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Organ Donation End of Life care in the Operating Room Matthew Bock Surgical recovery coordinator

Organ Donation End of Life care in the Operating Room Matthew Bock Surgical recovery coordinator. University of Wisconsin Organ Procurement Organization 1-866-UWHC OPO (1-866-894-2676). Perspective. Remembering why we’re here. Save lives through transplantation

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Organ Donation End of Life care in the Operating Room Matthew Bock Surgical recovery coordinator

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  1. Organ DonationEnd of Life care in the Operating RoomMatthew BockSurgical recovery coordinator University of Wisconsin Organ Procurement Organization 1-866-UWHC OPO (1-866-894-2676)

  2. Perspective

  3. Remembering why we’re here • Save lives through transplantation • Supporting the family’s choice • Honoring the patient’s wishes

  4. Donation after Cardiac Death (DCD)

  5. Uniform Determination of Death Act, 1980 • Irreversible cessation of circulatory and respiratory function - OR- • Irreversible cessation of all functions of the entire brain, including the brain stem

  6. Donation After Brain Death Donation After Cardiac Death (DCD) Two ways to donateDeceased Organ Donation

  7. Brain Death Severe neurological injury Meets Brain death criteria: -Clinical exam -Apnea test DCD Severe neurological injury Does not meet criteria for brain death Family has elected to withdraw support

  8. Brain Death Severe neurological injury Meets Brain death criteria: -Clinical exam -Apnea test DCD Severe neurological injury Does not meet criteria for brain death Family has elected to withdraw support

  9. Clinical Diagnosis of Brain Death • Unresponsive to all stimuli • No spontaneous respiratory activity • All brain stem reflexes are absent: • Pupillary response to light • Corneal reflexes • Oculo-vestibular reflex (caloric response) • Oculocephalic reflex (doll’s eye phenomenon) • Gag reflex

  10. Apnea Test • Make sure patient has normal body temp, blood pressure, volume status, ABG’s • Disconnect from ventilator • Monitor continuous pulse oximetry • Administer 100% O2 at 6 L/min into the trachea • Monitor closely for respiratory movements • Check serial ABG’s, or at approx. 8 minutes • If no respiratory movement and arterial PCO2 is > 60 mm Hg, the apnea test supports the clinical diagnosis of brain death

  11. Apnea Test • Make sure patient has normal body temp, blood pressure, volume status, ABG’s • Disconnect from ventilator • Monitor continuous pulse oximetry • Administer 100% O2 at 6 L/min into the trachea • Monitor closely for respiratory movements • Check serial ABG’s, or at approx. 8 minutes • If no respiratory movement and arterial PCO2 is > 60 mm Hg, the apnea test supports the clinical diagnosis of brain death

  12. Brain Death Severe neurological injury Meets Brain death criteria: -Clinical exam -Apnea test DCD Severe neurological injury Does not meet criteria for brain death Family has elected to withdraw support

  13. Brain Death Severe neurological injury Meets Brain death criteria: -Clinical exam -Apnea test DCD Severe neurological injury Does not meet criteria for brain death Family has elected to withdraw support

  14. Severe Neurologic Injury • Trauma • MVA, Fall • SDH • Anoxia • Cardiac Arrest, near drowning

  15. Brain Death Severe neurological injury Meets Brain death criteria: -Clinical exam -Apnea test DCD Severe neurological injury Does not meet criteria for brain death Family has elected to withdraw support

  16. Two ways to donate Donation After Brain Death • Patient is maintained on ventilator for organ recovery • Organs dissected insitu • 3-4 hour surgery Donation After Cardiac Death (DCD) • Patient is extubated in the Operating Room or ICU • Surgery begins 5 minutes after cessation of cardiac function and declaration by patient’s physician • Rapid recovery with organs procured en bloc.

  17. Two ways to donate Donation After Brain Death • Patient is maintained on ventilator for organ recovery • Organs dissected insitu • 3-4 hour surgery Donation After Cardiac Death (DCD) • Patient is extubated in the Operating Room or ICU • Surgery begins 5 minutes after cessation of cardiac function and declaration by patient’s physician • Rapid recovery with organs procured en bloc.

  18. Two ways to donate Donation After Brain Death • Patient is maintained on ventilator for organ recovery • Organs dissected insitu • 3-4 hour surgery Donation After Cardiac Death (DCD) • Patient is extubated in the Operating Room or ICU • Surgery begins 5 minutes after cessation of cardiac function and declaration by patient’s physician • Rapid recovery with organs procured en bloc.

  19. “We don’t do that here”

  20. ICU nurse RT OPO staff No family yet

  21. Who is involved? Hospital Anesthesia Surgical Technician/Scrub Nurse Circulating Nurse Abdominal Transplant Team - Surgeon - Physician Assistant - Surgical Recovery Coordinator Cardiothoracic Team - Surgeon - Surgical Fellow - Surgical Recovery Coordinator

  22. Paperwork • Consent x2 • Time out • Post Op disposition • Death packet

  23. Prep & drape • Femoral cutdown • Cover patient and back table • Unnecessary staff exits the room

  24. DCD Withdrawal in the OR Accommodating the Family

  25. Meds, Withdrawal & Declaration

  26. How long can we wait?

  27. Rapid En-bloc recovery

  28. Organ Preservation Time • Heart: 4-6 hrs • Lungs: 4-6 hrs • Liver: 12 hrs • Pancreas: 18 hrs • Kidneys: 24 hrs

  29. A wedding story

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