The Organ Donation Process

1. The Organ Donation Process Lisa Seymour, RN Learning Specialist New York Organ Donor Network L. Seymour, New York Organ Donor Network

2. Objective Understanding of the process of donation from consent to recovery of the organs L. Seymour, New York Organ Donor Network

3. Topics of Discussion • Overview of the consent process • Brain Death protocol • Evaluation and screening • Organ specific testing • Allocation of the organs • Recovery process • Post recovery L. Seymour, New York Organ Donor Network

4. OVERVIEW OF THE CONSENT PROCESS L. Seymour, New York Organ Donor Network

5. TIMING IS CRUCIAL L. Seymour, New York Organ Donor Network

6. Assessment of family Introductions Identification of NOK Identification of decision makers, family support Eliciting family understanding of brain death Discussion of donation with the family Explanation of process of donation Addressing concerns and questions Meeting needs of the family WORKING WITH THE FAMILY L. Seymour, New York Organ Donor Network

7. CONSENT PROCESS • Consent forms • Medical and Behavioral History • Explanation of “what comes next?” • Constant updates for the family L. Seymour, New York Organ Donor Network

8. WORKING TOGETHER TO SUPPORT THE FAMILY L. Seymour, New York Organ Donor Network

9. BRAIN DEATH PROTOCOL • Full understanding of hospital plans for protocol • Assisting family with understanding • Explanation how protocol affects the timeline and donation process L. Seymour, New York Organ Donor Network

10. BRAIN DEATH PROTOCOL cont. • Based on NYS Guidelines • Clinical Exams by physicians • Supportive or confirmatory testing • Possible delays in protocol being completed L. Seymour, New York Organ Donor Network

11. SCREENING AND EVALUATION • Serology testing (HIV, Hepatitis, etc) • Blood type • Medical Suitability • Behavioral History • HLA (tissue typing, histocompatability) • Review of CT scans, chest x-rays, etc L. Seymour, New York Organ Donor Network

12. ORGAN SPECIFIC TESTING HEART • EKG • Echocardiogram • Cardiac catheterization • Lab values L. Seymour, New York Organ Donor Network

13. ORGAN SPECIFIC TESTING cont. LUNGS • Bronchoscopy • Chest X rays • Culture results • Arterial blood gases • Accurate measurements L. Seymour, New York Organ Donor Network

14. ORGAN SPECIFIC TESTING cont. LIVER • Lab testing • CT scans or ultrasound • Lab values L. Seymour, New York Organ Donor Network

15. ORGAN PLACEMENT cont. KIDNEYS • Lab testing • HLA (tissue typing) • Ultrasound or CT scan • Kidney anatomy (post recovery) • Pump numbers (post recovery) L. Seymour, New York Organ Donor Network

16. ORGAN PLACEMENT cont. PANCREAS • HLA • Ha1C • Lab testing • CT or ultrasound • Insulin dosing in hospital L. Seymour, New York Organ Donor Network

17. ALLOCATION BEGINS • UNOS specific guidelines and generation of the “list” • Performed by Transplant Coordinator in field, Organ Placement Coordinators and/or UNOS • Time frame ONE HOUR RULE L. Seymour, New York Organ Donor Network

18. During this time of consent, screening and evaluation and allocation stability of the donor and support the family is CRUCIAL L. Seymour, New York Organ Donor Network

19. All information in hand at this point (few exceptions) Multiple people may be involved Very time consuming process Multiple offers at once ALL information must be given for informed decision by surgeon Deciding surgeon may want more information Decision made to accept or decline ORGAN ALLOCATION L. Seymour, New York Organ Donor Network

20. A RECIPIENT IS FOUND Backup placing begins~ We understand that ANYTHING can happen L. Seymour, New York Organ Donor Network

21. ORGANIZATION OF RECOVERY • Operating room availability at the hospital • Organizing potentially up to 8 surgical teams to arrive AT THE SAME TIME, IN THE SAME PLACE, to work together to successfully recover these live saving organs ONE OF THE BIGGER CHALLENGES WE HAVE LITTLE CONTROL OVER L. Seymour, New York Organ Donor Network

22. RECOVERY • Abdominal teams (liver team) begins • All teams do extensive “prep work” needed for expedition of recovery post cross clamp • Heart and lungs are procured first • Liver, pancreas and intestine next • Kidneys are recovered last. This process takes between 4-6 hours L. Seymour, New York Organ Donor Network

23. WHY WOULD AN ORGAN BE REFUSED IN THE OR? • Suspicious mass or lesions found • Evidence of infection • Biopsies performed are incompatible with donation • Donor instability • Recipient instability or death L. Seymour, New York Organ Donor Network

24. WHAT HAPPENS IF THE ORGAN IS REFUSED? • Immediately the backup is called • Aggressive placement continues If, unfortunately, no recipient is found THE ORGANS WILL BE KEPT IN THE BODY OR RETURNED TO THE BODY BEFORE CLOSURE (if already procured) L. Seymour, New York Organ Donor Network

25. POST RECOVERY • Tissue typing to include lymph nodes, blood clot, spleen are obtained for secondary typing for kidneys, pancreas, intestine and heart • Preservation of the organs after initial anatomy documented • Kidneys placed on pumps L. Seymour, New York Organ Donor Network

26. THE RUSH TO TRANSPLANT IMMEDIATE TRANSPORTATION IMMEDIATE TRANSPLANTATION WHAT IS THE RUSH? THESE ORGANS ARE NOT FOR “WHAT IF?” A LIFE IS IN JEOPARDY L. Seymour, New York Organ Donor Network

27. POST RECOVERY KIDNEY ALLOCATION MAY CONTINUE WHY? Benefits of waiting to pumping kidneys • Use of kidney pumps gives more detailed information • Can “turn around” kidneys • Ultimately provides for best recipient L. Seymour, New York Organ Donor Network

28. POST RECOVERY cont. • Surgical teams “close” the donor in the same manner as any other surgery • Respect for the body continues • Carrying through the wishes of the family for arrangements for the body • Family called L. Seymour, New York Organ Donor Network

29. A QUITE COMPLICATED PROCESS • Begins with working with the hospital to assess the situation, the family and the initial suitability • The process of working with the family and obtaining consent • Further screening • Organ specific testing • Allocation to find the right recipient • Logistics of recovery L. Seymour, New York Organ Donor Network

30. IN SUMMARY • Organ transplantation is proven • The entire goal of organ transplantation is TO SAVE ANOTHER HUMAN LIFE • Organs are NEVER “wasted” • Intent is always to find the best recipient • Family wishes are ALWAYS respected L. Seymour, New York Organ Donor Network

31. Respect for the donor and their family L. Seymour, New York Organ Donor Network

32. While… assuring that all is possibly done to save another human being’s life L. Seymour, New York Organ Donor Network