Sue Weese, RN, BSN, CPTC Hospital Coordinator Giving the Gift of Life

Focus Referral Process Catastrophic Brain Injury Guidelines Brain death vs. death Circulatory Transitional Language/Huddles Partnership Care of the patient and family Tools and resources

LifeSource

A federally designated OPO (Organ Procurement Organization) serving: ND SD MN WI Douglas County St. Croix County Pierce County

120,000 Target field Lambeau Field

Referral Process Family mentions or has questions about donation When patient meets the Triggers for donation, LifeSource should be called within one hour Clinical Triggers include:  Neurological injury  Patient on a ventilator  Loss of two brain stem reflexes or a GCS of < 5 Call is mandated, staff does not need permission to make the call After initial referral, if decision made to withdraw life-sustaining measures or prior extubation Referral Units include: ICU’s/ED/OR

Donor designation is the practice of ensuring that an individual’s documented wishes about donation are fulfilled. Minnesota passed the Darlene Luther Anatomical Gift Act in April 2002 LifeSource implemented practice changes to incorporate Donor Designation in May 2003 “giving the donor a voice” What is Donor Designation

Neuro events  Injuries Anoxic –Cardiac arrest ICH/CVA Blunt Trauma GSW Asphyxiation Brain Tumor

Guide: The person who steers the boat down the river, giving paddle commands to the crew as paddle captain or rowing as oars person.

Catastrophic Brain Injury Guidelines (CBIG’s) A Trauma surgeon and ED Physician out of Kansas City developed the Catastrophic Brain Injury Guidelines to be used when a patient is deemed nonsurgical/nonsurvivable. Based the guidelines on the Surviving Sepsis Campaign Goal to save more lives and preserve the opportunity for donation. Outcome: 3 people survived 17 organs were transplanted

Complications of Brain Death

Maintain SBP > 90 (MAP > 60 ) – Perfusion Maintain Urine Output > 1ml/kg/hr < 300ml/hr – Fluid balance Maintain PO2 > 100 & pH Oxygenation Monitor glucose – Cell metabolism Monitor and treat electrolytes – Acid Base balance Critical Care end points

Policy Known etiology of brain death and/or evidence of irreversibility No brainstem function No respiratory effort/apnea test Brain Death Death by Neurological Criteria

Donation after Circulatory Determination of Death Policy Patient does not meet Brain Death criteria Family decides to withdraw life-sustaining medical treatment Patient ventilator dependent Patient is age < 60

"The individual represented by the hospital to request to the family must be an organ procurement representative or a designated requestor" (CMS Conditions of Participation (a)(3)

What do you say… …if the family raises the topic of donation? – Prior to Brain Death/Cardiac Death “Hennepin County supports donation. Donation may be possible. We work closely with the donation agency and I’ll arrange to have them speak with you” – After Brain Death/Cardiac Death “We work very closely with the donation agency and they are available to answer your questions about donation”

Acknowledge the donation comments Connect the family to LifeSource Support the family in meeting their needs Mention of Donation

Huddle Definitions Donation Assessment Huddle – Onsite or telephone response, after an evaluation Family Support Huddle – Prior to Family Discussion Family Outcome Huddle – After Family Discussion

Importance of clear and consistent language CaliforniaFlorida Family considers taking brain-dead son off life support

Corneas Heart/Heart Valves Lungs Liver Pancreas Kidneys Intestines Skin Bone/Connective Tissues Blood Vessels Donation Opportunities

Neuro injury Vented ICU Triggers for referral Chaplains Order sets Tissue and eye ME/OR/RT Policy Family Support Similarities

Differences Brain Death No age limit Clinical and Apnea Time of death- Brain Death- ICU Extubate or Donate Yes Anesthesia No Family in OR LS Manages DCD Age limit - 60 Evaluate for 60 minute CTOD Time of death-Cardiac Standstill- OR Decision to withdraw No Anesthesia-only lungs Family invited in OR MD manages

Brief moment taken in OR to honor the donor and provide a connect to purpose for everyone present.

Family Support Wrapped in Hugs Flag Raising Funeral Box Bracelets Wall of Heroes Family After Care Donor Family Gatherings

Flag Raising Donate Life Month During a case

HCMC Altru Health Abbott Northwestern North Memorial

Triggers for referral Death-Circulatory vs Neurological CBIG’s-avoid deceleration in care 64% of MN drivers over 18 DD >120K on waitlist Family/patient decision Summary