LifeShare University
LifeShare University
  • Home
  • General Donation
    • Benefits of Organ Donation
    • Benefits of Tissue Donation
  • Hospital Staff
    • Post Case Survey
    • Overview >
      • Hospital Unit Binders
      • 5 Donation Pathways
      • Regulations and Laws
      • Family Support
      • Approaching Donor Families
    • Organ Donation >
      • Clinical Triggers for Timely Referral
      • Brain Death and Donation
      • Circulatory Death and Donation
      • Donation Case Role Delineation
      • Operating Room
    • Tissue Donation >
      • Tissue Donation Criteria
    • Education >
      • 2025 Webinar Series
      • Hospital In-Service >
        • RT Role Information
        • Organ Donation Two Pathways
        • Timely Referrals and Pathways Training
        • Planned Donation Conversations
        • Tissue Education
      • Orientation Videos
      • DCD Education Guide
  • Public Education
    • Secondary Education
    • Higher Education
    • Driver's Education
    • Volunteers >
      • LifeShare Volunteer Training
    • Tag Agency Partnership
  • End-of-Life
    • Religious Leaders

CLINICAL TRIGGERS FOR TIMELY REFERRALS





​
Understanding Clinical Triggers
​for Organ Donation

presented by
Taylor Risenhoover, R.N.

TIMELY REFERRAL CRITERIA* ​FOR ORGAN DONATION

Report any patient immediately, within 60 minutes, on a ventilator that meets any of the following clinical triggers:
​•  Any discussion or consideration of withdrawal of life sustaining therapies, or deceleration of care (example: goals of care conversations, palliative care
    consults or DNR discussion for purposes to not escalate care) OR
•  Brain death testing discussed, planned or initiated OR
​•  GCS < 5, NOT due to sedation or paralytics OR   
•  Family initiates conversation about donation
*Any patient in ICU that is on bipap or ECMO may also qualify for organ donation with these triggers.
*A consult does NOT indicate a family conversation will occur. The consult is only made for initial evaluation of the clinical status for eligibility.

WHEN TO UPDATE THE DONOR REFERRAL

• Code status changes to DNR
​• Significant neurological decline
• Family decision to terminally wean or withdraw medical therapy
• Your patient becomes unstable
​• A cardiac time of death, even when previously referred for organ donation

REMEMBER: WAIT, DON'T EXTUBATE ​MAKE THE CALL 1-800-241-4483

• ME case does not rule out donation
• Per CMS, do not mention donation to the family

• LifeShare will check registry status and be the first to speak with family about donation
• Donor suitability is evaluated and a coordinator will notify the hospital of LifeShare’s plan
• Please call with any updates to patient status
• Reminder: Always call within 60 minutes of cardiac time of death
​*This criteria meets Center for Medicare & Medicaid Services regulations pertaining to organ and tissue donation.
Picture
Picture
Picture

TIMELY TISSUE REFERRAL CRITERIA*​ FOR TISSUE DONATION
​
​MAKE THE CALL 1-800-241-4483

•  Call on EVERY death
•  Call within ONE HOUR of patient's death​
•  DO NOT call the funeral home until after speaking with the LifeShare Coordinator
•  DO NOT initiate any donation conversation with family
•  ME case DOES NOT rule out donation
•  The bedside RN is the critical starting point for every life saved through donation
•  Refer every patient death, regardless of age or disease process
•  Late and missed referrals lose lives
•  ​Patient's donor registration status will be determined by LifeShare
​​*This criteria meets Center for Medicare & Medicaid Services regulations pertaining to organ and tissue donation.
Picture
Picture

RESPIRATORY THERAPIST CLINICAL TRIGGERS

•  When you receive an order for terminal extubation
OR

•  ​Plans for brain death and/or apnea testing are being made
•  Take a time out
•  Verify that the patient has been referred to and evaluated by LifeShare
•  DO NOT initiate any donation conversation with family

REMEMBER: WAIT, DON'T EXTUBATE ​​​MAKE THE CALL 1-800-241-4483

RESPIRATORY CARE OF A BRAIN DEAD DONOR

•  Please DO NOT make vent changes without speaking to the LifeShare Coordinator unless emergent care needed
•  If you have questions, please ask, so we can explain the process
•  Ensure ETT cuff is inflated at 
>30 cm H2O
•  Maintain current orders

•  Keep head of bed at 30 degree angle
•  Continue to perform oral care
•  Keep lavage suctioning to a minimum
Picture
Picture

​DONATION AFTER BRAIN DEATH (DBD) VS. ​DONATION AFTER CIRCULATORY DEATH (DCD)

c
​​Donation After Brain Death (DBD)
​Donation After Circulatory Death (DCD)
​TYPE
​Beating heart donor
​Deceased donor
ANESTHESIA
​Anesthesia required
​Anesthesia may be required
TIME FRAME
​Scheduled OR time - goes to OR on the vent
​Scheduled WDS time - OR staff available to help transport. Patient has a specified time frame to expire. After CTOD, rapid transport to OR for recovery. Hospital physician confirms death
​(5 minutes after CTOD) in the OR and recovery begins.
*Process at some hospitals may be different*
OR EQUIPMENT
NEEDED
Slush Machine x 2
Sternal Saw with Blade (test)
Neptune or Dornoch
Extra Back Tables x 2-5
Cautery Machine x 2
​10” Long Vascular Clamp
​IV poles x 2-3
Slush Machine x 2
Sternal Saw with Blade (test)
Neptune or Dornoch
Extra Back Tables x 2-5
Cautery may be required
​10” Long Vascular Clamp
​IV poles x 2-3
ORGANS
RECOVERED
​Heart, lungs, liver, pancreas, kidneys and intestines
​Heart, lungs, liver, pancreas, kidneys and intestines

OPERATING ROOM

• Surgical Recovery Coordinator (SRC) will arrive 1.5 hours before case to help set up and answer questions
• OR needs to be open and ready to go for all DCDs prior to WDS/extubation
• Circulator and anesthesia will assist in transporting donor to OR
• Prep and drape
• Time out performed by circulator
• LifeShare staff will perform a Moment of Silence for the donor

After Cross Clamp
• SRC will start flushing organs to start preservation process
• Anesthesia will turn off the anesthesia machine
• Order of operation: Heart, Lungs, Liver, Pancreas, Kidneys, Intestines unless organ is going for research. Research organs are recovered last.
• SRCs are responsible for identifying anatomy, dissecting, cannulating renal arteries, and placing kidneys on pump
• If a medical examiner case, all lines will be left in place
Picture
Picture

Picture
Picture
Picture
*This criteria meets Center for Medicare & Medicaid Services regulations pertaining to organ and tissue donation.

LifeShare University is brought to you by LifeShare Network, Inc.
Headquarters: 4705 NW Expressway • Oklahoma City, OK 73132 • (405) 840-5551
Tulsa Branch: 1924 S. Utica Avenue, Suite 1000, Tulsa, OK 74104
Clinical Innovation Center: 7001 NW 63rd Street, Oklahoma City, OK 73132
All Rights Reserved. Copyright © 2025