The Organ Donation Process

1
The Organ Donation Process

• Presented By
• Gabbi Barnes
• In-House Transplant Coordinator

2
The Incident

• Motor vehicle accident occurs
• Paramedics arrive
• Patient is intubated en-route
• Paramedics attempt to stabilize patient
• Patient is transported to nearest facility

3
The Emergency Room

• Trauma team present report received from EMS
• Blood obtained
• X-rays done
• Medications administered
• CT of head and abdomen done
• Patient admitted to ICU for care

4
CT Results

• Abdomen
• Normal
• Head
• Diffuse scattered SAH, bilateral mixed density
  subdural hematomas, widespread cerebral edema,
  evidence of downward transtentorial and tonsillar
  herniation with effacement of the 4th ventricle

5
ICU Clinical Evaluation

• Glasgow Coma Scale 3T
• Patient unresponsive to painful stimuli
• No cough or gag response
• Hypotensive

6
Neurology in Critical Care Glasgow Coma Scale The
GCS is scored between 3 and 15, 3 being the worst
score, and 15 the best. It is composed of 3
parts Best Eye Response, Best Verbal Response,
and Best Motor Response, as shown. When doing a
neuro assessment, it is important to watch for
trends indicating a decreasing LOC. A coma scale
of 13 or higher indicates a possible mild brain
injury, 9 12 is a moderate injury, and 8 or
less a severe brain injury. Eye Response Opens
Spontaneously 4 To Verbal Command 3 To
Pain 2 No Response 1 Best Verbal Response
Oriented and Converses 5 Disoriented and
Converses 4 Inappropriate Words 3 Incomprehe
nsible Sounds 2 No Response 1 Best Motor
Response Obeys 6 Localizes
Pain 5 Withdraws from Pain 4 Abnormal
Flexion 3 Abnormal Extension 2 No
Response 1
7
What Happens Next?
8
Organ Donation Clinical Triggers
Donor Referral line 1-800-882-7177 Regardless
of age/diagnosis, refer intubated patients with a
cerebral injury/insult and meeting clinical
trigger criteria Prior to discussion of DNR /
withdrawal of mechanical support Call whenever a
family member inquires about donation Do not
mention donation to the patients family LifeLink
will determine medical suitability for
donation

• Organ Donation
• Clinical Triggers
• Your patient is intubated and shows evidence of
  the following
• Coma
• Stroke
• Hypoxia
• Brain Tumor
• Cerebral Injury
• Near-Drowning
• Cerebral Edema
• Cerebral Hemorrhage
• AND
• Two or more of the following criteria are met
• GCS lt 5, not sedated
• Unresponsive or posturing
• No pupillary or corneal reflex
• No cough or gag
• No spontaneous respiration

9
IF YOUR PATIENT MEETS BOTH TRIGGERS OR THE FAMILY
ASKS ABOUT DONATION, PLEASE CALL LIFELINK
IMMEDIATELY 1-800-882-7177
10
The Referral Meets Both Triggers

• Call is made to referral line by the hospital.
• The Medical Screener on the referral line
  conducts a preliminary screening of the patient.
• The Medical Screener contacts a Referral
  Coordinator and relays the referral information
  obtained from the hospital.
• The Referral Coordinator returns the hospital's
  call to obtain additional information about the
  patient.
• The collected information is then passed on to a
  Designated Requestor (DR) for the next steps.

11
Who is LifeLink?

• LifeLink of Georgia is an independent, non-profit
  organ and tissue recovery organization which
  provides deceased donor organs and tissues for
  transplantation to approved transplant centers
  within the state of Georgia as well as throughout
  the nation.
• LifeLink of Georgia is one of six divisions of
  LifeLink Foundation, located in Tampa, Florida.

12
Who is LifeLink?

• LifeLink Coordinators are formally trained in
  every aspect of the donation process, including
  the placement and retrieval of life-saving organs
  and life-enhancing tissues. This specialized team
  works in a cooperative environment with nurses
  and physicians and is available 24 hours a day to
  counsel families and provide specific services in
  nursing units. Their collaborative efforts
  provide hearts, lungs, pancreas, small
  intestines, liver, kidneys, bone, skin, corneas,
  eyes, and heart valves for patients in need.
• LifeLink has evolved and improved by implementing
  innovative programs that address the donor
  shortage, such as the Hospital Development
  program. The Hospital Development staff reaches
  out to medical professionals across the LifeLink
  service area and builds trusting relationships.
• LifeLink of Georgias service area includes 159
  counties in Georgia, 2 counties in South Carolina
  with a population of approximately 7.9 million
  people.

13
What is an OPO?

• Organ Procurement Organization.
• A not-for-profit organization responsible for
  identification and care of organ donors, organ
  retrieval, organ preservation, transportation,
  and data follow up regarding cadaveric organ
  donors.
• OPO staff work with donor families, and educate
  medical staff and the general public about organ
  donation.

14
Who is UNOS?

• Located in Richmond, Virginia, the United Network
  for Organ Sharing (UNOS) is a not-for-profit,
  scientific and educational organization that
  administers the nation's only Organ Procurement
  and Transplantation Network (OPTN), established
  by the U.S. Congress in 1984.
• UNOS follows a collaborative policy development
  process for administering the Organ Procurement
  and Transplantation Network (OPTN) and handles
  the development, monitoring, enforcement and
  modification of the policies that govern the
  allocation, procurement and transportation of
  human organs.

15
Designated Requestor to Hospital for Evaluation

• The Designated Requestor (DR) arrives at the
  hospital.
• The Designated Requestor will evaluate to ensure
  the patient meets the criteria for brain death,
  family dynamics, the familys emotional state,
  past medical history, current medications, labs,
  and test results.
• The Designated Requestor will present the case to
  LifeLinks Administrator on Call (AOC) and then
  formulate a plan of action.

16
Who is Administrator on Call?

• Administrator on Call (AOC)
• The Administrator on Call is responsible for
  helping formulate the plan of action regarding
  donors.
• Kathleen T. Lilly Senior Vice President /
  Executive Director
• V. Lee Langley Vice President / Associate
  Executive Director
• Shri Bharadwaj Manager, Recovery Services
• Barbara Bianchi Manager, Professional Services

17
The Plan

• Designated Requestor will review the physicians
  evaluation with the family to ensure that all
  questions have been answered they have a
  thoroughly understanding of brain death and why
  it is a non-survivable instance, request consent
  and review medical/social history on the patient.
• Once consent for organ/tissue donation is
  obtained the Referral Coordinator is notified and
  a Recovery Services Coordinator is sent to the
  hospital.
• Information is consistently shared with AOC and
  Medical Director on Call (MDOC) through out the
  donation process.
• Notification of family wishes to donate are made
  to the Medical Examiner (ME) or Coroner,
  clearance is obtained on all stated ME/Corner
  cases.

18
Who is MDOC?

• Medical Director On Call (MDOC).
• Dr. Pearson Emory University
• Dr. Whelchel Piedmont Hospital
• Dr. Wynn MCG
• A group of local transplant surgeons who offer
  suggestions regarding the plan of action and are
  available for medical consultation.

19
Recovery Services Coordinator Arrives

• Assess patient
• Review consent, brain death, and CT results
• Review current medications and ventilator
  settings
• Review lab results
• Write orders
• Order tests
• (ekg, echo, cxr, bronch, labs)

• Donor stabilization
• Obtain blood and lymph node for immunology and
  tissue typing
• Try to decrease pressors
• Paperwork
• Phone calls
• Multiple faxes

20
The Results are In

• Recipient lists are formulated based on donor
  height, blood type, and weight.
• The lists are formulated by UNOS according to
  their policy on listing criteria.
• Organ offers are made to transplant centers,
  beginning at the top of the waiting list.
• If a transplant center declines an organ offer,
  the reason is coded and the next center is called
  on the list.

21
Organs Have Been Placed

• AOC and Referral Coordinator are notified of the
  plan to set OR time.
• A group effort of coordination occurs between the
  Recovery Services Coordinator, hospital OR, ICU
  staff, transportation, Referral Coordinator,
  recipient teams, and recipient ORs.
• OR TIME IS SET!!!!!!!!

22
OR Time

• Supplies are brought in either by a Recovery
  Services Coordinator or by a Surgical
  Coordinator.
• OR is prepared by Surgical Coordinator
• Patient is transported to the OR by a Recovery
  Services Coordinator, an ICU Nurse, a Respiratory
  Therapist, and any extra hands that might be
  available.

23
Anesthesia

• No anesthetic gas is necessary due to patients
  status of brain death.
• Monitors patients hemodynamics during the case.
• Administers prescribed medications (heparin,
  lasix, mannitol, and pressors) when asked by the
  Recovery Surgeons.
• Completes anesthesia paperwork.
• Turns off ventilator at time which Recovery
  Surgeons request.

24
Recovering Organs

• Organs are flushed prior to being removed from
  the body.
• Organs are taken to a small back table for
  inspection and/or biopsy, if requested by
  recovery team.
• Organs are packaged according to UNOS policy
  prior to leaving the OR.
• Organs are then transported to the transplant
  center.

25
Final Steps

• The body is closed surgically with suture.
• The body is cleaned and all tubes are removed
  (depending on if there will be an autopsy).
• Toe tag and body are placed in a body bag.
• Body is transported to the morgue.
• Toe tag placed on the outside of the body bag.

26
At the End of the Donation Process

• The donation process wouldn't be possible without
  the extraordinary efforts from all members of the
  hospital staff and the procurement team working
  as one.  We can all walk away from this
  experience knowing that a family's wish for their
  loved one was facilitated, and the lives of many
  other people were touched in a very extraordinary
  way.