a day in the life of an opc - home | uw health · douglas t. miller symposium on organ donation and...

A Day in the Life of an OPC Douglas T. Miller Symposium on Organ Donation

and Transplantation Kelsi Knivila, RN, TNCC Pamela Chambers, RN, BSN, CPTC

Laura VanDrese, RN, BSN, CPTC

Douglas T. Miller Symposium on Organ Donation and Transplantation

Your Mission Today:

• Take an in-depth look at the day of a UW OTD Organ Procurement Coordinator

• Observe the multiple interactions that an OPC has with other staff throughout the course of an organ donation case from referral through allocation

• Recognize the intricate steps involved in the

donation process


Overview • Burning Questions • Introduce UW OTD Staff • Quick Overview of the Donation Process • Taking a New Referral • Laying the Foundation for an Approach • Donation Case Elements • Allocation of Organs • Answer Burning Questions


Glossary • OPC = Organ Procurement Coordinator • DSS = Donation Support Specialist • DSA = Donor Service Area • FPA = First Person Authorization • POA = Power of Attorney • DR = Designated Requestor • NOK = Next-of-Kin • MOC = Medical on Call • AOC = Administrator on Call


Burning Questions • Do you have questions or need further explanation about the

donation process? • Have you ever wondered what an OPC does? • Now is your time to ask!!

ACTION 1) Write down your questions on the post-it notes provided on

your tables. 2) Hand them in and at the end of the session, any questions

we have not answered will be addressed as time allows.

Ask anything!!!

OPC Team

Karen - Operations Manager

Adam - Senior Organ Procurement

Coordinator

Rachel (Fish) Ana

Kayla Pamela

Angella Shana

Meg Kate

Kelsi Roni

Bill Laura

Tamarra

Heather Kathy

Sara


OTD Scheduling Model


Shift Handoff • OPCs, DSS, AOC at 7A and 7P handoff • Review current open referrals, upcoming deployments/

consent opportunities, active cases, import/fly out organs


Overview of the Donation Process

Donor Recipient

Transplant

24 -36 Hours minutes – 72 hours


It all starts with a referral…

Clinical Triggers Referral

Coroner/ Medical

Examiner Donor

Registries Determining

Eligibility


Clinical Triggers Mechanically

ventilated patient

Confirmed severe neurologic insult

or injury

Physician is evaluating for brain

death

Patient has a Glasgow Coma

Score ≤ 5

A plan to discuss withdraw treatment

The Referral Process

When a patient meets Clinical Triggers Statline

1-866-UWHC-OPO (1-866-894-2676)

Triage center for: •Solid Organ •Tissue •Eye •Death Reporting


The Referral Process

Clinical Triggers are met

Hospital staff should call a

referral in within 1 hour of the

patient meeting clinical triggers

Statline is called by the hospital

staff and referral is made

Statline pages the OPC and gives basic

patient information

OPC responds to hospital staff

within 15 minutes to get more detailed information


Information Needed on Initial Referral

Name (Including Middle Initial) Age/ Date of Birth Height/Weight Cause of admission Ventilator status Coroner’s Case (County of accident/event) Past Medical/Social History Current pressors, vital signs, neuro status, labs Family status/ Plan of Care


Electronic Medical Record Access

OPC’s have access to most hospitals’ EMR

OPC’s will review labs, VS, notes, medical history, medications, etc.

OPC access varies from hospital staff access


Donor Registry State

Registries

WI, MI and IL include organ, tissue and eye

for transplant, research and

education & training

State registry authorizations vary

National Donor Registry

New in 2016


Wisconsin Coroner/Medical Examiner

• OTD works with coroners/medical examiners throughout the donation process.

• Wisconsin Act 230: Coroner or medical examiner cannot restrict donation of anatomical gifts in Wisconsin. • The appropriate OPO must notify the coroner when

the referral is received on all potential donation cases.

• In Michigan and Illinois, coroners/medical examiners are called when a referral becomes a donation case.

• Process allows coroners or medical examiners to complete their investigation.

• Coroners/medical examiners can photograph or videotape a recovery in the OR.

Coroner/ Medical Examiner Process


New Referral Intake


Determining Eligibility

OPCs Complete EMR Review

Discussion with MOC and/or

AOC

Can take time to complete

** Each patient is evaluated on a case by case basis **


Laying the Foundation for an Effective

Approach


An Effective Partnership/ An Effective Approach

• Hospital Designated Requestor (DR) and Donation

Support Specialist (DSS) partner together – Ensures that every family gets the same information about

eligibility, registry status, and the donation process. – Supports hospital ICU staff. – Supports families making end of life decisions.

• Goal: Provide support and education to the donor

family so they can make the best decision about organ and tissue donation.


Six Deployment Trigger Scenarios


Scenario #1

Rationale: These conditions will likely result in a grave prognosis meeting. UW OTD’s goal is to be on-site ahead of these meetings to coordinate huddles with the care team to prepare for how/when donation could be introduced.


Scenario #2

Rationale: These conditions may result in an unplanned family meeting and/or approach. The DSS can intercept the conversation and/or huddle with the staff to make a plan.


Scenario #3

Rationale: Family has accepted the grave prognosis and is starting to make end-of-life decisions. Registry status and/or donation eligibility should be discussed with the family.


Scenario #4

Rationale: Supports the UW OTD/ hospital partnership and provides family support.


Scenario #5

Rationale: DSS can support the family and hospital staff as an organ donation resource.


Scenario #6

Rationale: DSS can speak with family to see if a more recent advance directive exists or if patient verbalized a change in his desire to be an organ donor.


Conversation Between the OPC and DSA Hospital Staff

• DSA hospital staff snapshot – Timing considerations – If possible, OPC to connect with attending MD

prior to the conversation with family. – Is a DR available to discuss an approach? – OPC will provide contact information to

hospital staff for updates.


Conversation Between the OPC and DSA Hospital Staff (cont’d)

• Family snapshot – Who is the legal NOK or decision maker? – What’s the legal NOK’s or decision maker’s

plan? – Family dynamics? – Cultural considerations?



• Family snapshot (cont’d) – Are the family’s basic needs being met? – Is family understanding and/or accepting the

prognosis? – Is family in agreement with the plan of care? – Are there financial concerns compounding the

circumstances?



• Patient snapshot – Hemodynamically stable? – Neurological status (sedation/paralytic

masking?) – Past medical/social history – Diagnostic testing performed – Current labs and trends – Procedures performed (ex. bone flap)


Case Study • Pt is a 52 yo male who lives in an independent group home came to the ER

on 5/7 c/o falls and instability. He’s been having extra stress due to a bad gambling streak.

• MRI shows multiple small, acute infarcts presenting in a way suggestive of cardioembolic disease. The CVA protocol was put in place, including anticoagulation.

• On 5/11 pt went from alert and oriented to unresponsive and apneic. Subsequently he went into v-tach. Code blue was called and pt was coded for 20 minutes until ROSC. Pt’s neuro status deteriorated until all reflexes were absent. After the appropriate testing, brain death was declared.

• Pt’s mother is 78 yo and LNOK. Pt is one of 12 siblings and one who lives nearby is a nurse. A family care meeting is not planned but the mother and sister have been notified that they need to come to the hospital for further discussion on how to proceed.

• Pt is not on the registry. Eligibility has been determined by the OPO and pt is potentially eligible to donate his heart, liver, pancreas, and kidneys.


OPC and DSS Conversation


DSS Setting Up Transportation


DSS Donor Hospital Arrival Plans


Donation Case Elements


Five Essential Elements

Consent

Brain Death Declaration/ Futility Note

Blood Type x 2

Serology/ Infectious Disease Testing

Donor Risk Assessment

Interview (DRAI)

Consent First Person Authorization/

Record of Gift

NOK Consent First Person Authorization/

Record of Gift


Consent (cont.)

Legal Directives (Advanced Directives)


DCD Consent

OPC must ensure that the following elements are transcribed on a hospital surgical consent form.


Brain Death Declaration

Clinical Exam Apnea Test Confirmatory Testing Documentation of Brain Death Signed by MD


Brain Death Declaration Tool

OPC must ascertain that all elements are performed and documented clearly.


Confirmatory Testing

Nuclear Flow (Consistent with BD)

Cerebral Angiography Consistent with BD


Futility Note • Must be obtained for all DCD donors • OPC ensures the following elements are

included: – Non-recoverable injury/irreversible

neurological injury. – Decision was made by family to withdraw life

sustaining measures. – Physician has signed the note and there is a

clear date and time.


Sample of a Futility Note

Must state that family has decided to withdraw treatment.


ABO/Type and Screen • OPC ensures two ABOs are drawn at

separate times per regulatory standards. • OPC reports blood type and double verifies

the ABO/subtyping. • OPC determines if blood sample is

hemodiluted. – Affects ABO/ Subtyping and infectious disease

testing results. – Could designate donor as Increased Risk for

Disease Transmission.

2


Serology/ Infectious Disease Testing

Communication between OPC/RN for timing of draw to be completed

RN draws serologies/faxes instruction form back to OPC

Blood transported to ER for pickup

Courier transports blood back to UW, GOH, IL for testing


Donor Risk Assessment Interview (DRAI)/Medical Social History

• A single instrument used by all organ, tissue, and eye donation organizations that supplements lab testing and known past medical/social history to accurately identify suitable donors and their increased risk designation.

• OPC completes a DRAI with best historian of patient. – May need to complete multiple DRAIs. – May not be legal next-of-kin.

• OPC determines increased risk status, documents appropriately, and communicates to all transplant centers.

• OPC completes Family Care Checklist.


Family Care Checklist • Completed by DSS during consent

conversation and after DRAI by OPC. • Sets expectations and a communication plan

for families. • Topics discussed:

– Moment of Silence – Pins and bracelets for funeral – Timing considerations – Code status – Communication plan


DRAI and Family Care Checklist


Management Phase Overview

• Complete DRAI • Provide family support • Ensure placement of lines • Monitor lab trends • Monitor VS/UOP/CVP/IV infusions • Organ evaluation/Recruitment


Procurement Checklist • OPC Procurement Checklist (7 pages)


Organ Allocation


After consent is obtained • Create a unique patient identifier called a UNOS ID.

• Work with RN to obtain blood for infectious disease

testing.

• Complete thorough chart review.

• Begin collecting data (labs, vitals, tests).

• Upload relevant tests into an image sharing program.


• Database overseen by the United Network for Organ Sharing that links recipient and donor information for the purposes of matching donor organs with recipients.

• OPC responsibilities:

– Enter all patient information into the UNOS database.

– Generate match runs for each organ. – Allocate organs based on regulatory guidelines.


DonorNet


Donor Details


UNOS Regulations • Before match runs can be generated, the

following must be obtained: – Consent – Brain death note/ futility note – ABOs x2 – Infectious disease testing – DRAI (Donor Risk Assessment Interview) – Required organ specific testing, labs, vitals – HLA


Organ Specific Regulations


Generating Match Runs


Allocation • Three electronic notifications at a time. • One hour to acknowledge. • Additional hour to review donor and

potential recipient information and accept or decline offer.

• Other tests/ labs may be requested by the transplant centers.

• Offers for different organs are made simultaneously.


Serum Cross-Matching Some transplant centers may request blood for cross-matching (kidney and pancreas). Serum cross-matching prior to shipping the organ decreases the cold time. RN to use pre-made cross-matching kits and label all tubes with time, date, initials written on patient labels. OPC to arrange for transportation of blood to transplant center.


Placing Organs for Research Current Research

Organizations

• UWHC – Ongoing research projects

• IIAM – International Institute for the Advancement of Medicine

• NDRI – National Development and Research Institutes

OPC’S Role: Ensure family has

consented for research, education and training.

Attempt to place any organs that are not able to be transplanted with research organizations.

Back up any organs intended to be transplanted with research organizations.

Provide recovery team with protocols required by the research organizations.


Was your mission accomplished today?

• Take an in-depth look at the day of a UW OTD Organ Procurement

Coordinator. – We hope you are able to better understand the role of an OPC.

• Observe the multiple interactions that an OPC has with other staff

throughout the course of an organ donation case from referral through allocation. – It takes a village to provide organ and tissue donation to families and

recipients. You saw the role of the OPC and the many interactions we have with varying partners.

• Recognize the intricate steps involved in the donation process.

– A donation case is complex and we have touched on some of the critical key elements in the process. Completing these key elements in a timely manner helps move this lengthy process along.


Burning Questions…

• We will take the next few minutes to answer some of the questions submitted.


A hero is within each of us. An everyday hero. Consider your Call to Action

Guardian of the Gift Icon of Innovation Voice of Valor Illuminator of Life Idol of Inspiration Face of Fortitude


A Day in the Life of an OPCYour Mission Today:OverviewGlossaryBurning QuestionsOPC TeamOTD Scheduling ModelShift HandoffSlide Number 9Overview of the Donation ProcessIt all starts with a referral…Clinical TriggersThe Referral ProcessThe Referral ProcessInformation Needed on Initial ReferralSlide Number 16Donor RegistrySlide Number 18New Referral IntakeDetermining EligibilityLaying the Foundation �for an Effective ApproachAn Effective Partnership/ �An Effective ApproachSix Deployment Trigger ScenariosScenario #1Scenario #2Scenario #3Scenario #4Scenario #5Scenario #6�Conversation Between the OPC and DSA Hospital StaffConversation Between the OPC and DSA Hospital Staff (cont’d)Conversation Between the OPC and DSA Hospital Staff (cont’d)Conversation Between the OPC and DSA Hospital Staff (cont’d)Case StudyOPC and DSS ConversationDSS Setting Up TransportationDSS Donor Hospital Arrival PlansSlide Number 38Five Essential ElementsConsentConsent (cont.)DCD ConsentBrain Death Declaration Brain Death Declaration ToolConfirmatory Testing Futility NoteSample of a Futility NoteABO/Type and ScreenSerology/ �Infectious Disease TestingDonor Risk Assessment Interview (DRAI)/Medical Social HistoryFamily Care ChecklistDRAI and Family Care Checklist Management Phase OverviewProcurement ChecklistOrgan AllocationAfter consent is obtainedSlide Number 57Slide Number 58DonorNetDonor DetailsUNOS RegulationsOrgan Specific RegulationsGenerating Match RunsAllocationSlide Number 65Slide Number 66Serum Cross-MatchingPlacing Organs for ResearchWas your mission �accomplished today?Burning Questions…A hero is within each of us.�An everyday hero.Slide Number 72

a day in the life of an opc - home | uw health · douglas t. miller symposium on organ donation and...

Documents