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B&B: Basics and Burning Questions - Don't miss out on understanding organ and tissue donation!

Join Mary Nachreiner from UW OPO as she discusses the donor referral process, clinical triggers, and the difference between DCD and DBD. Learn about the importance of donation and care for donor families. Find answers to your burning questions about organ and tissue donation.

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B&B: Basics and Burning Questions - Don't miss out on understanding organ and tissue donation!

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Presentation Transcript

  1. Welcome!

  2. Donation B & B: Basics and Burning Questions Mary Nachreiner, Community/Family Services UW OPO

  3. Objectives • Understand the Donor Referral Process • Understand Clinical Triggers and Apply Appropriately • Identify the Difference Between Donation After Cardiac Death (DCD) and Donation After Brain Death (DBD) • Appreciate the Personal Impact of Donation and Care of the Donor Family • Clarify “Burning Questions”

  4. What is the UW Organ Procurement Organization (OPO)? • One of 58 OPOs • Service 104 Hospitals in Wisconsin, Illinois, and Michigan • Regulated by the Federal Government • 30+ Staff Members • Hospital Development • Procurement Coordinators • Recovery Team • Family Support • Community Education

  5. What are the Recovery Agencies? Solid Organ Recovery • University of Wisconsin Organ Procurement Organization Tissue Recovery • Musculoskeletal Transplant Foundation (MTF) • Wisconsin Tissue Bank • RTI Donor Services • ATSF Whole Eyes/Corneal Recovery • Lions Eye Bank of Wisconsin

  6. The Difference Between Organ and Tissue Donation 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 • No Mechanical Ventilator Needed • One Donor Can Help From 50 to 100 People Organ Donation • The Patient Must be Maintained by a Mechanical Ventilator • Organs Must be Properly Preserved and Transplanted Quickly • Life-Saving Procedure • One Donor Can Help 8 People

  7. Kelly’s Legacy

  8. Kelly Nachreiner Bill (AB-764) • Signed by Governor Tommy Thompson on May 9, 2000 • Requires all Driver’s Education Programs in Wisconsin to Give at Least 30 Minutes of Instruction on Organ Donation • The First of Its Kind in the Country

  9. Why is Organ Donation So Important?

  10. Tyler Double Lung Recipient

  11. Why is Donation so Important? • Every Day… • 18 People in the U.S. Die Waiting • 111 People are Added to the National Wait List • Only 2-4% of Deaths are Eligible for Solid Organ Donation

  12. The National Story Type of TransplantWaiting Kidney 88,314 Liver 16,159 Lung 1,777 Heart 3,176 Heart-Lung 65 Kidney-Pancreas 2,223 Pancreas 1,383 Intestines 264 Totals 110,693 Source: Organ Procurement and Transplant Network 04/13/2011

  13. Our Local Stories Wisconsin 1780 Illinois 4937 Michigan 2976 80-85% Awaiting Kidneys Source: Organ Procurement and Transplant Network 4/8/2011

  14. Your Role in Donation ● Provide Care to Families ● Recognize Clinical Triggers ● Make the Referral Within 1 Hour of Clinical Triggers ● Understand How the Donation Process Works ● Effective Requesting (Consent) ● Sign Consent with Family ● Be an Advocate for Donation in Your Community

  15. Clinical Triggers: What and Why? What are Clinical Triggers? • Specific Medical Patient Parameters Requiring Notification to the OPO (Referral) Why are Clinical Triggers Important? • Preserve the Option of Organ Donation for the Patient and Family • Ensures Adequate Time for Potential Donor Screening, Medical Management, and Allocation of Organs • Follow Requirements of Joint Commission and CMS

  16. Clinical Triggers Are Met When a Patient: • Is Mechanically Ventilated AND • Has a Severe Neurologic Insult/Injury AND ONE of the Following: • A Physician is Evaluating for Brain Death OR • Has a Glasgow Coma Scale (GCS) < 5 OR • Plans to Discuss Withdrawal Life-Sustaining Therapies

  17. Clinical Triggers Severe Neurological Injuries: • Trauma • CVA • Primary CNS Tumor • Anoxia • Cardiac Arrest/MI • Drug Overdose • Drowning/Hanging

  18. Clinical Triggers • Simply a “Heads Up” • Notification Does NOT Mean: • That the Patient is Going to be an Organ Donor • That the OPO is Going to Arrive at Your Hospital • All Life Saving Efforts are Pursued as They Are With Any Patient

  19. Only 6-7% of Patients Referred to the OPO Actually Become Donors

  20. Clinical Trigger Case Studies

  21. Jack is a 68 yr old WM with prostate cancer, pancreatitis, renal failure, and liver failure due to ETOH abuse. He is hepatitis B+. He has hepatic encephalopathy and was intubated in the ER to maintain his airway. His GCS is 3. Refer? Not Refer?

  22. Henry is a sixty-nine year old male who 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?

  23. Clinical Triggers: Moral of the Story KISS: Keep It So Simple

  24. The Referral Process Statline Pages On Call OPO Coordinator Referral From Hospital: 1-866-894-2676 (Statline) Yes Statline: Is Patient Ventilated? Statline Refers to Tissue Agency No

  25. Reminder: All Deaths and Imminent Deaths Must be Reported 1-866-894-2676 Statline Triage Center • 1 Phone Number • Imminent Deaths: OPO Paged • Deaths: Tissue and Eye Banks Paged

  26. How Does Donation Occur? Two Opportunities… Donation After Brain Death (DBD) Donation After Cardiac Death (DCD)

  27. Brain Death Irreversible cessation of all functions of the entire brain, including the brain stem Cardiac Death Irreversible cessation of circulatory and respiratory function Brain Death vs. Cardiac Death

  28. Donation After Brain Death

  29. Brain Death Brain Death Is… • LEGAL TIME OF DEATH • Irreversible • Usually a Result of Direct Insult to the Head (Trauma, Anoxia, Stroke, etc.) • Declared Only by Patient’s MD/Donor Hospital Designee (NOT OPO) • Declared Through Clinical Exams, Apnea Testing, and Confirmatory Exam* *Additional Details Available

  30. Angiogram Normal Blood Flow No Blood Flow

  31. Donation after Brain Death The Process ● Patient is Declared Brain Dead; This is the Legal Time ofDeath ● Patient is Maintained on Ventilator Throughout the Organ Recovery ● Organs are Dissected in situ (Naturally Situated in Body) ● 3-4 Hour Surgery ● Heart, Lungs, Liver, Kidneys, Pancreas, and Intestines Can be Recovered

  32. Donation After Cardiac Death

  33. Donation After Cardiac Death (DCD) For Donation After Cardiac Death to Occur: • Severe Neurologic Insult or Injury • Trauma (MVA, GSW) • Cerebral Vascular Accident (CVA) • Anoxia (MI, Drug Overdose, Drowning, Hanging) Patients Do Not Meet the Criteria For Brain Death • Gives Family the Option of Organ Donation for the Severely Brain Injured (but Not Brain Dead) Patient. • US DCD Donors Average: 10% • UW OPO DCD Donors Average: 30%

  34. Donation After Cardiac Death (DCD) For Donation After Cardiac Death to Occur: • All Medical Treatments are Futile and Long-Term Prognosis Poor • Family and Physician Elect to Withdraw Support • Referral is Made to OPO • Withdrawal of Ventilated Support in OR vs. ICU • Cardiac Death Occurs • Surgery Begins 5 Minutes After Cessation of Cardiac Function and Declaration by Patient’s Physician • Rapid Recovery with Organs Procured en bloc • 1-2 Hour Surgery • Lungs, Liver, Kidneys, and Pancreas Can Be Recovered

  35. Key Differences Between DBD and DCD Donation After Cardiac Death (DCD) • Patient Extubated in OR vs. ICU • Surgery Begins 5 Minutes After Cessation of Cardiac Function and Declaration by Patient’s Physician • Rapid Recovery With Organs Procured en bloc (as a Whole) • 1-2 Hour Surgery Donation After Brain Death (DBD) • Patient is Maintained on Ventilator During Organ Recovery • Organs Dissected in situ • 3-4 Hour Surgery

  36. The Reward of Many Efforts

  37. Burning Questions

  38. FYI: Sensitive Terminology Please UseInstead of “Recover” “Harvest” “Deceased Donor” “Cadaver” “Mechanical or “Life Support” “Ventilated Support”

  39. BQ: How Long Are Each of the Organs Viable After Being Recovered? Organ Preservation Time • Heart: 4-6 Hours • Lungs: 4-6 Hours • Liver: 8 Hours • Pancreas: 12-18 Hours • Kidneys: 72 Hours • Small Intestines: 4-6 Hours

  40. BQ: How Do You Determine Who Receives The Organs? UNOS (United Network for Organ Sharing) Allocation Criteria • Blood Type • Medical Urgency • Tissue Match • Waiting Time • Organ Size • Immune Status • Geographic Distance

  41. BQ: Can a Person With Autoimmune Disorder (Not AIDS/HIV) be a Donor? Yes

  42. How Can a Patient Become a Donor if They Have No Family? • Healthcare Agent or Power of Attorney – But only if given the responsibility of making an anatomical gift. Most POA and living wills in use cover only the power to make health care decisions – not anatomical gifts. We are working with the WI Dept. of Health to have their standard forms changed as soon as possible. • Spouse • Adult Children • Parents • Adult Siblings • Adult Grandchildren • Grandparents • Adults Who Exhibited Special Care or Concern, Except as a Compensated Health Care Provider for That Individual • Legal Guardian • Whomever Would be Responsible for the Disposal of the Body NOK Hierarchy

  43. Other Burning Questions??

  44. Thanks!

  45. Donation after Brain Death Brain Death Criteria Clinical Diagnosis of Brain Death ● Unresponsive to All Stimuli ● No Spontaneous Respiratory Activity ● All Brain Stem Reflexes are Absent • Pupillary Response to Light • Corneal/Lash Reflexes • Oculo-Vestibular Reflex (Cold-Caloric Response) • Oculocephalic Reflex (Doll’s Eye Phenomenon) • Gag/Cough Reflex • Response to Intense Central Pain

  46. Donation after Brain Death Brain Death Criteria Apnea Test • Make Sure Patient Has Normal BodyTemp, Blood Pressure, Volume Status, ABGs • Disconnect From Ventilator • Monitor Continuous Pulse Oximetry • Administer 100% O2 at 6 L/min Into The Trachea • Monitor Closely for Respiratory Movements • Check Serial ABGs 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

  47. Donation after Brain Death Criteria for Brain Death Confirmatory Exams • Cerebral blood flow (CBF) studies • 4 Vessel Angiogram • Transcranial Doppler • EEG

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