Referral to specialist nurse in organ donation — FFICM MCQ

Correct answer: C — Refer early to the specialist nurse in organ donation

The correct answer is C, refer early to the specialist nurse in organ donation. Once a decision has been made that further treatment is non-beneficial and death is anticipated, current UK guidance states that the healthcare team caring for the patient should initiate discussions about potential organ donation with the specialist nurse for organ donation at the time the relevant referral criteria are met, before any discussion of consent, withdrawal, or death testing takes place. Early referral allows the specialist nurse to assess donation potential, check the Organ Donor Register, and support the family in a structured end-of-life conversation, separate from the treatment-withdrawal discussion led by the clinical team. This patient has absent brainstem reflexes and devastating irreversible brain injury, exactly the trigger point at which referral criteria are met, regardless of whether formal death testing has occurred yet. Referral timing matters clinically because donation after brain death or circulatory death planning, organ matching, and family conversations all depend on the specialist nurse being involved before, not after, care decisions are finalised. Why the other options are wrong: E. Ask the family for organ consent before referral: consent conversations should be led or supported by the trained specialist nurse, not initiated independently by the treating team before referral, as this risks a poorly informed or mistimed approach. A. Wait until after extubation to contact donation services: delaying referral until after withdrawal or extubation eliminates the opportunity for donation after circulatory death planning and stabilisation, and contradicts the requirement to refer at the point non-beneficial treatment is identified. D. Stop physiological support immediately: withdrawing support before donation assessment and family discussion removes any possibility of organ donation and does not respect the structured pathway. B. Perform organ matching tests without discussion: tissue typing and matching cannot proceed without consent and specialist nurse involvement, so doing so without discussion breaches consent and process requirements. Key point: Refer to the specialist nurse in organ donation as soon as treatment is deemed non-beneficial and death is anticipated, before any withdrawal, extubation or consent conversation occurs.

Reference: NICE Clinical Guideline CG135, Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation, recommendation 1.1.2, https://www.nice.org.uk/guidance/cg135/chapter/Recommendations