1 / 41

Donate Life: End-of-life Opportunities for Patients and Families

Donate Life: End-of-life Opportunities for Patients and Families. Bill Snyder, RN, BSN, CPTC Senior Procurement Coordinator University of Wisconsin Hospital and Clinics Organ Procurement Organization. Key Questions. Why is Organ Donation So Important? What is the OPO?

quintessa
Download Presentation

Donate Life: End-of-life Opportunities for Patients and Families

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Donate Life: End-of-life Opportunities for Patients and Families Bill Snyder, RN, BSN, CPTC Senior Procurement Coordinator University of Wisconsin Hospital and Clinics Organ Procurement Organization

  2. Key Questions • Why is Organ Donation So Important? • What is the OPO? • What is Your Role? • Clinical Triggers • 2 donation types

  3. Why is Organ Donation So Important?

  4. Why is Organ Donation So Important? • The list is growing at the rate of one person every 13 minutes, and 20 people die daily while waiting on the list. • More than 90% of Americans approve of organ donation, yet less than half say “yes” when approached at the time of donation. • Only 2-4% of deaths are eligible for solid organ donation

  5. National Transplant Waiting List Type of TransplantWaiting Transplanted in ‘08 Kidney 78,957 16,514 Liver 15,768 6,318 Lung 1,966 1,478 Heart 2,803 2,163 Heart-lung 83 27 Kidney-pancreas 2,266 836 Pancreas 1,552 437 Intestines 213 185 Totals 101,216 27,958 Source: Organ Procurement and Transplant Network - As of 03/20/09

  6. Type of TransplantWaiting Transplanted in ‘08 Kidney 1,057 445 Liver 206 155 Lung 64 40 Heart 79 29 Heart-lung 0 0 Kidney-pancreas 53 49 Pancreas 12 15 Intestines 2 0 Total 1,436734 Source: Organ Procurement and Transplant Network, As of 03/20/09 Wisconsin Transplant Waiting List

  7. Challenges: Donors, Transplants and Patients Waiting * Data based on snapshot of the UNOS, OPTN waiting list and transplants on the last day of each year *

  8. What is the OPO?

  9. What is the Organ Procurement Organization? • One of 58 OPO’s • Service 104 Hospitals in Wisconsin, Illinois and Michigan • Population base: 3.2 Million people • 30+ staff members • Hospital Donation • Procurement Coordinators • Recovery Team • Family Support • Community education

  10. Legislation and Organ Donation • CMS Conditions of Participation • Effective August 22, 1998, the Centers for Medicare and Medicaid Services (CMS) enacted legislation mandating: • All hospitals are required to report all deaths and imminent deaths to their designated OPO • Designated Requestor training (3.5 hour course) The Joint Commission • Donation after cardiac death policies • Surveyors ask hospital leadership about donation conversion rates

  11. Legislation and Organ Donation(cont.) HIPAA Regulations • OPO/Tissue/Eye agencies operate as an extension of your hospital • OPO has a Letter of Agreement with your hospital and CMS Conditions of Participation grant us access to any relevant patient information, medical records, etc. Allowing us to have access to medical records, you are in no way violating patient confidentiality

  12. Your Role in Donation • Recognize when to notify the OPO • Make the referral • Continue patient care • Provide care to families • Effective requesting (consent) • Supply information during a donation case

  13. When Do I Notify the OPO?

  14. Clinical Triggers • Mechanically ventilated • Severe neurologic insult/injury ·    For whom a physician is evaluating for brain death OR ·    A patient with a Glasgow Coma Scale (GCS) < 5 OR ·    Plan to discuss withdrawal life-sustaining therapies

  15. Clinical Triggers (cont.) Severe Neurological Injury • Trauma • CVA • Primary CNS Tumor • Anoxia • Cardiac Arrest/MI • Drug Overdose • Drowning/Hanging

  16. Clinical Triggers (cont.) Timely Referral • Referral made within 1 hour of a patient meeting clinical triggers • JCO/CMS regulation • Majority of organ donors meet clinical triggers in the Emergency Department, but most referrals are made from the ICU or CCU

  17. Clinical Triggers (cont.) How Do Clinical Triggers and Timely Referrals Improve the Donation Process? • Clarifies when to notify the OPO • The initial referral is not the time to be talking to the family about organ donation • We are still in full-treatment mode • It does not mean that the patient is going to be an organ donor or that the OPO is going to arrive at your hospital • It does not mean that the patient will not recover from the injury

  18. Clinical Triggers (cont.) How Do Clinical Triggers and Timely Referrals Improve the Donation Process? • Allows time for relationship building • Ensures adequate time for potential donor screening, medical management and allocation of organs • Preserves the opportunity for donation for the family

  19. Clinical Triggers (cont.) Clinical Trigger Case Studies

  20. #1A sixty-nine year old male arrived at the hospital unresponsive due to a CVA. He was intubated on admission and then weaned off of the vent. A week later his condition declined and was re-intubated. The physician had a meeting with the family and they decided to extubate the patient.Refer? __Not Refer? __ If not, why not?

  21. #2A sixty-eight year old male was admitted to the hospital unresponsive. He was intubated on arrival. CT scan of head showed multiple infarcts throughout the brain. He was admitted to the ICU with a GCS of 4. His prior medical history includes: Hypertension, hyperlipidemia, morbid obesity, CAD, and glucose intolerance. He had a coronary artery stent placed a couple of years ago.Refer? __Not Refer? __ If not, why not?

  22. How Do I Make the Referral?

  23. The Referral Process How do I make a referral? 1-866-UWHC-OPO (1-866-894-2676) One Number: • Solid Organ • Tissue • Eye • Death Reporting

  24. The Referral Process (cont.) • Contact 1-866-UWHC-OPO (STATLINE Call Center) • Have patient’s chart available to provide: • Name • Age • Ventilator status • Diagnosis • Coroner’s case? • General health and social history • Time of brain death or cardiac death

  25. The Referral Process (cont.) Current Criteria for Organ Donation • Up to age 75 (for now - this can change!) • HIV – • No active malignancy • Exception: Primary CNS tumors Note: Only the OPO can determine donor suitability

  26. How Does Donation Occur?

  27. How Does Donation Occur?DBD vs. DCD Two opportunities… Donation After Brain Death (DBD) Donation After Cardiac Death (DCD)

  28. How Does Donation Occur? (cont.) Donation After Brain Death Meets Criteria for Brain Death: Clinical Exam + Apnea Test both consistent with Brain Death Clinical Exam • Unresponsive to all stimuli • No spontaneous respiratory activity • All brain stem reflexes are absent • Pupillary response to light • Corneal reflexes • Oculo-vestibular reflex (cold-caloric response) • Oculocephalic reflex (doll’s eye phenomenon) • Gag reflex

  29. Meets Criteria for Brain Death: 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

  30. Meets Criteria for Brain Death: Confirmatory Tests • Cerebral blood flow (CBF) studies • Cerebral angiography • Nuclear flow study • EEG

  31. How Does Donation Occur? (cont.) Confirmatory Test: Cerebral Angiography Normal Blood Flow No Blood Flow

  32. How Does Donation Occur? (cont.) Confirmatory Test: Nuclear Flow Study

  33. Donation After Brain Death • Patient is declared brain dead, THAT IS THE LEGAL TIME OF DEATH • Patient is maintained on ventilator throughout the organ recovery • Organs are separated in situ • 3-4 hour surgery • All 8 solid organs can be recovered

  34. Donation After Cardiac Death • Family and physician elect to withdraw life support • Patient has some brain stem reflexes, so not brain dead, but no meaningful chance of survival • Withdrawal of life support in the OR or ICU • Surgery begins 5 minutes after cessation of cardiac function, death declared by patient’s physician • Rapid recovery with organs procured en bloc • 1-2 hour surgery • Lungs, liver, kidneys and pancreas can be recovered

  35. Donation After Cardiac Death Key Points • Donation is discussed with family only after decision to withdraw support has been made • DCD offers families expanded organ donation opportunities • If patient’s heart/respiratory function goes beyond 2 hours post-extubation, solid organ donation is no longer possible

  36. How Does Donation Occur? (cont.)Organ Preservation Time • Heart: 4-6 hours • Lungs: 4-6 hours • Small Intestines: 4-6 hrs • Liver: 12 hours • Pancreas: 12-18 hours • Kidneys: 48 hours

  37. How Does Donation Occur? (cont.) Donation Process: From Consent to Recovery • Brain death declaration or DCD evaluation • Evaluate organ function • Consent signed • Serology and recipient compatibility testing (4 hours) • Medical-social history • Locate potential recipients (can take up to 18 hours) • Manage hemodynamics • Arrange OR time and set up of OR

  38. What Can Be Donated? Organs Recovered and Indications for Transplant • Heart • Cardiomyopathy, Coronary Artery Disease, Congenital Heart Disease, Valvular Heart Diseases • Lungs • Emphysema/COPD, Cystic Fibrosis, Pulmonary Fibrosis, Primary Pulmonary Hypertension, Congenital • Liver • Hepatitis A,B,C, Cirrhosis, Biliary Disease, Metabolic, Neoplasms • Pancreas • Diabetes Type I without Renal Disease, Hypoglycemic Unawareness, Pancreas after Kidney Transplant • Kidneys • End Stage Renal Disease, Diabetes with Renal Disease • Small Intestines • Short Gut Syndrome, Severe Vascular Disease

  39. What Can Be Donated? (cont.) The Differences…. Organ Donation • The patient must be maintained by a mechanical ventilator • Organs must be properly preserved and transplanted quickly • Life-saving procedure Tissue/Eye Donation • Occurs in the first 24 hours after the heart has stopped beating • The tissues can be preserved and used at a later date • Life-enhancing procedure

  40. Through donation ... ...lives are changed forever

More Related