OPERATING ROOM
Authorization/Consent
Authorization for organ recovery surgery looks different from the hospital’s usual consent for a procedure.
If a patient is registered, the Document of Gift verifying the patient’s registry status and the Notification paperwork signed by the legal next-of-kin are considered their surgical consent.
If a patient is not registered, the Authorization paperwork signed by the legal next-of-kin and witnessed by hospital staff is considered their surgical consent.
Hospital OR Personnel Needed
• OR Nurse
• Scrub Tech
• Anesthesia
• All brain dead donors
• DCD donors where lungs or heart are being recovered
• Pronouncing physician
• For DCD donors ONLY
• Physician may leave once death note has been completed and signed
Authorization for organ recovery surgery looks different from the hospital’s usual consent for a procedure.
If a patient is registered, the Document of Gift verifying the patient’s registry status and the Notification paperwork signed by the legal next-of-kin are considered their surgical consent.
If a patient is not registered, the Authorization paperwork signed by the legal next-of-kin and witnessed by hospital staff is considered their surgical consent.
Hospital OR Personnel Needed
• OR Nurse
• Scrub Tech
• Anesthesia
• All brain dead donors
• DCD donors where lungs or heart are being recovered
• Pronouncing physician
• For DCD donors ONLY
• Physician may leave once death note has been completed and signed
OPERATING ROOM PROCESS
• 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
• 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
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• LifeShare retractors are dropped off when the LifeShare Coordinator comes on case and needs to be sterilized so it’s ready for the case. LifeShare understands that retractors cannot be flashed and if need be will utilize the hospital retractors.
• The Organ Recovery Coordinator (ORC) will notify the OR once all organs have been placed and set up an OR time with board runner.
• The Surgical Recovery Coordinator (SRC) will arrive to the hospital at least 1.5 hours prior to OR time.
• The Surgical Recovery Coordinator (SRC) will huddle with the board runner and make sure that everything is still on schedule.
• Slush for 2 machines needs to be started 1.5 hours prior to OR time. 3 bottles of NaCl in each slush machine will have continuous slush going. SRC will ask scrub nurse to put slush in a basin, so that more slush can be made once the case has started.
Instruments needed:
• Slush Machine x2
• Sternal Saw with blade
• Neptune or Dornoch
• Extra back tables x 2-5
• Cauther Machine x2
• 10” Long Vascular Clamp
• IV poles x 2-3
Soft items needed for all donors:
• Umbilical tape
• Vessel loops
• Silk ties (2-0, 3-0, 4-0, 0)
• Lap sponges
• Several gowns
• Gloves ranging from sizes 7, 7 ½, 8, 4-0 prolene suture
• 2 -0 silk pops
• 2 ethlion
Instruments needed on mayo:
• Debakeys
• Metz
• Mayo
• Hemostats
• Right angles
• Umbilical tape
• Silk ties
Surgical Recovery coordinator (SRC) will set up LifeShare back table and will possibly ask for more plastic basins. This all depends on how many organs are being procured.
LifeShare Organ Recovery Coordinator (ORC) will communicate with OR staff before and during recovery process.
After recovery is completed, the LifeShare retractors will need to be washed, not sterilized.
On Medical Examiner (ME) organ cases, lines must remain in place and the LifeShare Organ Recovery Coordinator will notify the ME to let them know that the case has been completed.
LifeShare Organ Recovery Coordinator will notify funeral home.
Hospital staff will call security.
Hospital staff will complete death paperwork, if the case is a Donor after circulatory death (DCD).
Hospital pronouncing physician is responsible for the death note on all DCD cases.
LifeShare Organ staff will wait with the donor until they go to the morgue.
*If you have any questions, please contact the LifeShare Coordinator on site.
• The Organ Recovery Coordinator (ORC) will notify the OR once all organs have been placed and set up an OR time with board runner.
• The Surgical Recovery Coordinator (SRC) will arrive to the hospital at least 1.5 hours prior to OR time.
• The Surgical Recovery Coordinator (SRC) will huddle with the board runner and make sure that everything is still on schedule.
• Slush for 2 machines needs to be started 1.5 hours prior to OR time. 3 bottles of NaCl in each slush machine will have continuous slush going. SRC will ask scrub nurse to put slush in a basin, so that more slush can be made once the case has started.
Instruments needed:
• Slush Machine x2
• Sternal Saw with blade
• Neptune or Dornoch
• Extra back tables x 2-5
• Cauther Machine x2
• 10” Long Vascular Clamp
• IV poles x 2-3
Soft items needed for all donors:
• Umbilical tape
• Vessel loops
• Silk ties (2-0, 3-0, 4-0, 0)
• Lap sponges
• Several gowns
• Gloves ranging from sizes 7, 7 ½, 8, 4-0 prolene suture
• 2 -0 silk pops
• 2 ethlion
Instruments needed on mayo:
• Debakeys
• Metz
• Mayo
• Hemostats
• Right angles
• Umbilical tape
• Silk ties
Surgical Recovery coordinator (SRC) will set up LifeShare back table and will possibly ask for more plastic basins. This all depends on how many organs are being procured.
LifeShare Organ Recovery Coordinator (ORC) will communicate with OR staff before and during recovery process.
After recovery is completed, the LifeShare retractors will need to be washed, not sterilized.
On Medical Examiner (ME) organ cases, lines must remain in place and the LifeShare Organ Recovery Coordinator will notify the ME to let them know that the case has been completed.
LifeShare Organ Recovery Coordinator will notify funeral home.
Hospital staff will call security.
Hospital staff will complete death paperwork, if the case is a Donor after circulatory death (DCD).
Hospital pronouncing physician is responsible for the death note on all DCD cases.
LifeShare Organ staff will wait with the donor until they go to the morgue.
*If you have any questions, please contact the LifeShare Coordinator on site.
BRAIN DEAD DONOR – MULTI ORGAN DONOR CASE
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INSTRUMENTS (OPEN)
1 Laparatomy/Major Set 2 Large Long Curved Aortic Clamps 1 Sternal Saw or Lebshe Knife w/mallet 3-4 Metz Scissors (more avail.) 3-4 Debakey Pickups (more avail.) 3 Suction Tubing 3 ea. Yankauer and Poole Suction Tips * 1 Large Balfour * 1 Chest/Sternal Retractor Have Available 1 Vascular Set 1 Deep/Long Set Hemo Clip Appliers (all sizes) Internal Defibrillating Paddles Coronary Artery Dilators 1 Tenotomy Scissors STERILE SUPPLIES (OPEN) 1 Laparatomy Drape w/pouches 2-3 Cautery Pencils 2 ea. #10, #11, #15 blades 2 Asepto 2 Vascular/Rummel Tourniquets 1 Bone Wax 20 Lap Sponges (more avail.) 6 Gowns (more avail.) 1 Basin for Slush 1 Basin per organ recovered 2 Umbilical Tape (more avail.) Extra blue towels SUTURE (OPEN) 2 ea. 0, 2-0, 3-0, 30” Silk Ties (more avail.) 1-2-0 Silk SH pop offs (more avail.) 2 ea. #1 or #2 Ethilon LR (more avail.) Have available 4-0 Prolene RB-1 (for Kidney Bx) 5-0 Prolene RB-1 (for Pericardiam) 1 Large loban or Skin Stapler 1 Trucut Needle (Liver Biopsy Only) Vessel Loops Telfa (for biopsies) 14g Angiocath |
UNSTERILE SUPPLIES/EQUIPMENT
2 Pressure Bags (for Heart) Flexible Branch (for Lungs) I Stat Machine (for Lungs) Defibrillating Machine 2 Neptune Suction Units (or equivalent) 2-3 Cautery Units 2-3 Headlamps 2-3 IV Poles 2-5 Extra Backtables (depending on organs recovered) 2 Prep Stands or 1 Small table (for kidney pumps) 2 Slush Units - If no slush units available, LifeShare will need 15 or more bottles of NS for alcohol/ ice bath 2 Large containers (ex. clean sharps bin) of unsterile ice PREP 2-3 Chloraprep or Duraprep (for skin) 1 Small bottle of Betadine (for Pancreas prep) 1 Toomey Syringe (for Pancreas prep) 1 small bowl (for Pancreas prep) SURGEON’S GLOVES LifeShare will provide sizes once surgeon is known Biogel 7.5 green available Biogel 7.5 white available Biogel 8 white available HELPFUL HINTS Start sterile slush 1 hour prior to OR time Make sure to test sternal saw prior to patient’s arrival Don’t be afraid to ask questions * IF HOSPITAL DOES NOT HAVE RETRACTORS, LIFESHARE WILL BRING A SET TO BE STERILIZED |
DCD DONOR – HEART, LIVER, KIDNEYS AND/OR LUNGS
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INSTRUMENTS (OPEN)
1 Laparatomy/Major Set 2 Large Long Curved Aortic Clamps 1 Sternal Saw or Lebshe Knife w/mallet 2-3 Metz Scissors (more avail.) 2-3 Debakey Pickups (more avail.) 3 Suction Tubing 1 Yankauer, 3 Poole Suction Tips * 1 Large Balfour * 1 Chest/Sternal Retractor Have Available 1 Vascular Set 1 Deep/Long Set Hemo Clip Appliers (all sizes) Coronary Artery Dilators 1 Tenotomy Scissors STERILE SUPPLIES (OPEN) 1 Laparatomy Drape w/pouches 2 ea. #10, #11, #15 blades 2 Asepto 20 Lap Sponges (more avail.) 5 Gowns (more avail.) 1 Basin for Slush 1 Basin per organ recovered 2 Umbilical Tape (more avail.) Extra blue towels Skin stapler SUTURE (OPEN) 2 ea. 0, 2-0, 3-0, 30” Silk Ties (more avail.) 1-2-0 Silk SH pop offs (more avail.) 2 ea. #1 or #2 Ethilon LR (more avail.) Have Available 4-0 Prolene RB-1 (for Kidney Bx) 1 Trucut Needle (Liver Biopsy Only) Vessel Loops Telfa (for biopsies) 14g Angiocath 1 Vascular/Rummel Tourniquet |
UNSTERILE SUPPLIES/EQUIPMENT
1 Neptune Suction Unit (or equivalent) 1-2 Headlamps 2-3 IV Poles 2-5 Extra Backtables (depending on organs recovered) 2 Prep Stands or 1 Small table (for kidney pumps) 2 Slush Units - If no slush units available, LifeShare will need 15 or more bottles of NS for alcohol/ice bath 2 Large containers (ex. clean sharps bin) of unsterile ice Flexible bronch (if taking the lungs) PREP 3 Chloraprep or Duraprep (for skin) SURGEON’S GLOVES LifeShare will provide sizes once surgeon is known Biogel 7.5 green available Biogel 7.5 white available Biogel 8 white available HELPFUL HINTS Start sterile slush 1 hour prior to OR time Make sure to test sternal saw prior to patient’s withdrawal Don’t be afraid to ask questions No bovie is needed on DCD cases 2 scrub techs needed, if possible No anesthesia, however, if lungs are recovered, may need someone to reintubate patient Heart Team will bring equipment necessary to machine perfuse the heart after recovery. * IF HOSPITAL DOES NOT HAVE RETRACTORS, LIFESHARE WILL BRING A SET TO BE STERILIZED |