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The Logistics of Saving Lives as a Mass Exporter

Learn about the efficient management strategies of two OPOs, Nevada Donor Network and New Mexico Donor Services, in maximizing organ donation chances for critical cases.

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The Logistics of Saving Lives as a Mass Exporter

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  1. The Logistics of Saving Lives as a Mass Exporter Two OPOs and Their Experience with the Timing of Donor Cases

  2. Who Are We? Amanda “Mandi” Richard, RN, MSN, CCRN, CPTC • Clinical Manager, New Mexico Donor Services Lisa Magaro, RN, BSN, CPTC • Organ Team Lead and Procurement Transplant Coordinator, Nevada Donor Network Heather Osipowicz, BS, MSBS, CTBS • Hospital Services Educator, Nevada Donor Network

  3. Knowing More About Our OPOsNevada Donor Network Demographics • Population – 2,198,000 • DSA – 13 of 16 Counties in Nevada • 12th largest by land, 52nd largest by population • Transplant Center • 1 kidney center, located in Las Vegas • Recovery Surgeon • Local transplant surgeon is also the only local recovery surgeon currently

  4. Knowing More About Our OPOsNevada Donor Network

  5. Knowing More About Our OPOsNevada Donor Network • Nearly 2 million of our 2.198 million population reside in one county • Led the country in 2016 in transplants (164 TPMP) and donors per million population (49 DPMP) *Per OPTN and US Census Data • All A-C level hospitals within 30 miles of each other • Transplant Center is also the Nevada’s only Level One Trauma Center, and produces our highest yield of organ donors • Transient Community • Las Vegas visitors • Temporary community presence

  6. Authorization to Recovery TimeframesNevada Donor Network

  7. Knowing More About Our OPOsNew Mexico Donor Services Demographics • Population – 2,085,000 • DSA – State of New Mexico • 5th largest by land, 54th largest by population • Minority-Majority DSA • Transplant Centers • 2 Kidney Centers in Albuquerque • 1 Kidney Center just approved for pancreas • Recovery Surgeons: • 1 kidney [and now pancreas] surgeon who is also a localtransplant surgeon

  8. Knowing More About Our OPOsNew Mexico Donor Services

  9. Knowing More About Our OPOsNew Mexico Donor Services

  10. Knowing More About Our OPOsNew Mexico Donor Services • 2012-2014 period of time with no recovery surgeon • August 2014 Dr. Hanna Choate came to our team!

  11. Donor Management to Recovery TimeframesNew Mexico Donor Services

  12. Shared Allocation and LogisticalChallenges of Region 5 Mass Exporters • No local liver or thoracic programs • Limited flight options • Accepting centers have ability to accept multiple organ offers for same recipient • Late decline by transplant centers • OR timing delays due to backup center needs when primary • Identifying recovery team if local recovery surgeon is unavailable • Serology testing • Difficulty offering rapid recovery or uncontrolled DCD to donor families

  13. Case Studies

  14. Case Study #1New Mexico Donor Services • 7 year old who collapsed at home related to a recent asthma exacerbation. Received CPR with 3 rounds of medications, estimated downtime 26 minutes. • PMH: asthma • Timeline • 11/2: Admitted to hospital • 11/5 1200: Physician discussed donation with family • 11/5 1630: Sent ID testing • 11/6 2236: Declared Brain Dead

  15. Case Study #1New Mexico Donor Services • Timeline Continued… • Following Brain Death Determination: T4 Protocol Initiated • 11/7 0800: Levophed and Epinephrine drips weaned off completely • 11/7 1200: ECHO Completed • 11/7 1600: Heart, Liver, and Kidneys placed • Time to set the OR!

  16. Case Study #1New Mexico Donor Services Time to set the OR… • 2 teams coming • Liver team requests ASAP OR • Recipient in ICU, very ill, and “is going to die tonight if she doesn’t get transplanted”. • Heart team requests no sooner than 0800 the next morning • ICU patient, very unstable, may need ECMO overnight. • Surgeon cannot fly out as he would be the one to place the patient on ECMO • Could not agree on the OR time

  17. Case Study #1New Mexico Donor Services Where do we go from here? • Think outside the box! • OPO directly connected the heart and liver surgeons • Liver center identified a heart surgeon at their hospital that would come and recover • Heart center discussed, and agreed • Liver center hospital’s heart surgeon recovered the heart • Heart center sent perfusion staff and charter plane to return with heart

  18. Case Study #1New Mexico Donor Services A Successful Outcome! A 1 year old little girl and a 12 year old little girl were both successfully transplanted!

  19. Case Study #2New Mexico Donor Services • 57 year old female found down at home. Bystander CPR initiated, and patient was asystolic when EMS arrived. Estimated downtime 45 minutes. • PMH: COPD, asthma, chronic pain, HTN, depression, insomnia • Timeline • Heart, Liver, and Kidney allocation started simultaneously • Exhausted Heart List to Zone C • Liver and Kidneys placed

  20. Case Study #2New Mexico Donor Services Time to set the OR… • At 1400, OR set for 0200 • Liver was backed up • Center was verified to be interested as a backup • At 2000, OPO Coordinator was notified primary team was coding out for a “closer offer” • Backup center also coded out – due to “closer offer” • 0200 OR was cancelled, and Coordinator was back to liver allocation • At 0500, new OR set for 0900

  21. Case Study #2New Mexico Donor Services Case Outcome • Timeframe of case totaled 70 hours • Liver successfully transplanted • Allocated as SLK • Kidney placed in local back up due to recipient stability • Right kidney placed with a high CPRA recipient • Declined one hour post-recovery, due to flight schedules • 3 other mandatory shares with provisional code out • Ultimately placed at local transplant center

  22. Case Study #3Nevada Donor Network • 28 year old male, who had been complaining of a headache and went to bed early. Wife found him snoring loudly, and later he was in cardiac arrest, with unknown total downtime. Cardiac arrest was secondary to suspected drug overdose. • PMH: HTN and previous suicide attempt with drug overdose (2 months prior) • Toxicology: Positive for opiates and THC • Timeline • 10/22 1700: Initial Referral called, patient is areflexic • 10/22 1800: Family wanting to WDLS, Family Services and Transplant Coordinator onsite.

  23. Case Study #3Nevada Donor Network • Timeline Continued… • 10/22 1840: Neurology examined patient, and first exam consistent with brain death (this hospital requires 2 exams to pronounce). • 10/22 2200: Authorization and DRAI obtained. Family places time constraints on case, want case completed no later than 10/25, but prefer by evening of 10/24. • 10/22 2330: Serologies drawn and sent, ETA for results 11:15 next day. • 10/23 1440: Brain death declaration completed with second exam and CBF. • 10/24 0630: Echo completed and results pending; allocation not yet started. • 10/24 1020: Family onsite; allowing more time for case to be allocated and completed. • 10/24 2145: Heart, Liver, Kidneys, and Pancreas placed. Lung allocation continues.

  24. Case Study #3Nevada Donor Network Time to Set the OR… • 10/24 2240: OR scheduled for 10/25 0300 • 10/24 2320: Accepting liver center calls to say their liver team and surgeon are delayed on another case… for the same recipient! • Currently getting biopsy, and if good, accepting that liver, and declining ours. • Urgent calls made to backup liver centers. • One center unable to accept due to timing of OR and could not get a team mobilized in time. • 10/25 0005: Liver accepted by regional center, and okay with local recovery. OR proceeded as scheduled.

  25. Case Study #3Nevada Donor Network Final Outcome • Donor Family allowed us additional time outside of the original time constraints. • Backup Liver Center that ultimately accepted the liver was okay with local surgeon recovering, so OR time was not rescheduled. 4 lives were saved! • Heart transplanted into a 64 year old male • Liver transplanted into a 53 year old male • Right kidney transplanted into a 48 year old male • Left kidney transplanted into a 46 year old female

  26. Table Discussion Questions • How can we, as OPOs and transplant centers, work collaboratively to decrease timeframes from the start of a case to organ recovery? • During cases in which a donor family has placed time constraints, what policies or procedures do you have in place to be able to maximize the donation potential?

  27. Thank you!

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