[MUSIC] Medical assessment of a donor assesses the risk of organs being donated, allows them to be matched to recipients, and can predict the outcome for potential transplant recipients. Specifically we need to know the infectious risk, the malignancy risk and the function of the individual organs. As well as send off blood specimens for blood group analysis and tissue typing. It is essential that the transplant team is involved in this assessment. In 2015, a United Kingdom review of patients potentially brain dead concluded that only 3% of patients were medically unsuitable for donation. 45% were lost for other reasons. The medical assessment begins with a comprehensive history. This reviews the current admission and also the previous medical history. For example, a history of hypertension and diabetes doesn't exclude organ donation. Such information can be combined with the current clinical situation to allow an accurate assessment of the potential for organ donation. A -0-year-old diabetic, brain dead from a subarachnoid hemorrhage may be able to successfully donate a heart if it can be assessed with echocardiography and a coronary angiogram. Social history is taken regarding alcohol use, drug use and a history of incarceration. Alcohol use is of relevance to liver transportation or the latitude increase the infectious risks related to transportation. All donors are screened with blood tests for infections such as HIV, hepatitis, syphilis, CMV (cytomegalovirus), and EBV (Epstein-Barr virus).� These tests are very sensitive. They can potentially miss an infection which is in the window period, a time when a patient is just pick up an infection and tests are unable to detect it. Depending on the sensitivity of the testing, this window period can be formed a few hours to a few days. We use the most sensitive screening tests available to minimize infectious risks associated with transplantation. A full clinical examination is performed, some clinical parameters may exclude one organ but be irrelevant to the assessment of another. For example, an excessive dose of vasoppressor medication to maintain an adequate blood pressure, may exclude cardiac donation, but would not be of importance for renal transplantation if kidney function is preserved. Similarly, a chest X-ray with features of old tuberculosis or chronic obstructed airways disease, may exclude lung transplantation, but all other organs may well be transplantable. What is important is that each organ be individually assessed. Often, treating clinicians will cite medical reasons for not notifying the transplant team. They may be incorrect in their assessment. The default position should be for treating clinicians to refer all patients at the end of life based on recognized clinical triggers and not be making donor suitability. A combination of clinical parameters, laboratory investigations, and imaging modalities are used to assess each organ. Kidneys are assessed based on urine output, a microscopic analysis of the urine, and blood levels of urea and creatinine. The liver is initially assessed based on the blood results of liver function tests. The heart is routinely assessed by strong combination of cardiac output, the blood pressure, amount of medical support required to maintain the blood pressure, and the presence of ECG changes or chest x-ray changes. Lungs are assessed based on review of ventilator settings, blood gas analysis and the chest X-ray. Other imaging studies such as ultrasound, CT scan, echocardiography and coronary angiograms, can provide additional information when clinically indicated. For all organs, an assessment is also made intraoperatively on macroscopic inspection, and when doubt still exists, a histological evaluation is made of biopsy taken at surgery. Sometimes it is not one single contraindication, but rather a combination of factors that determines if an organ can be transplanted. For example, a 75 year-old, hypertensive, diabetic, on high doses on adrenaline, does not have an absolute contraindication for donation, but together they may combine to preclude heart and kidney donation. It may be possible for organs initially assessed as unsuitable to be transplanted, if their function can be improved doing donor management. Repeat testing is carried out during the course of donor management to ensure that a truly exhaustive analysis of each organ is carried out in order to fully explore the viability of the organ for donation. The final component of the donor workup is an assessment of compatibility. Blood is taken to check the donor's blood group, as well as for tissue typing. Tissue typing bloods have to be sent off to specialized laboratories, and testing can take some time, typically a few hours, to complete. These are usually sent to the laboratory as soon as an initial donor assessment is deemed favourable. To recap, donor assessment includes a thorough history and clinical examination. Screening for transmissible infections and malignancies is done by blood tests and radiological investigations. Organs are assessed on an individual basis by the transplant team to ensure the number of organs donated is maximized. [MUSIC]
