Introduction: Donation that occurs following death that is confirmed using circulatory determination criteria, referred to as donation after circulatory determination of death (DCDD), accounts for about 30% of deceased organ donation in Australia. If circulatory death occurs within a prescribed timeframe after withdrawal of cardio-respiratory (WCRS), then the intended organs to be donated can be transplanted.
The decision to withdraw treatment is a decision that is typically made in consensus between the treating healthcare staff and with the family. In rare circumstances, the patient themselves can provide first person consent if they are conscious and competent to make their own end-of-life decisions. [CVRVO(ESL1] 
This case review presents a 36-year-old man with rapid progressing amyotrophic lateral sclerosis (ALS) over a 2-year period. He presented in respiratory failure and was continuing to deteriorate with almost complete loss of motor function and dependence on non-invasive ventilation (NIV). He was non consenting for endo-tracheal intubation. He was wheel chairbound with only minimal remaining ocular motor ability and left forearm twitching, which he used to communicate via a NeuroNode.
On admission, it was determined that the progression of his ALS had come to end stage and no further treatment could mitigate alleviate his symptoms. He was admitted to the ICU under respiratory medicine and palliative care for end-of life care. Discussions surrounding donation had developing up to 12 months prior to this final admission. It was his final wish to become an organ donor.
For the purposes of this review, the patient will be referred to as AH.
Method: Following review in the community, AH was unable to be supported at home due to his rapidly deteriorating respiratory function. Initially, AH had proposed a plan for a medicalised death, however this was not possible.
Following admission and determination of end-of-life goals, the following needed to be clarified prior to the facilitation of the organ donation and organ offering. These were categorised as per the following:
First person consent - Capacity and Consent method
Organ Donation – ethics, law, and practice within Australia
End of Life Care – goals and values in context. Complexities associated with bedside care and a conscious patient
Ante mortem interventions – permitted under NSW State legislation
The DCDD process was outlined clearly with AH and his family members along with the intensive care team and donation specialist that were facilitating AH’s palliation.
Results: As a result, AH was able to donate his Heart and Kidneys.
Liver – was not retrieved due to poor perfusion and thrombus detected on back table inspection
Lungs - not medically suitable due to the prolonged time on NIV and extensive secretion load
Pancreas – not suitable due to age and pathway
Conclusion: This was a case of first person consent and a first DCDD where a patient was on NIV.