute. 2015. Available from https://www.lei.org.au/
    • DonateLife. 2015. Available from http://www.donatelife.gov.au/sites/default/files/E%26T%20facts_08102014_web.pdf
    • Vorstius Kruijff, P. E., Jansen, N. E., Muitjens, B. S., M., Blok-singerling, J., Tecklenburg, B. D., . . . Slappendel, R. (2014). Are all tissue donors recognised? A cohort study in three dutch hospitals. Cell and Tissue
    • Banking, 15(3), 483-90. doi:http://dx.doi.org/10.1007/s10561-013-9418-5
    • Caramiciu, J.A., Adams, J.P., McKown, B.T., French, C.D., Ruggieri, E.R., & Heard, S.O. (2014). ‘Effects of an in-house coordinator and practitioner referral rather than proxy referral on tissue donation rates’, Transplantation Proceedings, 46, 5, pp. 1274-1280
    • Hogan, Nancy S,R.N., PhD., Coolican, Maggie, RN,M.S., F.T. & Schmidt, Lee A,R.N., PhD. 2013, "Making meaning in the legacy of tissue donation for donor families", Progress in Transplantation, vol. 23, no. 2, pp. 180-
    • Ashkenazi, T, & Cohen, J. 2015. ‘Interactions between health care personnel and parents approach to organ and/or tissue donation: influences on parents’ adjustment to loss, Progress in Transplantation, 25, 2, pp. 124-13
    • Hermann, K.C., Pagnussato, F., Franke, C.A., & de Oliveira, M.L.B. (2014). ‘Reason for family refusal of ocular tissue donation’, Transplantation Proceedings, 46, 6, pp. 1669-167
    • Luo, J., Rothnie, A., Sanderson, E., Smith, Melissa, RN,B.NsgSc, GradDipC.C., Cowie, A., R.N., & Musiello, Toni,M.S.C., D.Phil. (2013). Families' knowledge, attitudes, and experiences of the tissue donation process. Progress in Transplantation, 23(3), 265-71. Retrieved from http://search.proquest.com/docview/1561057241?accountid=48400


    Evidence Table 

    You can find the evidence table for this guideline here


    Please remember to read the disclaimer


    The development of this nursing guideline was coordinated by Samantha Murphy, Nurse Coordinator Organ & Tissue Donation, Rosella Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated March 2016.