DCD Approach Process: Maximizing the Gift

Jamie Kothapalli, RN BSN

Wisconsin Donor Network

Background

• In early 2013, WIDN started evaluating DCD donors for the potential for BD to maximize the gift and improve recipient outcomes.

2013 DCD Approach Data

• 33 instances where family was asked to wait for BD

• 6 families did not want to wait - DCD donors• 27 families waited, time range 5-75 hours

• 13 of these patients progressed to BD (average wait time 24 hours)

• 14 instances where family was not asked to wait

2014 DCD Approach Data

• 22 instances where family was asked to wait for BD

• 2 families did not want to wait - DCD donors– 37/C/M- 3 small children, family emotionally drained– 35/C/M- wife was DOA family wanted dual funeral

• 20 families waited, time range 5-67 hours• 18 of these patients progressed to BD (average wait

time 21 hours)

• 11 instances where family was not asked to wait

Two Year Success

• 2013• 82% of families willing to wait for BD

• 48% of donors progressed to BD

• 2014• 91% of families willing to wait for BD

• 90% of donors progressed to BD

DCD Pre-Approach Process

• Huddle with Attending MD• Determine potential for DCD donation• Determine potential for progression to BD

– Discussion surrounding likelihood to progress and timing of progression

– Pre-approach discussion

Family Discussion• Focus of discussion is on BD donation• Talking points:

– Recipient Outcomes– Maximize the gift

• DCD donation only discussed in some situations

• Establish a plan with the family– How long they are comfortable waiting– Drive family support/future discussions

Donor Designation

Donor Designation No Donor Designation0

2

4

6

8

10

12

14

16

20132014

92 Lives Saved!

• 10 Hearts• 8 Lungs• 21 Livers• 47 Kidneys• 5 Pancreata• 1 Intestine

Highlights

• Skill of Family Services Coordinator

• Support of Attending Physician– Effective huddle to determine likelihood for BD

• Family’s willingness to optimize the gift