DIFFERENCES BETWEEN BRAIN DEATH AND DCD?
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BRAIN DEATH Pt has a legal declaration of death by neurological criteria. Pt remains on ventilator and hemodynamic support until OR time for donation. Tests include bedside clinical and apnea exam. When an apnea is not possible, ancillary testing such as, but not limited to, CBF can be done. |
DCD Pt is not legally declared deceased until after extubation and cardiac death occurs. The family has accepted grim prognosis and opt to modify goals of care for comfort measures and withdraw of life sustaining treatment. The donation pathway begins after that decision to withdrawal to coordinate a time for when compassionate extubation will occur. |
PHARMACY
Medications may be requested in support of donor optimization and organ recovery for the following reasons:
Electrolyte Replacement
Electrolyte abnormalities are common in donor cases and can impact donor stability and organ function. Replacement is important to maintain physiological balance and optimize organ outcomes, as electrolyte imbalances have been associated with poorer post-transplant outcomes, including graft dysfunction or loss.
Electrolyte abnormalities are common in donor cases and can impact donor stability and organ function. Replacement is important to maintain physiological balance and optimize organ outcomes, as electrolyte imbalances have been associated with poorer post-transplant outcomes, including graft dysfunction or loss.
Solu-Medrol (Methylprednisolone) – 1,000 mg IV
Solu-Medrol may be administered as part of donor optimization to reduce systemic inflammation and support organ function. This medication is commonly given after authorization for donation and prior to organ allocation. It is not administered for comfort or end-of-life care.
Solu-Medrol may be administered as part of donor optimization to reduce systemic inflammation and support organ function. This medication is commonly given after authorization for donation and prior to organ allocation. It is not administered for comfort or end-of-life care.
Heparin (DCD Donors)
For DCD donors, 30,000 units IV push or bolus may be administered approximately 5 minutes prior to withdrawal of life-sustaining therapy for comfort measures, if approved by the provider. The purpose is to reduce micro-clot formation during the warm ischemic period and support organ viability. Dosing and administration are ordered by the provider and supplied by pharmacy per hospital policy.
For DCD donors, 30,000 units IV push or bolus may be administered approximately 5 minutes prior to withdrawal of life-sustaining therapy for comfort measures, if approved by the provider. The purpose is to reduce micro-clot formation during the warm ischemic period and support organ viability. Dosing and administration are ordered by the provider and supplied by pharmacy per hospital policy.
tPA (Tissue Plasminogen Activator)
tPA may be requested for use with ex-vivo organ perfusion systems during organ recovery. This medication is not administered to the donor. If an organ is placed on a perfusion pump, tPA may be used per perfusion protocol. If unused and unopened, it is returned to pharmacy.
tPA may be requested for use with ex-vivo organ perfusion systems during organ recovery. This medication is not administered to the donor. If an organ is placed on a perfusion pump, tPA may be used per perfusion protocol. If unused and unopened, it is returned to pharmacy.
LABORATORY / BLOOD BANK
Laboratory Testing
Laboratory studies are trended throughout the donation process in accordance with OPTN policy and are required for organ allocation and recipient safety.
Laboratory studies are trended throughout the donation process in accordance with OPTN policy and are required for organ allocation and recipient safety.
Blood Products
Close to OR times, 4-8 units may be ordered to be placed on hold. This blood should be available if it is needed for pump perfusion. If the organ is not placed on pump, blood will be returned to the blood bank.
Close to OR times, 4-8 units may be ordered to be placed on hold. This blood should be available if it is needed for pump perfusion. If the organ is not placed on pump, blood will be returned to the blood bank.
RADIOLOGY / ECHO/ CATH LAB
Diagnostic Imaging
Diagnostic studies are ordered as needed to meet OPTN requirements and transplant center evaluation criteria. These may include X-ray, CT imaging with or without contrast, echo, or cardiac catheterization.
Diagnostic studies are ordered as needed to meet OPTN requirements and transplant center evaluation criteria. These may include X-ray, CT imaging with or without contrast, echo, or cardiac catheterization.
Heart Donor Evaluation
An echocardiogram is required to run an allocation report. If a transplant center expresses intent to accept the organ and requests further evaluation, a cardiac catheterization may be pursued when clinically appropriate.
An echocardiogram is required to run an allocation report. If a transplant center expresses intent to accept the organ and requests further evaluation, a cardiac catheterization may be pursued when clinically appropriate.
Indications for Cardiac Catheterization may include:
• Donor age (typically ≥40 years for males and ≥45 years for females)
• History of IV drug abuse
• Echo results indicate further diagnostics
• Donor age (typically ≥40 years for males and ≥45 years for females)
• History of IV drug abuse
• Echo results indicate further diagnostics
Criteria for brain death testing can be found on the American Association of Neurology website.
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