Becoming Better Predictors of Death

Region 5 Collaborative

Chuck ZollingerAdministrative Director, Organ Recovery

Snapshot• DSA serves 3.6 million• 9 ODCs (on the call schedule)

• 2-ODC model (sorta)

• One office (no satellite offices)

• ~500 miles N to S• 80:20 rule• Withdraw in ICU• 2-minute observation

• WI tool is a good basis but is not enough• ALL clinical indicators need to be examined before

predicting whether pt will expire within 60, 90 or 120o NIF -35=no way he’s going down, right?

• Respiratory assessment:o Usually prior to family involvemento CPAP trial (permission of MD)

• NIF, RR, TV, sats• Often done over the phone due to imminent withdrawal call• Variability in how NIF was obtained

• Missed opportunity lead to process change

Lessons Learned

• Ask MD to do 20-min trial, if tolerated– NIFs at start and end of CPAP trial

• Intent was to not give family false hope• Wouldn’t offer DCD if unlikely to expire

– Hospital and OPO staff uncomfortable w/duration• Medical Director recommended we only do CPAP

trials if family is on board with donation– Better transparency with staff and family– Reduced CPAP trial to 10 minutes– Allows us to have more control of how NIF is conducted

Revised Process

• Still finalizing tracking tool– Goal is to gather data on all evaluations

• We suspect having 2 NIFs will help guide decision– We’ve seen 10-point changes in short period of time—some

stronger and some weaker• We feel we’re able to give family more accurate

information• If we determine pt is unlikely to expire, we tell family

he/she is not eligible• If uncertain, we leave it up to the family

Conclusions