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All Hands On Deck!

All Hands On Deck!. Objectives. Review indications for rapid organ recovery Identify resources needed Describe challenges and solutions. Why rapid recovery?. Family time constraints Critically unstable donor Hospital/Medical examiner requirements. Resources. Required:

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All Hands On Deck!

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  1. All Hands On Deck!

  2. Objectives • Review indications for rapid organ recovery • Identify resources needed • Describe challenges and solutions

  3. Why rapid recovery? • Family time constraints • Critically unstable donor • Hospital/Medical examiner requirements

  4. Resources • Required: • Authorization, UNOS ID, death, surgeon, OR • Useful: • Additional ORC • Hospital development support • Family services support • Supplies • Kidney pumps

  5. Process • Establish what’s possible • Hospital location and capabilities • Staff availability • Surgeon availability • Discuss with family • Call in the troops!

  6. Process—ORC • Draw blood • Serologies • HLA • Organ/tissue requirements • Medical examiner requirements • Send labs • CMP, UA, PT/PTT, CBC, cultures • Donor assessment • Photos? • OME clearance

  7. Process—DFA • Authorization • MSHQ • Family support • Planning for withdrawal process

  8. Process—HDC • Notify hospital administration • Notify OR • Identify & coordinate declaring physician

  9. Process—AOC • Assist • Remind • Respond?

  10. Our case • 52/M/C s/p MVC into canal, 7 minutes in water, +CPR • Referred ~2 hours after admission • On HD#2, family decided to withdraw, asked about donation • Patient was requiring 3 pressors and boluses, MAP ~40 • CBF showed flow • 3 other donor cases in progress

  11. Action • ORC and DFA responded, established plan with ICU staff • ORC called for reinforcements • Additional ORC, ORT, HDC • Authorization at 1530 • To OR at 1730 • Kidneys recovered, pumped and transplanted

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