differences?
BRAIN DEATH
Pt has a legal declaration of death by neurological criteria. Pt remains on ventilator and hemodynamic support until OR time for donation.
Test include bedside clinical and apnea exam. When an apnea is not possible, ancillary testing such as, but not limited to, CBF can be done.
LifeShare becomes the attending provider in this pathway because the patient is declared deceased and a death note has been written.
Many hospitals have an attending named Dr. LifeShare for the patient to be transferred to. If your hospital does not have that option, the attending provider will remain listed.
Coordination of care will include ordering q 6 hour labs. Each organ is evaluated for potential transplant. Allocation is specified below!
The OR is set and coordinated with all incoming recovery teams and hospital OR.
There is minimal warm ischemia to the organs because the heart is beating until cross clamp of organs.
Test include bedside clinical and apnea exam. When an apnea is not possible, ancillary testing such as, but not limited to, CBF can be done.
LifeShare becomes the attending provider in this pathway because the patient is declared deceased and a death note has been written.
Many hospitals have an attending named Dr. LifeShare for the patient to be transferred to. If your hospital does not have that option, the attending provider will remain listed.
Coordination of care will include ordering q 6 hour labs. Each organ is evaluated for potential transplant. Allocation is specified below!
The OR is set and coordinated with all incoming recovery teams and hospital OR.
There is minimal warm ischemia to the organs because the heart is beating until cross clamp of organs.
DCD
Pt is not legally declared deceased until after extubation and cardiac death occurs.
The family has accepted grim prognosis and opt to modify goals of care for comfort measures and withdraw of life sustaining treatment.
The donation pathway begins after that decision to withdrawal to coordinate a time for when compassionate extubation will occur.
LifeShare continues to work with the hospital attending prior to a coordinated extubation time for any evaluation required for donation to occur after death.
Coordination of care will include standard labs, antibiotic dose prior to extubation and an x-ray at minimum.
A time for extubation will be set with family, hospital and incoming recovery team for organ procurement.
This is well coordinated because the recovery of organs must happen shortly after the time of death to minimize ischemic time.
If there is too much ischemia to the organs, they may not be suitable for transplant.
After the time of death, confirmation of death is checked after 5 minutes. This ensures that there is no auto resuscitation of the heart.
After the 5 minute confirmation time is observed, organ recovery begins and occurs rapidly.
Time Limits for Donation
There is a time limitation after time of extubation to time of death that has to occur in order for a patient to be an organ donor.
Typically, it can be 60-120 minutes and the time limit will differ on patient age and circumstances. The reason for this is because it affects the warm ischemia to the organs when there is not a source of perfusion.
If the patient does not pass within the alotted timeframe, palliative type care continues as usual.
The family has accepted grim prognosis and opt to modify goals of care for comfort measures and withdraw of life sustaining treatment.
The donation pathway begins after that decision to withdrawal to coordinate a time for when compassionate extubation will occur.
LifeShare continues to work with the hospital attending prior to a coordinated extubation time for any evaluation required for donation to occur after death.
Coordination of care will include standard labs, antibiotic dose prior to extubation and an x-ray at minimum.
A time for extubation will be set with family, hospital and incoming recovery team for organ procurement.
This is well coordinated because the recovery of organs must happen shortly after the time of death to minimize ischemic time.
If there is too much ischemia to the organs, they may not be suitable for transplant.
After the time of death, confirmation of death is checked after 5 minutes. This ensures that there is no auto resuscitation of the heart.
After the 5 minute confirmation time is observed, organ recovery begins and occurs rapidly.
Time Limits for Donation
There is a time limitation after time of extubation to time of death that has to occur in order for a patient to be an organ donor.
Typically, it can be 60-120 minutes and the time limit will differ on patient age and circumstances. The reason for this is because it affects the warm ischemia to the organs when there is not a source of perfusion.
If the patient does not pass within the alotted timeframe, palliative type care continues as usual.
Organ Diagnostics associated:
Heart |
The LifeShare team will work with you to evaluate if this is a possibility! The patient must be off vasopressor support prior to ordering an ECHO. For certain age ranges, the transplant centers may request a cath lab for visual diagnostic of vessels. An ECHO must be completed in order to start allocation for transplant. |
Lungs |
A chest x-ray, bronchoscopy, BALs, and ABGs must be done prior to starting allocation to transplant centers for lung donation. |
Liver |
A liver panel to be done q6 hours. CT or ultrasound of liver may be requested for further evaluation. |
Kidneys |
Urine output and q6 labs are important to keep track of. If there is no known kidney disease, they are typically allocated to transplant centers after recovery of all organs. |
Pancreas and Small Intestine |
Pancreas and Small Intestines are less common to transplant but will be evaluated on a case-by-case basis. If pursuing for transplant, labs such as amylase and lipase will be ordered q 6. |
With both pathways, nursing staff is essential and vital to successful outcomes of placing organs for transplant.
LifeShare serves as a liaison between the donor and the transplant centers. When they request for further testing or evaluation, we do our best to facilitate so they can make a decision to accept or decline the organ for their recipient.
LifeShare allocates each organ until its accepted or the list is exhausted and determined that there is not a match for the gift.
LifeShare coordinators are more involved with a brain-dead case because determination of death has occurred. With DCD donation, the patient remains under the attending physician until death is declared and the patient goes to the OR.
Criteria for brain death testing can be found on the American Association of Neurology website: https://www.aan.com/Guidelines/Home/GuidelineDetail/1085
LifeShare serves as a liaison between the donor and the transplant centers. When they request for further testing or evaluation, we do our best to facilitate so they can make a decision to accept or decline the organ for their recipient.
LifeShare allocates each organ until its accepted or the list is exhausted and determined that there is not a match for the gift.
LifeShare coordinators are more involved with a brain-dead case because determination of death has occurred. With DCD donation, the patient remains under the attending physician until death is declared and the patient goes to the OR.
Criteria for brain death testing can be found on the American Association of Neurology website: https://www.aan.com/Guidelines/Home/GuidelineDetail/1085
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