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Neurologically-Aware Donors: Neurologically-Aware Donors:

Neurologically-Aware Donors: - PowerPoint Presentation

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Uploaded On 2016-11-24

Neurologically-Aware Donors: - PPT Presentation

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

patient family hospital donation family patient donation hospital staff authorization neurologically care patients dependent sustaining measures life discussion withdrawal death aware process

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Slide1
Slide2

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?