Medical tests and procedures
Routine medical tests and procedures will be carried out shortly before or after the death of a donor to ensure that transplantation is likely to be safe, successful and a suitable match for somebody on the transplant waiting list.
The tests and procedures
The following tests and procedures are carried out in a hospital intensive care unit, by highly skilled health professionals in NHS Scotland with the greatest care and respect, as is the case for any medical procedure.
These tests and procedures, and the information they provide for diagnostic purposes, have been carried out in the UK to facilitate donation and transplantation since 2003. Without these taking place, donation won’t be able to proceed.
This means that:
- If a person registers to be a donor, they will be authorising these procedures to be carried out
- If a person hasn’t registered an opt out decision and are deemed to have authorised donation, it will be assumed that the person is willing for these routine procedures and tests to be carried out
Specialist nurses will always speak to family and friends to check that a person who may become a donor would not have been unwilling for these procedures and tests to happen.
Taking of samples such as:
- Blood, urine and chest secretion samples
- Swabbing or scraping of the skin
These procedures are carried out to provide health professionals with diagnostic information relating to the presence of infection or disease that might prevent transplantation taking place.
Radiological imaging such as:
- Ultrasound monitoring and transthoracic echocardiography
These procedures are carried out to provide health professionals with diagnostic information for wider assessment and informs clinicians about organ functionality. For example, a transthoracic echocardiography is a form of ultrasound imaging on the chest, to check on the condition and functioning of the heart.
All forms of imaging listed here will be completed by health professionals at the bedside.
Cardiovascular monitoring including:
- Electrocardiogram
- Cardiac output monitoring by way of an arterial line
- Central venous pressure monitoring
- Arterial blood pressure monitoring
These procedures allow clinicians to monitor the general condition of a patient, and inform their ongoing assessment of a patient’s condition and response to care.
Respiratory monitoring and support including:
- Measuring of oxygen saturation and sustaining the operation of pre-established airway and ventilatory support
These procedures permit health professionals to continue to deliver the appropriate respiratory care and obtain information on the ongoing condition of their patient. All people who may become donors will be critically ill and close to death. They will be connected to a ventilator which will be supporting their breathing.
Administration of medication such as administration of:
- Antimicrobials
- Intravenous fluids
- Medication to manage blood pressure
- Blood, blood components and blood products
Carrying out these procedures allow health professionals to manage their patient’s condition to, for example, treat infection.
On very rare occasions there may be a need to carry out further, more invasive medical tests and procedures, but only if the routine medical tests and procedures would not give enough information for a safe and successful transplant.
However, it won’t be assumed that you agree to these procedures, which means they will only go ahead with your family’s agreement.
Samples would be used to investigate the presence of malignant cells or infection in a potential donor. A swab (much like a cotton bud) would be rubbed over the area to be sampled or an instrument specifically designed for this purpose would be used to scrape off cells or layers of skin to later be analysed in a laboratory.
These procedures are carried out to provide diagnostic information to clinicians about organ functionality. They include a Magnetic Resonance Imaging (MRI) or Computerised Tomography (CT) scan, ultrasound, xray or transthoracic echocardiography.
A small skin biopsy would be carried out to assess whether cancerous cells are present, for example within a skin lesion.
As part of routine care of a patient in an intensive care unit, they would already have a breathing tube inserted into their windpipe to facilitate ventilation. During a bronchoscopy, a fine camera (bronchoscope) is passed down this breathing tube to allow visual inspection of the lungs. If secretions are present, these are removed via the bronchoscope. The samples would be sent to a laboratory for analysis to look for infection or malignancy.