242 M. Coombs and M. Woods
sets of tests are performed separately using the same procedures and
assessment with a clear set of preconditions and exclusion criteria. The
two tests are usually undertaken with a gap of several hours, to give fam-
ilies time to assimilate and understand the gravity of events. If both sets
of tests determine that brain death has occurred, the time of death is
recorded as the time the second set of tests are completed.
Deceased person organ donation is important, as the number of
living organ donations internationally remains small and, in some
countries, continues to be associated with controversies such as organ
trafficking (International Summit on Transplant Tourism and Organ
Trafficking 2008 ) and poor practice (Gardiner et al. 2012 ). In Aotearoa/
New Zealand, the number of deceased donors per million popula-
tion (pmp) was reported as 8.1 in 2013. When compared to reported
activity figures in Australia of 16.9 pmp and Spain of 35.1 pmp
(International Registry in Organ Donation and Transplantation 2014 ),
our deceased person organ donation rates are low. In 2014, the fami-
lies of 46 deceased patients from Aotearoa/New Zealand donated organs
for transplantation (Organ Donation New Zealand 2014 ). With a mean
age of 45.6 years (median 49.7 years) these were mainly younger people
who sustained catastrophic primary brain injuries including intracranial
haemorrhage (n = 15, 32.6%) and non-road traffic accident traumatic
brain injuries (n = 10, 21.7%). Given the growing need on both sides
of the Tasman for organs to be transplanted into people with end-stage
organ failure, it is unsurprising that local hospital-based and national-
level policy initiatives have been developed to increase donation rates
through earlier identification of potential donors (DonateLife 2008 ;
Organ Donation New Zealand 2014 ).
While end-of-life care and organ donation practices in intensive care
have much in common (in particular, the need for honest, clear com-
munication with families) there are also significant areas of difference
(such as the focus on palliative measures versus organ support measures,
and the reduction of interventions versus increased use of interven-
tions), which need to be taken into account in any discussion of inten-
sive care practice.
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