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EM Organ Donation Pathway

EM Organ Donation Pathway. UHW. Why?. UHW: very busy ED, 140,000 attendances per annum Neurosurgical tertiary referral, trauma centre Potential donors - 1 per fortnight ED pathway normalises and standardises referral

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EM Organ Donation Pathway

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  1. EM Organ Donation Pathway UHW

  2. Why? • UHW: • very busy ED, 140,000 attendances per annum • Neurosurgical tertiary referral, trauma centre • Potential donors - 1 per fortnight • ED pathway normalises and standardises referral • Gives a structure to something that remains stressful and usual for ED staff • Encourages and supports good practice • End of life care • Collaborative approach

  3. Identification and first steps Intubated and ventilated potential donor identified. Consensus agreed by at least two consultants of appropriate specialty on plan to withdraw treat in patients best interests in view of terminal and irreversible prognosis. Discussion with consultant on call for intensive care to agree that plan to consider organ donation is appropriate. Determine critical care capacity if donation is considered appropriate. Contact the Specialist Nurse for Organ Donation and check Organ Donation Register. Commence checklist re: documentation

  4. EU pathway

  5. The Story of Two Motorcyclists A cautionary tale

  6. The story begins one Monday evening… 22 year old motorcyclist pupils “fixed and dilated at the scene” GCS 4 with decerebrate posturing in ED Discussion with neurosurgery “further treatment futile”

  7. The story continues… • Difficult family dynamics • Father refuses to proceed with OD conversation before patient’s grandmother can attend the next day. • The patient is “optimised” overnight in the EU. • At some point the pupils are noted to be slightly unequal and sluggishly reacting. • The next morning the EU consultant is uncomfortable with the decision to withdraw and insists on further assessment. • Patient transferred to ITU for active medical treatment. • Patient since transferred to neuro ward for rehabilitation.

  8. Less than one week later; same department, same EM consultant…….. 44 year old motorcylist • ‘pupils fixed and dilated’ • GCS 5 at scene • GCS 4 on arrival in EU • Neurosurgeons • “treatment is futile” • Plan to withdraw treatment

  9. ITUreview • Non-collaborative approach • Family consent to donation • Transfer to ITU • Donation of kidney and pancreas ITU review:“hopeless prognosis” Plan to extubate, keep comfortable allow the family to sit with him and let him pass away peacefully.

  10. Learning Points • Open dialogue between ITU and EU is essential • Don’t take information for granted • Review everything and assume nothing • Document all decisions and their timings accurately and as contemporaneously as possible • Further introductory information to emphasis process of decision making about withdrawal • Addition of a checklist

  11. Conclusion • Local pathways should reflect local issues • UHW: • capacity is an issue • Senior decision makers present for extended hours • Needs regular review and a dialogue between senior colleagues

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