Case Study 24 y/o overdose with history of IVDA, found with needle in arm, & pronounced within 24 Hours of admission. Sharing Our Current Practices Hospital: What is your initial referral process after evaluating the patient? What is your social and clinical management pathway of this patient? What is your process of updating the OPO on the clinical status of changes neurologically, and progression toward brain death, with plans for testing? What is your process for pronouncement of brain death?

Sunrise Hospital Donation Process Most patients in the ICU who have devastating injuries are referred to the palliative care team for goals of care. This initial encounter includes the transparency of the condition including grim outcome including death All patients with a GCS of 5 or less triggers an automatic referral to the donor network Once triggered, the facility makes available to the OPO access to the clinical record On a daily basis, or any status change the OPO is notified

Palliative Care and the Organ Donor Process If the palliative care team is following this patient, we work collaboratively with the OPO to focus on goals of care If the option of withdraw of life support is discussed, this triggers communication with the OPO to engage the family If this case was not a traditional brain death donor and possibly a DCDD candidate, the palliative care team and the OPO work collaborative to ensure the end-of-life care is compassionate. The DCDD donor is compassionately extubated just as any other end-of-life patient is cared for

Determination of Brain Death Examination and determination is done exclusively by Neurology, Neurosurgery, Trauma, or Pulmonary Critical Care Documentation must include that the possible case and that brain function is irreversible, coma or unresponsiveness is present, absence of brain stem reflexes and apnea. Brain death may be established with confirmatory testing. For the purposes of organ donation, an apnea test must be performed unless contraindicated Ancillary testing is not mandatory in patients but is recommended for patients in whom specific components of clinical evaluation cannot be reliably performed or evaluated. Ancillary testing can include: radionuclide brain flow scan, angiography, electroencephalogram (EEG), transcranial doppler ultrasonography, and somatosensory evoked potentials

NEVADA STATE LAW NRS 451.007 Determination of death. 1. For legal and medical purposes, a person is dead if the person has sustained an irreversible cessation of: (a) Circulatory and respiratory functions; or (b) All functions of the person’s entire brain, including his or her brain stem. 2. A determination of death made under this section must be made in accordance with accepted medical standards. 3. This section may be cited as the Uniform Determination of Death Act and must be applied and construed to carry out its general purpose which is to make uniform among the states which enact it the law regarding the determination of death. (Added to NRS by 1979, 226; A 1985, 130) ***AB 424 AN ACT relating to the determination of death; revising provisions relating to the determination of brain death; Jun 02, 2017 Approved by the Governor Effective October 1, 2017