Policy responses and statements

Name of organisation:

Royal College of Anaesthetists

Name of policy document:

(1) Code of Practice for the Diagnosis and Certification of Death; and
(2) Guidelines for the Management of Potential Organ and Tissue Donors

Deadline for response:

18 August 2006

Background: The Academy of Medical Royal Colleges and the Department of Health have requested a revision of the 1998 document “Code of Practice for the Diagnosis of Brain Stem Death”. This resulting Revised Code of Practice has been prepared by a Working Party established through the Royal College of Anaesthetists on behalf of the Academy of Medical Royal Colleges and the English Department of Health. This code of practice is designed to address the diagnosis and certification of death in all situations and to make practical recommendations which are acceptable both to the relatives of the deceased, to society in general and also to the medical, nursing and other professional staff involved. In two distinct sections, it seeks to separate the diagnosis of death from any subsequent events, allowing patients in whatever situation to be diagnosed and treated appropriately. Responding to a number of requests, the working party has gone into considerably greater detail than the previous guidelines in some areas, particularly in stating relevant biochemical values and other data. In addition, it is intended that Sections 1 and 2 will be used together with the Intensive Care Society’s guidelines, providing a linked “portfolio” of documents to address all situations.

COMMENTS ON
ROYAL COLLEGE OF ANAESTHETISTS  CODE OF PRACTICE FOR THE DIAGNOSIS AND CERTIFICATION OF DEATH
& 
GUIDELINES FOR THE MANAGEMENT OF POTENTIAL ORGAN AND TISSUE DONORS

The Royal College of Physicians of Edinburgh is pleased to respond to the Royal College of Anaesthetists on its request for comments on these two documents.  This is a collated response following consultation with some of our Fellows.

The authors are to be congratulated upon clear, concise and well thought out documents which should prove extremely useful as guidelines for the medical professions.  We strongly support the introduction of both documents. 

We have a few minor suggestions that we feel might improve and clarify the guidelines.

1. In Section 1, para 5.2.3, we concur with the reluctance to issue exact levels for biochemical values; whilst there may be some criticism of this we feel that the authors have dealt with this problem pragmatically because there are no evidence-based guidelines to provide exact figures.  We wonder if the term “BM check” (pages 12 and 15) should be replaced as this refers to a specific manufacturer’s measurement which may not be employed in all units. 

2. Appendix 1.  We wonder whether in the check list the heading ‘Metabolic or endocrine disturbances’ might specifically mention some biochemical values such as serum sodium, potassium, glucose, phosphate and magnesium. 

3. Section 2.   Likewise, this was considered an excellent and helpful document and, in particular, we found the flow charts extremely clear which is important as this is likely to be the most used section of the document.  Adaptation from Coroner to Procurator Fiscal will be required for use in Scotland.  The authors might also consider some clarification as to why the absolute contraindications differ between organ donation and tissue donation, particularly as these guidelines will also be used to inform non-medical staff.

4. Section 2, para 10.2.  The last paragraph might be more specific in its recommendation for a collaborative approach between medical, nursing and donor transplant co-ordinators, and this paragraph could perhaps be expanded a little.

5. Section 2, para 10.3.  This section might again have mentioned donor cards since some patients may carry an organ donation card, but may not be registered because they were unaware of this facility. 

We hope you will find our comments useful.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324    ext 608
Fax: 0131 220 3939

[17 August 2006]