Brain Death vs. DCD
Brain Death
A patient has been pronounced clinically deceased via brain death testing.
If authorization for donation is obtained, LifeShare will assume care of the deceased patient and become the attending physician.
The patient will remain on the ventilator for the next few days while LifeShare works to find recipients for the donated organs.
If authorization for donation is obtained, LifeShare will assume care of the deceased patient and become the attending physician.
The patient will remain on the ventilator for the next few days while LifeShare works to find recipients for the donated organs.
Donation After Cardiac Death
The patient is not clinically deceased; however, they have been given a grave prognosis, and family has agreed to withdraw life sustaining therapies. Without the support of life sustaining therapies, death would likely occur.
After the decision for comfort care, donation authorization is obtained if the patient is an organ candidate for DCD.
The patient will remain in the care of the hospital, while LifeShare works in the background to identify recipients.
LifeShare is not the treating team, and all requested orders are recommendations for organ donation to effectively take place.
When all recipients are identified, we collaborate with the family, ICU staff, OR staff, accepting transplant center, and LifeShare staff, to schedule a time to remove all life sustaining therapies (Extubation, ECMO, Bipap, Pressors, etc.).
Medications for comfort will be given only by a member of the hospital staff, LifeShare does not give recommendations for comfort medications.
If cardiac death occurs within the set timeframe for donation, the patient will be moved rapidly to the OR. If the patient does NOT pass, they will continue their comfort care process and organ donation is no longer a possibility. However, tissue donation may still be possible after the patient experiences a cardiac death.
After the decision for comfort care, donation authorization is obtained if the patient is an organ candidate for DCD.
The patient will remain in the care of the hospital, while LifeShare works in the background to identify recipients.
LifeShare is not the treating team, and all requested orders are recommendations for organ donation to effectively take place.
When all recipients are identified, we collaborate with the family, ICU staff, OR staff, accepting transplant center, and LifeShare staff, to schedule a time to remove all life sustaining therapies (Extubation, ECMO, Bipap, Pressors, etc.).
Medications for comfort will be given only by a member of the hospital staff, LifeShare does not give recommendations for comfort medications.
If cardiac death occurs within the set timeframe for donation, the patient will be moved rapidly to the OR. If the patient does NOT pass, they will continue their comfort care process and organ donation is no longer a possibility. However, tissue donation may still be possible after the patient experiences a cardiac death.
Role Delination
RT Responsibilities
Performing scheduled therapy, charting ventilator checks, assisting LifeShare coordinators with ventilator settings, transporting patients to necessary diagnostic testing, extubation for DCD donation, clamping ETT before removing from ventilator, challenge ABG’s, and collecting respiratory samples/cultures.
Performing scheduled therapy, charting ventilator checks, assisting LifeShare coordinators with ventilator settings, transporting patients to necessary diagnostic testing, extubation for DCD donation, clamping ETT before removing from ventilator, challenge ABG’s, and collecting respiratory samples/cultures.
LifeShare Responsibilities
BD: Making vent changes for lung recruitment, communicating transport needs to RT, suctioning, initiation of proning, ABG’s, and changing respiratory orders
DCD: (all are recommendations) Vent settings, Respiratory medications/CPT orders, communicating the lung goals.
BD: Making vent changes for lung recruitment, communicating transport needs to RT, suctioning, initiation of proning, ABG’s, and changing respiratory orders
DCD: (all are recommendations) Vent settings, Respiratory medications/CPT orders, communicating the lung goals.
Clinical Management
Challenge ABG’s: All ABG’s, unless told otherwise, will need to be challenge ABG’s.
How to: Place the patient on a peep of 5 and 100% FiO2 for 30 minutes. After waiting 30 minutes, draw your ABG. The patient can now be changed back to original peep and FiO2 settings.
*If your patient can not tolerate these changes safely, notify the LifeShare Organ Recovery Coordinator*
Clamping ETT: It is important to remember to always clamp the ETT with hemostats when moving to a transport ventilator. LifeShare may be assessing lung donation potential and working to optimize recruitment. If recruitment is lost, there is the risk of needing to re-recruit (can take up to 12+ hours).
Transporting: Ventilator transport is always required when the lungs are being donated. Ambubags are less optimal for all donors but can be done if lungs are not being donated. Always check in with the organ recovery coordinator if you are unsure about the transport method.
How to: Place the patient on a peep of 5 and 100% FiO2 for 30 minutes. After waiting 30 minutes, draw your ABG. The patient can now be changed back to original peep and FiO2 settings.
*If your patient can not tolerate these changes safely, notify the LifeShare Organ Recovery Coordinator*
Clamping ETT: It is important to remember to always clamp the ETT with hemostats when moving to a transport ventilator. LifeShare may be assessing lung donation potential and working to optimize recruitment. If recruitment is lost, there is the risk of needing to re-recruit (can take up to 12+ hours).
Transporting: Ventilator transport is always required when the lungs are being donated. Ambubags are less optimal for all donors but can be done if lungs are not being donated. Always check in with the organ recovery coordinator if you are unsure about the transport method.
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FAQ
Who is eligible to be a donor? - Anyone on a life-sustaining therapy (Vent, Bipap, ECMO) with the intention of removing support to allow for a natural death
Does it have to be an RN to call? - No! Anyone from the healthcare team can call -in a patient
How do I call in a referral? - Call 1-800-241-4483. They will ask some basic questions: Chief complaint, plans to withdrawal support (Y/N), plans for brain death testing, and PMH questions
I made the call, now what? - After making a referral, it will get paged to a LifeShare coordinator who will call you back with more questions or come to the unit to follow up.
If comfort care orders (extubation) are placed, what should I do? - Before extubating for comfort care, ensure that LifeShare has already been called and the patient is not eligible for organ donation
If my patient is on high flow nasal/trach oxygen, do I need to call in a referral prior to CMO? – No. Only patients that are on life sustaining therapies (Ventilator, Bipap, or ECMO) need to be called into LifeShare. Why? – although oxygen can be lifesaving, there is no mechanical support keeping them alive, and death cannot be predicted as imminent
Who is eligible to be a tissue donor? - Anyone with a cardiac time of death (CTOD). Includes DCD and BD donors.
Does it have to be an RN to call? - No! Anyone from the healthcare team can call -in a patient
How do I call in a referral? - Call 1-800-241-4483. They will ask some basic questions: Chief complaint, plans to withdrawal support (Y/N), plans for brain death testing, and PMH questions
I made the call, now what? - After making a referral, it will get paged to a LifeShare coordinator who will call you back with more questions or come to the unit to follow up.
If comfort care orders (extubation) are placed, what should I do? - Before extubating for comfort care, ensure that LifeShare has already been called and the patient is not eligible for organ donation
If my patient is on high flow nasal/trach oxygen, do I need to call in a referral prior to CMO? – No. Only patients that are on life sustaining therapies (Ventilator, Bipap, or ECMO) need to be called into LifeShare. Why? – although oxygen can be lifesaving, there is no mechanical support keeping them alive, and death cannot be predicted as imminent
Who is eligible to be a tissue donor? - Anyone with a cardiac time of death (CTOD). Includes DCD and BD donors.
