Donation After Circulatory Death Noël Stout LPN CTBS Myrna Garcia BA Family Support Coordinators Objectives Provide context for honoring the neurologicallyaware patients desire to donate organs within a nontraditional clinical picture ID: 492711
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Neurologically-Aware Donors:Donation After Circulatory Death
Noël Stout, LPN, CTBS
Myrna Garcia, BA
Family Support CoordinatorsSlide3
Objectives:
Provide context for honoring the neurologically-aware patient’s desire to donate organs within a non-traditional clinical picture
.
Provide information surrounding the referral, discussion and legal authorization from neurologically-aware patients for organ donation after circulatory death. Slide4
“Neurologically-Aware” Patients
Examples:
High cervical spine fractures; quadriplegia
Degenerative neurological diseases in the end-stages; Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Huntington’s Chorea
Ventilator dependent and family/patient have chosen to withdraw life-sustaining measuresSlide5
Consider Neurologically-Aware patients as potential referrals!
General Triggers:
Vented, GCS <5, heart-beating and/or family planning to d/c life-sustaining interventions
Non-traditional Triggers to consider in addition:
Ventilator dependent, GCS higher than 5, likely to die immediately after extubation, any mention of donation by family or patientSlide6
ProcessAs in all DCD discussions, decision to withdraw life-sustaining measures must already have been made by the family
OPO and medical staff meet to determine the best way to discuss organ donation with family
If patient is communicative, he/she must be included in the discussionSlide7
Ethical ConsiderationsThe hospital
Ethics
C
ommittee may review
the
case.
The committee felt it appropriate for the intensivist to speak with the patient regarding withdrawal of care.
Once the patient, family and I
ntensivist have agreed
upon the withdrawal of care, the hospital
Ethics Committee can permit the OPO staff to approach the patient. Slide8
Discussion
Assess patients method of communication and neurological state
Family members/hospital staff involvement
Assess sedation level
Determine patient’s understanding of their condition
Determine who will be in room for donation discussion
Thorough staff huddle prior to approachSlide9
AuthorizationNo difference from traditional paperwork process
Confirm Registry status
Complete Written Authorization, if not registered
Obtain DCD Procedures Authorization
Heparin administrationSlide10
Case Study
56 year old female, registered donor admitted s/p fall from deck
CT scan revealed severe cord laceration at C2 level with contusion from C1-C3
No acute intracranial injury identified
Family given prognosis of vent dependent quadriplegia
Withdrawal of care brought up by familySlide11
The Intensivist Conversation
Family/Family Support Coordinator present
“Once for yes, twice for no”
Neurological state assessed
Confirming pt’s understanding of ventilator-dependent quadriplegia
Discussed life-sustaining measures will be withdrawn
Clarify that this would result in her deathSlide12
The OPO Approach
Family and hospital staff present
Confirm that at the time of death, organ donation would occur
Authorization completed by husband
Patient included in process
Questions answeredSlide13
The Recovery
Comfort care measures per hospital protocol
Significant Hospital OR staff preparation
Withdrawal of care in OR
or
ICU per patient/family wishes
No pre-OR prep doneSlide14
Case CollaborationSlide15
What have we learned?