The Organ Donation Process

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The Organ Donation Process

• Lisa Seymour, RN
• Learning Specialist
• New York Organ Donor Network

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Objective

• Understanding of the process of donation from
  consent to recovery of the organs

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Topics of Discussion

• Overview of the consent process
• Brain Death protocol
• Evaluation and screening
• Organ specific testing
• Allocation of the organs
• Recovery process
• Post recovery

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OVERVIEW OF THE CONSENT PROCESS
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TIMING IS CRUCIAL
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WORKING WITH THE FAMILY

• Assessment of family
• Introductions
• Identification of NOK
• Identification of decision makers, family support
• Eliciting family understanding of brain death

• Discussion of donation with the family
• Explanation of process of donation
• Addressing concerns and questions
• Meeting needs of the family

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CONSENT PROCESS

• Consent forms
• Medical and Behavioral History
• Explanation of what comes next?
• Constant updates for the family

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WORKING TOGETHER TO SUPPORT THE FAMILY
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BRAIN DEATH PROTOCOL

• Full understanding of hospital plans for protocol
• Assisting family with understanding
• Explanation how protocol affects the timeline and
  donation process

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BRAIN DEATH PROTOCOL cont.

• Based on NYS Guidelines
• Clinical Exams by physicians
• Supportive or confirmatory testing
• Possible delays in protocol being completed

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SCREENING AND EVALUATION

• Serology testing (HIV, Hepatitis, etc)
• Blood type
• Medical Suitability
• Behavioral History
• HLA (tissue typing, histocompatability)
• Review of CT scans, chest x-rays, etc

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ORGAN SPECIFIC TESTING

• HEART
• EKG
• Echocardiogram
• Cardiac catheterization
• Lab values

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ORGAN SPECIFIC TESTING cont.

• LUNGS
• Bronchoscopy
• Chest X rays
• Culture results
• Arterial blood gases
• Accurate measurements

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ORGAN SPECIFIC TESTING cont.

• LIVER
• Lab testing
• CT scans or ultrasound
• Lab values

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ORGAN PLACEMENT cont.

• KIDNEYS
• Lab testing
• HLA (tissue typing)
• Ultrasound or CT scan
• Kidney anatomy (post recovery)
• Pump numbers (post recovery)

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ORGAN PLACEMENT cont.

• PANCREAS
• HLA
• Ha1C
• Lab testing
• CT or ultrasound
• Insulin dosing in hospital

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ALLOCATION BEGINS

• UNOS specific guidelines and generation of the
  list
• Performed by Transplant Coordinator in field,
  Organ Placement Coordinators and/or UNOS
• Time frame

ONE HOUR RULE
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During this time of consent, screening and
evaluation and allocation stability of the donor
and support the family is CRUCIAL
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ORGAN ALLOCATION

• All information in hand at this point (few
  exceptions)
• Multiple people may be involved
• Very time consuming process

• Multiple offers at once
• ALL information must be given for informed
  decision by surgeon
• Deciding surgeon may want more information
• Decision made to accept or decline

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A RECIPIENT IS FOUND
Backup placing begins We understand that
ANYTHING can happen
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ORGANIZATION OF RECOVERY

• Operating room availability at the hospital
• Organizing potentially up to 8 surgical teams to
  arrive AT THE SAME TIME, IN THE SAME PLACE, to
  work together to successfully recover these live
  saving organs
• ONE OF THE BIGGER CHALLENGES
• WE HAVE LITTLE CONTROL OVER

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RECOVERY

• Abdominal teams (liver team) begins
• All teams do extensive prep work needed for
  expedition of recovery post cross clamp
• Heart and lungs are procured first
• Liver, pancreas and intestine next
• Kidneys are recovered last.
• This process takes between 4-6 hours

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WHY WOULD AN ORGAN BE REFUSED IN THE OR?

• Suspicious mass or lesions found
• Evidence of infection
• Biopsies performed are incompatible with donation
• Donor instability
• Recipient instability or death

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WHAT HAPPENS IF THE ORGAN IS REFUSED?

• Immediately the backup is called
• Aggressive placement continues
• If, unfortunately, no recipient is found
• THE ORGANS WILL BE KEPT IN THE BODY OR RETURNED
  TO THE BODY BEFORE CLOSURE (if already procured)

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POST RECOVERY

• Tissue typing to include lymph nodes, blood clot,
  spleen are obtained for secondary typing for
  kidneys, pancreas, intestine and heart
• Preservation of the organs after initial anatomy
  documented
• Kidneys placed on pumps

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THE RUSH TO TRANSPLANT
IMMEDIATE TRANSPORTATION
IMMEDIATE TRANSPLANTATION
WHAT IS THE RUSH?
THESE ORGANS ARE NOT FOR WHAT IF?
A LIFE IS IN JEOPARDY
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POST RECOVERY

• KIDNEY ALLOCATION MAY CONTINUE
• WHY?
• Benefits of waiting to pumping kidneys
• Use of kidney pumps gives more detailed
  information
• Can turn around kidneys
• Ultimately provides for best recipient

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POST RECOVERY cont.

• Surgical teams close the donor in the same
  manner as any other surgery
• Respect for the body continues
• Carrying through the wishes of the family for
  arrangements for the body
• Family called

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A QUITE COMPLICATED PROCESS

• Begins with working with the hospital to assess
  the situation, the family and the initial
  suitability
• The process of working with the family and
  obtaining consent
• Further screening
• Organ specific testing
• Allocation to find the right recipient
• Logistics of recovery

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IN SUMMARY

• Organ transplantation is proven
• The entire goal of organ transplantation is
• TO SAVE ANOTHER HUMAN LIFE
• Organs are NEVER wasted
• Intent is always to find the best recipient
• Family wishes are ALWAYS respected

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Respect for the donor and their family
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While assuring that all is possibly done to save
another human beings life