Becoming Better Predictors of Death Region 5 Collaborative Chuck Zollinger Administrative Director, Organ Recovery

Snapshot DSA serves 3.6 million 9 ODCs (on the call schedule) 2-ODC model (sorta) One office (no satellite offices ) ~500 miles N to S 80:20 rule Withdraw in ICU 2-minute observation

WI tool is a good basis but is not enough ALL clinical indicators need to be examined before predicting whether pt will expire within 60, 90 or 120 o NIF -35=no way he’s going down, right? Respiratory assessment: o Usually prior to family involvement o CPAP trial (permission of MD) NIF, RR, TV, sats Often done over the phone due to imminent withdrawal call Variability in how NIF was obtained Missed opportunity lead to process change Lessons Learned

Ask MD to do 20-min trial, if tolerated – NIFs at start and end of CPAP trial Intent was to not give family false hope Wouldn’t offer DCD if unlikely to expire – Hospital and OPO staff uncomfortable w/duration Medical Director recommended we only do CPAP trials if family is on board with donation – Better transparency with staff and family – Reduced CPAP trial to 10 minutes – Allows us to have more control of how NIF is conducted Revised Process

Still finalizing tracking tool – Goal is to gather data on all evaluations We suspect having 2 NIFs will help guide decision – We’ve seen 10-point changes in short period of time— some stronger and some weaker We feel we’re able to give family more accurate information If we determine pt is unlikely to expire, we tell family he/she is not eligible If uncertain, we leave it up to the family Conclusions