Sue Weese, RN, BSN, CPTCHospital Coordinator

Giving the Gift of Life

Focus

• Referral Process• Catastrophic Brain Injury Guidelines• Brain death vs. death Circulatory • Transitional Language/Huddles• Partnership

Care of the patient and familyTools and resources

LifeSource

A federally designated OPO (Organ Procurement Organization) serving:

ND

SD

MN

WI

Douglas County

St. Croix CountyPierce County

120,000

Target field

Lambeau Field

Referral Process

• Family mentions or has questions about donation• When patient meets the Triggers for donation, LifeSource should be

called within one hour• Clinical Triggers include:

Neurological injury Patient on a ventilator Loss of two brain stem reflexes or a GCS of < 5

• Call is mandated, staff does not need permission to make the call• After initial referral, if decision made to withdraw life-sustaining

measures or prior extubation

Referral Units include: ICU’s/ED/OR

Donor designation is the practice of ensuring that an individual’s documented wishes about donation are fulfilled.

Minnesota passed the Darlene Luther Anatomical Gift Act in April 2002

LifeSource implemented practice changes to incorporate Donor Designation in May 2003

“giving the donor a voice”

What is Donor Designation

Neuro events

Injuries Anoxic –Cardiac arrestICH/CVABlunt TraumaGSW AsphyxiationBrain Tumor

Guide:The person who steers the boat down the river, giving paddle commands to the crew as paddle captain or rowing as oars person.

Catastrophic Brain Injury Guidelines(CBIG’s)

A Trauma surgeon and ED Physician out of Kansas City developed the Catastrophic Brain Injury Guidelines to be used when a patient is deemed nonsurgical/nonsurvivable.

Based the guidelines on the Surviving Sepsis Campaign

Goal to save more lives and preserve the opportunity for donation.

Outcome:3 people survived17 organs were transplanted

0%

10%

20%

30%

40%

50%

60%

70%

80%

PLTs DIC pressor DI cardisch

acid renalfailure

NPE

Complications of Brain Death

• Maintain SBP > 90 (MAP > 60)– Perfusion

• Maintain Urine Output > 1ml/kg/hr < 300ml/hr– Fluid balance

• Maintain PO2 > 100 & pH 7.35-7.45 Oxygenation

• Monitor glucose– Cell metabolism

• Monitor and treat electrolytes– Acid Base balance

Critical Care end points

• Policy• Known etiology of brain death and/or evidence

of irreversibility

• No brainstem function

• No respiratory effort/apnea test

Brain DeathDeath by Neurological Criteria

Donation after Circulatory Determination of Death

• Policy• Patient does not meet Brain Death criteria

• Family decides to withdraw life-sustaining medical treatment

• Patient ventilator dependent

• Patient is age < 60

"The individual represented by the hospital to request to the family must be an organ procurement representative or a designated requestor" (CMS Conditions of Participation

482.45(a)(3)

What do you say……if the family raises the topic of donation?

– Prior to Brain Death/Cardiac Death• “Hennepin County supports donation. Donation may

be possible. We work closely with the donation agency and I’ll arrange to have them speak with you”

– After Brain Death/Cardiac Death• “We work very closely with the donation agency and

they are available to answer your questions about donation”

• Acknowledgethe donation comments

• Connectthe family to LifeSource

• Supportthe family in meeting their needs

Mention of Donation

Huddle Definitions

• Donation Assessment Huddle– Onsite or telephone response, after an evaluation

• Family Support Huddle– Prior to Family Discussion

• Family Outcome Huddle– After Family Discussion

Importance of clear and consistent language

California Florida

Family considers taking brain-dead son off life support

Corneas

Heart/Heart Valves

Lungs

Liver

Pancreas

Kidneys

Intestines

Skin

Bone/Connective Tissues

Blood Vessels

Donation Opportunities

Neuro injuryVented

ICU Triggers for referral

Chaplains

Order sets

Tissue and eye

ME/OR/RT

Policy

Family Support

Similarities

Differences

Brain Death• No age limit• Clinical and Apnea • Time of death- Brain Death-

ICU• Extubate or Donate• Yes Anesthesia • No Family in OR• LS Manages

DCD• Age limit - 60 • Evaluate for 60 minute CTOD• Time of death-Cardiac Standstill-

OR• Decision to withdraw• No Anesthesia-only lungs• Family invited in OR• MD manages

Brief moment taken in OR to honor the donor and provide a connect to purpose for

everyone present.

Family Support

• Wrapped in Hugs• Flag Raising• Funeral Box• Bracelets• Wall of Heroes• Family After Care• Donor Family Gatherings

Flag Raising

Donate Life MonthDuring a case

HCMC Altru Health

Abbott Northwestern

North Memorial

• Triggers for referral• Death-Circulatory vs Neurological• CBIG’s-avoid deceleration in care• 64% of MN drivers over 18 DD• >120K on waitlist• Family/patient decision

Summary

www.mydonationresource.org