DIFFERENCES?
BRAIN DEATH
Patient has a legal declaration of death based on neurological criteria. Patient remains on ventilator and hemodynamic support until OR time for donation.
Tests include bedside clinical and apnea exam. When an apnea exam is not possible, ancillary testing such as, but not limited to, a cerebral perfusion scan (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 Q6 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 aorta.
Tests include bedside clinical and apnea exam. When an apnea exam is not possible, ancillary testing such as, but not limited to, a cerebral perfusion scan (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 Q6 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 aorta.
DCD
Patient is not legally declared deceased until after extubation and cardiac death occurs.
The family has accepted grim prognosis and opted to modify goals of care for comfort measures and withdrawal of life sustaining treatment.
The donation pathway begins after the decision to withdraw has occured, and a time will be coordinated for compassionate extubation.
LifeShare continues to work with the hospital attending prior to extubation for any evaluation and diagnostic needs related to the donation process. The LifeShare coordinator will request orders, but the order are ordered by the attending physician.
At a minimum, coordinator of care may include standard labs, an antibiotic dose prior to extubation, and an x-ray.
A time for extubation will be arranged with the family, hospital and incoming recovery team for organ procurement.
This process 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 reassessed after 5 minutes. This ensures that there has been no autoresuscitation 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 in place where death must occur for a patient to be an organ donor. This time limitation starts when the patient is extubated.
Typically, this time limitation ranges from 60-120 minutes from time of extubation to time of death. The time limit will differ based on patient age and other circumstances. The reason for this time limitation is because warm ischemic damage to organs occurs when there is not a good source of perfusion.
If the patient does not pass within the alotted timeframe, palliative type care by hospital staff continues as usual.
The family has accepted grim prognosis and opted to modify goals of care for comfort measures and withdrawal of life sustaining treatment.
The donation pathway begins after the decision to withdraw has occured, and a time will be coordinated for compassionate extubation.
LifeShare continues to work with the hospital attending prior to extubation for any evaluation and diagnostic needs related to the donation process. The LifeShare coordinator will request orders, but the order are ordered by the attending physician.
At a minimum, coordinator of care may include standard labs, an antibiotic dose prior to extubation, and an x-ray.
A time for extubation will be arranged with the family, hospital and incoming recovery team for organ procurement.
This process 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 reassessed after 5 minutes. This ensures that there has been no autoresuscitation 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 in place where death must occur for a patient to be an organ donor. This time limitation starts when the patient is extubated.
Typically, this time limitation ranges from 60-120 minutes from time of extubation to time of death. The time limit will differ based on patient age and other circumstances. The reason for this time limitation is because warm ischemic damage to organs occurs when there is not a good source of perfusion.
If the patient does not pass within the alotted timeframe, palliative type care by hospital staff 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 heart cath for visual diagnostic of vessels. An ECHO must be completed in order to start allocation for transplant. |
Lungs |
A chest x-ray, bronchoscopy, bronchial cultures, 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 track. If there is no known kidney disease, the kidneys 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 Q6 hours. |
With both pathways, hospital 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 the transplant centers request for further testing or evaluation, we do our best to facilitate their request. This ensures they can make a decision to accept or decline the organ for their recipient.
LifeShare works to allocate each organ until it's accepted or it's determined that there is not a match for the gift.
LifeShare coordinators are more involved with a brain dead donation because determination of death has occurred. With DCD donation, the patient remains under the care of 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 the transplant centers request for further testing or evaluation, we do our best to facilitate their request. This ensures they can make a decision to accept or decline the organ for their recipient.
LifeShare works to allocate each organ until it's accepted or it's determined that there is not a match for the gift.
LifeShare coordinators are more involved with a brain dead donation because determination of death has occurred. With DCD donation, the patient remains under the care of 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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