LifeShare University
LifeShare University
  • Home
  • General Donation
  • Healthcare Professionals
    • Post Donor Case Experience
    • Orientation Videos
    • The Alliance Online Training CME Credits
    • Clinical Triggers for Timely Referral
    • Brain Death and Donation
    • Circulatory Death and Donation
    • Living Donation
    • Tissue Donation
    • Approaching Donor Families
  • Education
    • Secondary Education
    • Higher Education
    • Driver's Education
  • End-of-Life
    • Funeral Home Partnership
    • Religious Leaders
  • Advocates
    • Required Advocate Training
    • Request a Speaker
    • Event Booth Set Up
    • Talking Points
  • Tag Agency Partnership

CLINICAL TRIGGERS FOR TIMELY REFERRALS





​
Understanding Clinical Triggers
​for Organ Donation

presented by
Taylor Risenhoover, R.N.

TIMELY REFERRAL CRITERIA* ​FOR ORGAN DONATION

Immediately report any ventilated patient meeting any of the following clinical triggers:
​•  GCS < 5, regardless of sedation     
•  Brain death testing discussed, planned or initiated
•  Any consideration of de-escalation of care, DNR or withdrawal of any life sustaining therapies

•  Family initiates conversation about donation

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

•  The bedside RN is the critical starting point for every life saved
•  DO NOT initiate any donation conversation with family
•  ME case DOES NOT rule out donation
•  Refer every patient that meets criteria, regardless of age or disease process
•  Call on all status, changes even if patient has been previously referred
•  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.
DOWNLOAD ORGAN REFERRAL CRITERIA BADGE CARDS
Picture
Picture

GLASGOW COMA SCALE

Picture
​•   DO NOT approach the family for donation
•   First person authorization will be determined by a LifeShare
•   ME case does not rule out donation
•   LifeShare will send a coordinator on-site for each organ referral
    to medically evaluate.

MAKE THE CALL 1-800-241-4483


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 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.
TIMELY TISSUE REFERRAL CRITERIA BADGE CARDS
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 TYPICAL 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 overinflated (>30 cm H20)
•  Keep head of bed at 30 degree angle
•  Continue to perform oral care
•  ​Keep lavage suctioning to a minimum
RESPIRATORY THERAPIST CLINICAL TRIGGERS
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
​No anesthesia required - in most cases
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 pronounces final time of death (5 minutes after initial CTOD) in the OR and recovery begins.
OR EQUIPMENT
NEEDED
Slush Machine x 2
Sternal Saw (test)
Neptune or Dornoch
Extra Back Tables
Cautery Machine x 2
​10” Long Vascular Clamp
Slush Machine x 2
Sternal Saw (test)
Neptune or Dornoch
Extra Back Tables
No Cautery
​10” Long Vascular Clamp
ORGANS
RECOVERED
​Heart, lungs, liver, pancreas, kidneys and intestines
​Lungs, liver, pancreas and kidneys

OPERATING ROOM

•  ​Surgical Recovery Coordinator (SRC) will arrive no less than 1 hour before case to help set up and answer questions
•  ​OR needs to be open and ready to go for all DCD’s 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, Kidneys, Pancreas, Intestines
•  ​SRCs are responsible for identifying anatomy, dissecting, cannulating renal arteries, and placing on kidney pump
DONATION AFTER BRAIN DEATH VS. DONATION AFTER CIRCULATORY DEATH
Picture
Picture

​REFERRAL FLOW SHEET
Picture

​TISSUE AND EYE SCREENING INFORMATION SHEET
ORGAN, TISSUE AND EYE SCREENING INFORMATION SHEET
Picture
Picture

​MAKE THE CALL POSTER FOR ORGAN DONATION
MAKE THE CALL POSTER FOR TISSUE DONATION
Picture
Picture
Picture
*This criteria meets Center for Medicare & Medicaid Services regulations pertaining to organ and tissue donation.

Picture
Picture
Picture
LifeShare University is brought to you by LifeShare Transplant Donor Services of Oklahoma
4705 NW Expressway • Oklahoma City, OK 73132 • (405) 840-5551
All Rights Reserved. Copyright © 2015