The Role of the Specialist Nurse-Organ Donation (SNOD) Louise Colson Team Manager, South Wales ODT

When we can’t cure we can only continue to care 2010 Organ donation 81 If a patient is close to death and their views cannot be determined, you should be prepared to explore with those close to them whether they had expressed any views about organ or tissue donation, if donation is likely to be a possibility. 82 You should follow any national procedures for identifying potential organ donors and, in appropriate cases, notify the local Specialist Nurse for Organ Donation.

Specialist Nurse- Organ Donation Band 7 Senior Nurse Post Critical Care Background (ICU/ED) Post Basic Critical Care Qualifications Block Recruitment NHSBT Training 1/4 weeks residential to include Consent Hospital Development Mandatory Training Insight Reports Negotiating and Influencing

Specialist Nurse- Organ Donation Mentors in each team supported by Team Managers and Practice Development Specialist (PDS) National Competencies 21-26 week expected completion 26 weeks onwards continued support from Peer, Managers and PDS PDPR’s 1:1s

Specialist Nurse- Organ Donation Teams 212 Whole Time Equivalents (WTE) 12 Regional Teams Smaller Teams average 12 WTE Mid Teams average 16 WTE Larger Teams 24-32 WTE Main Offices NHSBT buildings SNODs based remotely within Critical Care Areas/ED Departments

Specialist Nurse- Organ Donation Role Facilitation of Donation Donor referrals Planned collaborative approach Family support and information Consent/Authorisation Donor characterisation EOS Offering and organ placement NORS Theatre Last Offices Post donation family support (letters and donation outcomes)

Specialist Nurse- Organ Donation Role Embedded Role Essential to educate health professionals and promote donation within the hospital and the wider community the hospital serves. Work collaboratively with the CLOD, Organ Donation Committee and others to formulate, review and maintain policies and protocols providing information and direction on donor identification and referral Develop and deliver comprehensive educational strategies to promote organ/tissue donation in their hospital.

Specialist Nurse- Organ Donation Role Embedded Role Motivate and educate intensive care and emergency department health professionals to refer all potential donors. Develop and maintain influential relationships with consultant anaesthetists, intensivists, nursing staff, retrieval teams, laboratory and mortuary staff at participating hospitals and with HM Coroner/ Procurator Fiscal in the advancement of the organ/tissue donation process

Specialist Nurse- Organ Donation Role Embedded Role Establish and maintain effective lines of communication with transplant surgeons, recipient transplant co-ordinators, NHSBT, other Specialist Nurses in Organ Donation and all relevant staff in existing and potential donating centres in relation to organ/tissue donation Liaise with NHSBT ensuring all relevant documentation including audit requirements are met such as the Potential Donor Audit. Promote and educate health care professionals and the general public about the benefits of organ/ tissue donation and transplantation.

Specialist Nurse- Organ Donation Aim for consistent approach Utilising best practice Well defined in literature Intensive training Time and commitment Constant exposure / experience Seamless service Help the critical care staff to identify potential donors Can establish pathways to ensure that all potential donors are referred

Specialist Nurse- Organ Donation Early referral / minimum notification criteria ODR check Discussions with consultant Assessment of patient Approach family – dynamics, NOK, issues, acceptance of death Register donor / complete EOS Offering of organs to recipient centres Additional organ assessments if requested Acceptance / Decline of organs Mobilisation of retrieval teams Continued support of staff & family Negotiation with theatres Donor optimisation Withdrawal of treatment if DCD Transfer to theatre

Case Review 8pm Referral from ED Consultant to on call SNOD MJ, Age 44. Nil PMH except previous motorbike accident 6 years ago and depression Came off motorbike and hit a tree with his head CT scan shows diffuse brain injury. No neurosurgical intervention On ODR - no restrictions Will admit to ICU if family say yes to donation ED Consultant told family of poor prognosis and his son said he always said he would want to be a donor Transfer to ICU

On Intensive Care 22:35 Appears to have become brainstem dead Not sedated, pupils fixed and dilated, no respiratory effort. Unable to complete BSD Tests as one consultant only available Plan to support overnight to perform the next morning. Family present and seen by SNOD, agreed for Organ Donation “Wish to complete paperwork to go home. Other information regarding the process given at this time.” Consented to DCD and DBD as awaiting outcome of BSD Tests

The Process 01:00 Consent/Authorisation obtained from siblings DCD/DBD for all organs, including research and heart valves PA1 completed Family home, will return at approx 11:30 am. Pt has become quite unstable Several episodes of hypotension bp <50 Central line inserted and CVS support commenced Patient now taking some spontaneous breaths Lactate now 7 ?due to compartment syndrome of right arm Bloods sent for virology and tissue typing Trying to stabilise patient Increase in donor management attempts and completion of donor characterisation forms

The Process Coroner / Procurator Fiscal consent given no restrictions 03:34 Eos completed following full donor characterisation, bloods, investigations of individual organ function Full assessment of patient including detailed body map (without GP information at this time) Earlier appeared to no longer fulfil criteria for BSD Testing however spont breaths stopped, so plan to wait for BSD tests to be done before organs are offered. Proceed as a DBD if able ICU consultant aware of this and current progress Not able to contact GP, for morning follow up 09:00 handover to morning SNOD Family due at 11:00 am BSDT to be done, ASAP.

The Process 14:00 BSDT tests still not complete Patient’s condition now becoming more difficult to manage Family present with patient. Waiting to hear what is going on 15:20 BSDT confirmed Family still want to proceed Pt requiring intensive donor management to stabilise and support required increasing. 19:00 Organ offering commenced All centres decline cardiothoracic organs on function and high inotropic requirements Kidney/pancraes accepted at Oxford, Rt Kidney Bristol Liver accepted at Birmingham

Offering Process Offering of organs, each centre has one hour to respond to the offer Cardiothoracic organs declined Liver accepted Kidney/Panc accepted Kidney only accepted Heart valves to HV Bank

The Process Theatre and Organ Placement Lt Kidney Leeds Rt Kidney Bristol Heart Valves to HV Bank Offering complete NORS requested for retrieval expected at 22.00 23:10 Theatre 23:26 Knife to skin00:00 06:00 Donation complete and last offices performed. 09.00 Family contacted as requested once all was finished

Communicating with staff and family Clear communication of the process, roles and responsibilities Information updates regularly Senior attending physician must be informed of progress Family considerations and support Comfort measures can be administered Donor dignity and respect Post donation follow up with staff and family

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