CLINICAL TRIGGERS FOR TIMELY REFERRALS
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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
• 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
• 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.
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GLASGOW COMA SCALE
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• 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
• 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.
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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
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
• 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
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DONATION AFTER BRAIN DEATH (DBD) VS. DONATION AFTER CIRCULATORY DEATH (DCD)
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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
• 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
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*This criteria meets Center for Medicare & Medicaid Services regulations pertaining to organ and tissue donation.
