sue weese, rn, bsn, cptc hospital coordinator giving the gift of life
TRANSCRIPT
Focus
• Referral Process• Catastrophic Brain Injury Guidelines• Brain death vs. death Circulatory • Transitional Language/Huddles• Partnership
Care of the patient and familyTools and resources
A federally designated OPO (Organ Procurement Organization) serving:
ND
SD
MN
WI
Douglas County
St. Croix CountyPierce County
Referral Process
• Family mentions or has questions about donation• When patient meets the Triggers for donation, LifeSource should be
called within one hour• Clinical Triggers include:
Neurological injury Patient on a ventilator Loss of two brain stem reflexes or a GCS of < 5
• Call is mandated, staff does not need permission to make the call• After initial referral, if decision made to withdraw life-sustaining
measures or prior extubation
Referral Units include: ICU’s/ED/OR
Donor designation is the practice of ensuring that an individual’s documented wishes about donation are fulfilled.
Minnesota passed the Darlene Luther Anatomical Gift Act in April 2002
LifeSource implemented practice changes to incorporate Donor Designation in May 2003
“giving the donor a voice”
What is Donor Designation
Guide:The person who steers the boat down the river, giving paddle commands to the crew as paddle captain or rowing as oars person.
Catastrophic Brain Injury Guidelines(CBIG’s)
A Trauma surgeon and ED Physician out of Kansas City developed the Catastrophic Brain Injury Guidelines to be used when a patient is deemed nonsurgical/nonsurvivable.
Based the guidelines on the Surviving Sepsis Campaign
Goal to save more lives and preserve the opportunity for donation.
Outcome:3 people survived17 organs were transplanted
0%
10%
20%
30%
40%
50%
60%
70%
80%
PLTs DIC pressor DI cardisch
acid renalfailure
NPE
Complications of Brain Death
• Maintain SBP > 90 (MAP > 60)– Perfusion
• Maintain Urine Output > 1ml/kg/hr < 300ml/hr– Fluid balance
• Maintain PO2 > 100 & pH 7.35-7.45 Oxygenation
• Monitor glucose– Cell metabolism
• Monitor and treat electrolytes– Acid Base balance
Critical Care end points
• Policy• Known etiology of brain death and/or evidence
of irreversibility
• No brainstem function
• No respiratory effort/apnea test
Brain DeathDeath by Neurological Criteria
Donation after Circulatory Determination of Death
• Policy• Patient does not meet Brain Death criteria
• Family decides to withdraw life-sustaining medical treatment
• Patient ventilator dependent
• Patient is age < 60
"The individual represented by the hospital to request to the family must be an organ procurement representative or a designated requestor" (CMS Conditions of Participation
482.45(a)(3)
What do you say……if the family raises the topic of donation?
– Prior to Brain Death/Cardiac Death• “Hennepin County supports donation. Donation may
be possible. We work closely with the donation agency and I’ll arrange to have them speak with you”
– After Brain Death/Cardiac Death• “We work very closely with the donation agency and
they are available to answer your questions about donation”
• Acknowledgethe donation comments
• Connectthe family to LifeSource
• Supportthe family in meeting their needs
Mention of Donation
Huddle Definitions
• Donation Assessment Huddle– Onsite or telephone response, after an evaluation
• Family Support Huddle– Prior to Family Discussion
• Family Outcome Huddle– After Family Discussion
Importance of clear and consistent language
California Florida
Family considers taking brain-dead son off life support
Corneas
Heart/Heart Valves
Lungs
Liver
Pancreas
Kidneys
Intestines
Skin
Bone/Connective Tissues
Blood Vessels
Donation Opportunities
Neuro injuryVented
ICU Triggers for referral
Chaplains
Order sets
Tissue and eye
ME/OR/RT
Policy
Family Support
Similarities
Differences
Brain Death• No age limit• Clinical and Apnea • Time of death- Brain Death-
ICU• Extubate or Donate• Yes Anesthesia • No Family in OR• LS Manages
DCD• Age limit - 60 • Evaluate for 60 minute CTOD• Time of death-Cardiac Standstill-
OR• Decision to withdraw• No Anesthesia-only lungs• Family invited in OR• MD manages
Family Support
• Wrapped in Hugs• Flag Raising• Funeral Box• Bracelets• Wall of Heroes• Family After Care• Donor Family Gatherings
• Triggers for referral• Death-Circulatory vs Neurological• CBIG’s-avoid deceleration in care• 64% of MN drivers over 18 DD• >120K on waitlist• Family/patient decision
Summary