The Organ Donation Process Lisa Seymour, RN Learning Specialist New York Organ Donor Network 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network Objective Understanding of the process of donation from consent to recovery of the organs 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network Topics of Discussion Overview of the consent process Brain Death protocol Evaluation and screening Organ specific testing Allocation of the organs Recovery process Post recovery 11/14/2018 L. Seymour, New York Organ Donor Network

OVERVIEW OF THE CONSENT PROCESS CANNOT HAPPEN WITHOUT EACH COMPONENT, MAY TAKE TIME, TIMING !! 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network TIMING IS CRUCIAL 11/14/2018 L. Seymour, New York Organ Donor Network

WORKING WITH THE FAMILY Assessment of family Introductions Identification of NOK Identification of decision makers, family support Eliciting family understanding of brain death Discussion of donation with the family Explanation of process of donation Addressing concerns and questions Meeting needs of the family FAMILY SERVICE COUNSELORS, TRANSPLANT COORDINATORS, SOCIAL WORK 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network CONSENT PROCESS Consent forms Medical and Behavioral History Explanation of “what comes next?” Constant updates for the family 11/14/2018 L. Seymour, New York Organ Donor Network

WORKING TOGETHER TO SUPPORT THE FAMILY Family includes supports not only NOK, rabbi, pastor, priests, extended family 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network BRAIN DEATH PROTOCOL Full understanding of hospital plans for protocol Assisting family with understanding Explanation how protocol affects the timeline and donation process 11/14/2018 L. Seymour, New York Organ Donor Network

BRAIN DEATH PROTOCOL cont. Based on NYS Guidelines Clinical Exams by physicians Supportive or confirmatory testing Possible delays in protocol being completed 11/14/2018 L. Seymour, New York Organ Donor Network

SCREENING AND EVALUATION Serology testing (HIV, Hepatitis, etc) Blood type Medical Suitability Behavioral History HLA (tissue typing, histocompatability) Review of CT scans, chest x-rays, etc 11/14/2018 L. Seymour, New York Organ Donor Network

ORGAN SPECIFIC TESTING HEART EKG Echocardiogram Cardiac catheterization Lab values 11/14/2018 L. Seymour, New York Organ Donor Network

ORGAN SPECIFIC TESTING cont. LUNGS Bronchoscopy Chest X rays Culture results Arterial blood gases Accurate measurements 11/14/2018 L. Seymour, New York Organ Donor Network

ORGAN SPECIFIC TESTING cont. LIVER Lab testing CT scans or ultrasound Lab values 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network ORGAN PLACEMENT cont. KIDNEYS Lab testing HLA (tissue typing) Ultrasound or CT scan Kidney anatomy (post recovery) Pump numbers (post recovery) 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network ORGAN PLACEMENT cont. PANCREAS HLA Ha1C Lab testing CT or ultrasound Insulin dosing in hospital 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network ALLOCATION BEGINS UNOS specific guidelines and generation of the “list” Performed by Transplant Coordinator in field, Organ Placement Coordinators and/or UNOS Time frame **describe listing of patients, equity, directed donation ONE HOUR RULE 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network During this time of consent, screening and evaluation and allocation stability of the donor and support the family is CRUCIAL 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network ORGAN ALLOCATION All information in hand at this point (few exceptions) Multiple people may be involved Very time consuming process Multiple offers at once ALL information must be given for informed decision by surgeon Deciding surgeon may want more information Decision made to accept or decline 11/14/2018 L. Seymour, New York Organ Donor Network

A RECIPIENT IS FOUND Backup placing begins~ We understand that ANYTHING can happen 11/14/2018 L. Seymour, New York Organ Donor Network

ORGANIZATION OF RECOVERY Operating room availability at the hospital Organizing potentially up to 8 surgical teams to arrive AT THE SAME TIME, IN THE SAME PLACE, to work together to successfully recover these live saving organs ONE OF THE BIGGER CHALLENGES WE HAVE LITTLE CONTROL OVER 11/14/2018 L. Seymour, New York Organ Donor Network

RECOVERY Abdominal teams (liver team) begins All teams do extensive “prep work” needed for expedition of recovery post cross clamp Heart and lungs are procured first Liver, pancreas and intestine next Kidneys are recovered last. This process takes between 4-6 hours 11/14/2018 L. Seymour, New York Organ Donor Network

WHY WOULD AN ORGAN BE REFUSED IN THE OR? Suspicious mass or lesions found Evidence of infection Biopsies performed are incompatible with donation Donor instability Recipient instability or death 11/14/2018 L. Seymour, New York Organ Donor Network

WHAT HAPPENS IF THE ORGAN IS REFUSED? Immediately the backup is called Aggressive placement continues If, unfortunately, no recipient is found THE ORGANS WILL BE KEPT IN THE BODY OR RETURNED TO THE BODY BEFORE CLOSURE (if already procured) 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network POST RECOVERY Tissue typing to include lymph nodes, blood clot, spleen are obtained for secondary typing for kidneys, pancreas, intestine and heart Preservation of the organs after initial anatomy documented Kidneys placed on pumps 11/14/2018 L. Seymour, New York Organ Donor Network

THE RUSH TO TRANSPLANT IMMEDIATE TRANSPORTATION IMMEDIATE TRANSPLANTATION WHAT IS THE RUSH? THESE ORGANS ARE NOT FOR “WHAT IF?” A LIFE IS IN JEOPARDY 11/14/2018 L. Seymour, New York Organ Donor Network

POST RECOVERY KIDNEY ALLOCATION MAY CONTINUE WHY? Benefits of waiting to pumping kidneys Use of kidney pumps gives more detailed information Can “turn around” kidneys Ultimately provides for best recipient 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network POST RECOVERY cont. Surgical teams “close” the donor in the same manner as any other surgery Respect for the body continues Carrying through the wishes of the family for arrangements for the body Family called 11/14/2018 L. Seymour, New York Organ Donor Network

A QUITE COMPLICATED PROCESS Begins with working with the hospital to assess the situation, the family and the initial suitability The process of working with the family and obtaining consent Further screening Organ specific testing Allocation to find the right recipient Logistics of recovery 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network IN SUMMARY Organ transplantation is proven The entire goal of organ transplantation is TO SAVE ANOTHER HUMAN LIFE Organs are NEVER “wasted” Intent is always to find the best recipient Family wishes are ALWAYS respected 11/14/2018 L. Seymour, New York Organ Donor Network

Respect for the donor and their family 11/14/2018 L. Seymour, New York Organ Donor Network

L. Seymour, New York Organ Donor Network While… assuring that all is possibly done to save another human being’s life 11/14/2018 L. Seymour, New York Organ Donor Network