ORGAN DONATION in the ED Presented by: Robert D. Kerns, NREMT-P, CPTC Advanced Practice Coordinator UWHC In-House Coordinator UWHC Organ Procurement Organization Lee Faucher, MD Director of Trauma Services UWHC

OBJECTIVES  Identify potential emergent and/or uncontrolled DCD candidates  Define Uncontrolled DCD  Define the process of successful Uncontrolled DCD  Identify the resources needed to support an Uncontrolled DCD candidate  Identify the staff needed for a successful Uncontrolled DCD  Demonstrate that the care received in the ER directly impacts Donation even if the patient makes admission to the ICU  Identify barriers to Uncontrolled DCD in the ER  Identify strategies to overcome barriers to Uncontrolled DCD  Identify key members of hospital staff that can champion Uncontrolled DCD  Define communication strategies for hospital staff that will facilitate the Uncontrolled DCD process  Define communication strategies that will support families when presenting the option of Uncontrolled DCD

OBJECTIVES  Identify potential emergent and/or uncontrolled DCD candidates  Define Uncontrolled DCD  Define the process of successful Uncontrolled DCD  Identify the resources needed to support an Uncontrolled DCD candidate  Identify the staff needed for a successful Uncontrolled DCD  Demonstrate that the care received in the ER directly impacts Donation even if the patient makes admission to the ICU  Identify barriers to Uncontrolled DCD in the ER  Identify strategies to overcome barriers to Uncontrolled DCD  Identify key members of hospital staff that can champion Uncontrolled DCD  Define communication strategies for hospital staff that will facilitate the Uncontrolled DCD process  Define communication strategies that will support families when presenting the option of Uncontrolled DCD

CASE 1  0209: Patient arrived at ED  ~20 Year old male in high speed MVC  Long extrication w/ deaths on scene  ETT upon arrival  Patient had severe closed head injury  Left femoral head dislocation

 0345:  Patient to OR for Craniotomy  Patient has bilat SDH Left > Right  Hematoma evacuated spontaneously  Bone flap left out and closed CASE 1

 0601: Admitted to TLC  CVP placed  Patient began bleeding profusely from all open areas  ICP remained elevated  Patient maxed on Epi, Norepi, and Neo  Requiring continuous FFP and PRBC’s CASE 1

 0802: Family Discussion  Family decides to WLS  Family agrees to Organ Donation  OPO Activated CASE 1

 0830: OPO arrived on TLC  Received report from Attending MD  Met with patient’s parents CASE 1

 0845:  Activated OPO recovery team to UW  Scheduled OR for 0930  0900:  Written consents completed  Serology blood drawn  Family services arrives at TLC CASE 1

 0930: OPO recovery team in TLC  0945: Patient to OR with TLC Attending  1030: Extubation  1051: CTOD  1057: Organ recovery begun CASE 1

 Kidneys recovered for transplant –2 patients are transplanted  Eye and tissue recovered –2 patients’ sight restored –100’s of patients benefited from tissue transplants CASE 1 - Outcome

 0802: OPO activated  0830: OPO arrives in TLC  0845: OPO recovery team activated & OR set  0900: Written consent completed  0930: OPO recovery team arrives  0945: Patient to OR  1030: Extubation CASE 1 – Emergent DCD

Emergent DCD  Can this happen at your hospital? YES!!

CASE 2  0942: Patient arrives at ED  ~ 10 year old male w/ GSW to head  Patient in full arrest & ETT upon arrival to ED  Patient stabilized in ED and then to CT  Head CT shows non survivable injury  No NOK available yet  Pt to be supported and admitted to PICU

 1007: OPO activated from ED  1032: Patient arrives in PICU  1035: OPO arrives in PICU  Patient is being supported  NO NOK yet  Police in PICU attempting to locate NOK  ME notified and clears case for donation CASE 2

 1037:  Activated OPO recovery team  Reserved OR for emergency DCD  Pt stabilized on pressors and albumin  No NOK yet CASE 2

 1101:  OPO recovery team onsite  OR suite ready  Serology blood drawn  No NOK yet CASE 2

 1137: Patient’s mother on phone w/ PICU  1140: Mother decides to WLS & consents for DCD Mother is over an hour away  1141: Patient is moved to OR w/ PICU staff and Police  1142: CPR begun  1147: arrive in OR  1201: Extubation & CPR stopped  1206: CTOD  1208: Organ recovery begun CASE 2

 Kidneys recovered for transplant –2 patients are transplanted  Eye and tissue recovered –2 patients’ sight is restored –100’s of patients benefited from tissue transplants CASE 2 - Outcome

 1007: OPO activated from ED  1035: OPO arrives in PICU  1037: Recovery team activated & OR set  1101: Recovery team onsite  1140: Consent obtained for DCD  1141: Patient to OR and CPR begun  1201: Extubation CASE 2 – Uncontrolled DCD

Uncontrolled DCD  Can this happen at your hospital? YES!?!?

ORGAN DONATION in the ED Lee Faucher, MD Director of Trauma Services UWHC

Disclosure  Started my medical career as an EMT in East-Central Wisconsin  Worked as a Surgical Technician at the UW while in college –Member of the transplant team  Faculty member of the Division of General Surgery since 2004 –Director of Trauma since 2006

CASE 3  22 year old male involved in a motor vehicle crash. –Unconscious –Intubated for airway control and diminished mental status –Blood pressure and pulse present and stable –Obvious external injury to head, without other signs of trauma

CASE 3  Social worker has contact information for mother about two hours away.  Mother said she wanted him to be a donor if nothing else could be done.

DISCUSSION  UNCONTROLLED DCD  EMERGENT DCD

THANK YOU!!