DCD Approach Process: Maximizing the Gift Jamie Kothapalli, RN BSN Wisconsin Donor Network

Background In early 2013, WIDN started evaluating DCD donors for the potential for BD to maximize the gift and improve recipient outcomes.

2013 DCD Approach Data 33 instances where family was asked to wait for BD 6 families did not want to wait - DCD donors 27 families waited, time range 5-75 hours 13 of these patients progressed to BD (average wait time 24 hours) 14 instances where family was not asked to wait

2014 DCD Approach Data 22 instances where family was asked to wait for BD 2 families did not want to wait - DCD donors –37/C/M- 3 small children, family emotionally drained –35/C/M- wife was DOA family wanted dual funeral 20 families waited, time range 5-67 hours 18 of these patients progressed to BD (average wait time 21 hours) 11 instances where family was not asked to wait

Two Year Success % of families willing to wait for BD 48% of donors progressed to BD % of families willing to wait for BD 90% of donors progressed to BD

DCD Pre-Approach Process Huddle with Attending MD Determine potential for DCD donation Determine potential for progression to BD –Discussion surrounding likelihood to progress and timing of progression –Pre-approach discussion

Family Discussion Focus of discussion is on BD donation Talking points: –Recipient Outcomes –Maximize the gift DCD donation only discussed in some situations Establish a plan with the family –How long they are comfortable waiting –Drive family support/future discussions

Donor Designation

92 Lives Saved! 10 Hearts 8 Lungs 21 Livers 47 Kidneys 5 Pancreata 1 Intestine

Highlights Skill of Family Services Coordinator Support of Attending Physician –Effective huddle to determine likelihood for BD Family’s willingness to optimize the gift