ORGAN REFERRAL
• Clinical Triggers - Hospital staff makes the call to initiate the referral process. The bedside RN plays a key role here.
• LifeShare coordinators determine donor eligibility.
• LifeShare will speak with the family about donation at the appropriate time.
• Every referral call is an opportunity to SAVE A LIFE.
• LifeShare coordinators determine donor eligibility.
• LifeShare will speak with the family about donation at the appropriate time.
• Every referral call is an opportunity to SAVE A LIFE.
ORGAN ALLOCATION
• Allocation is completed through UNOS (the United Network Sharing System)
• Patients are matched on the waiting list by various factors:
• Match blood type, HLA tissue typing
• Severity of the waiting patient’s illness
• Size of the organ
• Distance between the donor and recipient
• Time on the waiting list
• Patients are matched on the waiting list by various factors:
• Match blood type, HLA tissue typing
• Severity of the waiting patient’s illness
• Size of the organ
• Distance between the donor and recipient
• Time on the waiting list
TYPES OF DONATION CASES
Donation after Circulatory Death (DCD)
• Patient has non-survivable illness or injury.
• Family opts to withdraw life sustaining therapies. If they are determined to be a donation candidate, LifeShare approaches the family and if authorization is obtained, then a time for compassionate extubation is determined and scheduled.
• Scheduled OR time is the same time as withdrawal of life-sustaining therapies. Family is heavily involved with this timing.
• The patient must expire within a timeframe to allow for donation, depending on patient’s age and medical history.
• Family is normally present for the withdrawal. The withdraw can take place in the ICU room, PACU, or OR suite and is dependent on circumstances, logistics and hospital protocols.
• Family opts to withdraw life sustaining therapies. If they are determined to be a donation candidate, LifeShare approaches the family and if authorization is obtained, then a time for compassionate extubation is determined and scheduled.
• Scheduled OR time is the same time as withdrawal of life-sustaining therapies. Family is heavily involved with this timing.
• The patient must expire within a timeframe to allow for donation, depending on patient’s age and medical history.
• Family is normally present for the withdrawal. The withdraw can take place in the ICU room, PACU, or OR suite and is dependent on circumstances, logistics and hospital protocols.
Brain Death
• All cessation of neurological function is noted.
• Legal time of death is documented by physician prior to OR on the brain death note.
• Patient will enter the operating room intubated for continued perfusion.
• Legal time of death is documented by physician prior to OR on the brain death note.
• Patient will enter the operating room intubated for continued perfusion.
Scheduling OR
There are many moving parts to any case. When scheduling an OR the LifeShare Staff are working with the schedules of:
• LifeShare Transplant Surgeons
• Transplant Surgeons of the Recipient for each gift
• Donor Families
• Hospital Physicians & other Staff
• Flights & other transportations
• Current OR schedule
• LifeShare Transplant Surgeons
• Transplant Surgeons of the Recipient for each gift
• Donor Families
• Hospital Physicians & other Staff
• Flights & other transportations
• Current OR schedule
Getting Set Up
• SRC will arrive 2 hours before OR time to help set up and answer questions.
• SRC have all been through extensive training and can set up and assist in the OR independently.
• SRC have all been through extensive training and can set up and assist in the OR independently.
DCD Set Up
• OR needs to be ready to go for all DCDs prior to WDS/extubation.
• Pronouncing physician will pronounce death after patient has expired.
• 5-minute observation time to confirmation of death starts.
• Donor is transported to OR in ICU bed with the help of LS staff, circulator and anesthesia, etc.
• Time-out performed by circulator.
• LifeShare staff will perform a Moment of Silence for the donor and staff.
• Prep and drape to be completed.
• At the 5-minute mark, the pronouncing physician confirms the time of death. If auto resuscitation occurs, the pronouncement process restarts.
• This process is reviewed and explained to the pronouncing physician prior to withdrawal. The pronouncing physician will accompany the donor to the OR for the confirmation of death.
• At this time, the LifeShare team is allowed to begin the recovery process. Incision is made and the organ recovery begins.
• To maintain the highest level of ethics, the LifeShare team is not involved in the pronouncement process or the withdrawal of life sustaining therapies. LifeShare staff cannot fill out the postmortem record.
• Pronouncing physician will pronounce death after patient has expired.
• 5-minute observation time to confirmation of death starts.
• Donor is transported to OR in ICU bed with the help of LS staff, circulator and anesthesia, etc.
• Time-out performed by circulator.
• LifeShare staff will perform a Moment of Silence for the donor and staff.
• Prep and drape to be completed.
• At the 5-minute mark, the pronouncing physician confirms the time of death. If auto resuscitation occurs, the pronouncement process restarts.
• This process is reviewed and explained to the pronouncing physician prior to withdrawal. The pronouncing physician will accompany the donor to the OR for the confirmation of death.
• At this time, the LifeShare team is allowed to begin the recovery process. Incision is made and the organ recovery begins.
• To maintain the highest level of ethics, the LifeShare team is not involved in the pronouncement process or the withdrawal of life sustaining therapies. LifeShare staff cannot fill out the postmortem record.
After Cross Clamp
• SRC will start flushing organs to start preservation process.
• Anesthesia will continue to inflate lungs if lungs are placed for transplant until they are procured. If lungs are not placed, anesthesia will turn off the anesthesia machine.
• Order of operation:
Heart, Lungs, Liver, Pancreas, Intestine and Kidneys
• SRCs are responsible for identifying anatomy, dissecting, cannulating renal arteries and placing on kidney pump.
• Please be aware that additional time is needed when organs have to be reallocated or if biopsies have been requested from the transplant centers.
• LifeShare staff will close the patient.
• It’s important to keep the room sterile until all organs are properly placed in sterile packaging.
• Anesthesia will continue to inflate lungs if lungs are placed for transplant until they are procured. If lungs are not placed, anesthesia will turn off the anesthesia machine.
• Order of operation:
Heart, Lungs, Liver, Pancreas, Intestine and Kidneys
• SRCs are responsible for identifying anatomy, dissecting, cannulating renal arteries and placing on kidney pump.
• Please be aware that additional time is needed when organs have to be reallocated or if biopsies have been requested from the transplant centers.
• LifeShare staff will close the patient.
• It’s important to keep the room sterile until all organs are properly placed in sterile packaging.
Pumps
Liver Pump
• OrganOx Metra, our liver perfusion machine that provides normothermic perfusion technology to preserve donor livers for up to 24 hours prior to transplant.
• OrganOx Metra, our liver perfusion machine that provides normothermic perfusion technology to preserve donor livers for up to 24 hours prior to transplant.
Kidney
• LifePort Kidney Transporter allows for the perfusion circuit to contain the kidney and perfusate under aseptic conditions during transport.
• It is designed to pump OR to OR.
• Eliminates the need for separate cold storage.
• LifePort Kidney Transporter allows for the perfusion circuit to contain the kidney and perfusate under aseptic conditions during transport.
• It is designed to pump OR to OR.
• Eliminates the need for separate cold storage.
Heart
• Transmedics may be consulted to bring a heart pump in the OR
• Transmedics may be consulted to bring a heart pump in the OR
NRP (Normothermic Regional Perfusion)
• In-situ perfusion technique used in DCD donors to restore oxygenated blood flow to organs after circulatory death.
• Cerebral vessels are mandatory to be clamped prior to initiation of perfusion.
• Provides regional perfusion of abdominal (A-NRP) or thoracic (T-NRP) organs while excluding cerebral circulation.
• Reduces warm ischemic injury and allows for assessment of organ viability prior to recovery.
• Initiated after death declaration using extracorporeal circulation at physiologic temperature.
• Performed in accordance with institutional policy and OPTN requirements.
• In-situ perfusion technique used in DCD donors to restore oxygenated blood flow to organs after circulatory death.
• Cerebral vessels are mandatory to be clamped prior to initiation of perfusion.
• Provides regional perfusion of abdominal (A-NRP) or thoracic (T-NRP) organs while excluding cerebral circulation.
• Reduces warm ischemic injury and allows for assessment of organ viability prior to recovery.
• Initiated after death declaration using extracorporeal circulation at physiologic temperature.
• Performed in accordance with institutional policy and OPTN requirements.
THANK YOU FOR HELPING US SAVE LIVES AND INSPIRE HOPE!
