1. The Role of the Specialist Nurse-Organ Donation (SNOD)
Louise Colson
Team Manager, South Wales ODT

2. When we can’t cure we can only continue to care
2010
Organ donation
81 If a patient is close to death and their views cannot be determined, you should be prepared to explore with those close to them whether they had expressed any views about organ or tissue donation, if donation is likely to be a possibility.
82 You should follow any national procedures for identifying potential organ donors and, in appropriate cases, notify the local Specialist Nurse for Organ Donation.

3. Specialist Nurse- Organ Donation
Band 7
Senior Nurse Post
Critical Care Background (ICU/ED)
Post Basic Critical Care Qualifications
Block Recruitment
NHSBT Training 1/4 weeks residential to include
Consent
Hospital Development
Mandatory Training
Insight Reports
Negotiating and Influencing

4. Specialist Nurse- Organ Donation
Mentors in each team supported by Team Managers and Practice Development Specialist (PDS)
National Competencies
21-26 week expected completion
26 weeks onwards continued support from Peer, Managers and PDS
PDPR’s
1:1s

5. Specialist Nurse- Organ Donation Teams
212 Whole Time Equivalents (WTE)
12 Regional Teams
Smaller Teams average 12 WTE
Mid Teams average 16 WTE
Larger Teams WTE
Main Offices NHSBT buildings
SNODs based remotely within Critical Care Areas/ED Departments

6. Specialist Nurse- Organ Donation Role Facilitation of Donation
Donor referrals
Planned collaborative approach
Family support and information
Consent/Authorisation
Donor characterisation
EOS
Offering and organ placement
NORS
Theatre
Last Offices
Post donation family support (letters and donation outcomes)

7. Specialist Nurse- Organ Donation Role Embedded Role
Essential to educate health professionals and promote donation within the hospital and the wider community the hospital serves.
Work collaboratively with the CLOD, Organ Donation Committee and others to formulate, review and maintain policies and protocols providing information and direction on donor identification and referral
Develop and deliver comprehensive educational strategies to promote organ/tissue donation in their hospital.

8. Specialist Nurse- Organ Donation Role Embedded Role
Motivate and educate intensive care and emergency department health professionals to refer all potential donors.
Develop and maintain influential relationships with consultant anaesthetists, intensivists, nursing staff, retrieval teams, laboratory and mortuary staff at participating hospitals and with HM Coroner/ Procurator Fiscal in the advancement of the organ/tissue donation process

9. Specialist Nurse- Organ Donation Role Embedded Role
Establish and maintain effective lines of communication with transplant surgeons, recipient transplant co-ordinators, NHSBT, other Specialist Nurses in Organ Donation and all relevant staff in existing and potential donating centres in relation to organ/tissue donation
Liaise with NHSBT ensuring all relevant documentation including audit requirements are met such as the Potential Donor Audit.
Promote and educate health care professionals and the general public about the benefits of organ/ tissue donation and transplantation.

10. Specialist Nurse- Organ Donation
Aim for consistent approach
Utilising best practice
Well defined in literature
Intensive training
Time and commitment
Constant exposure / experience
Seamless service
Help the critical care staff to identify potential donors
Can establish pathways to ensure that all potential donors are referred

11. Specialist Nurse- Organ Donation
Early referral / minimum notification criteria
ODR check
Discussions with consultant
Assessment of patient
Approach family – dynamics, NOK, issues, acceptance of death
Register donor / complete EOS
Offering of organs to recipient centres
Additional organ assessments if requested
Acceptance / Decline of organs
Mobilisation of retrieval teams
Continued support of staff & family
Negotiation with theatres
Donor optimisation
Withdrawal of treatment if DCD
Transfer to theatre

12. Case Review 8pm Referral from ED Consultant to on call SNOD
MJ, Age 44. Nil PMH except previous motorbike accident 6 years ago and depression
Came off motorbike and hit a tree with his head
CT scan shows diffuse brain injury. No neurosurgical intervention
On ODR - no restrictions
Will admit to ICU if family say yes to donation
ED Consultant told family of poor prognosis and his son said he always said he would want to be a donor
Transfer to ICU

13. On Intensive Care 22:35 Appears to have become brainstem dead
Not sedated, pupils fixed and dilated, no respiratory effort.
Unable to complete BSD Tests as one consultant only available
Plan to support overnight to perform the next morning.
Family present and seen by SNOD, agreed for Organ Donation
“Wish to complete paperwork to go home. Other information regarding the process given at this time.”
Consented to DCD and DBD as awaiting outcome of BSD Tests

14. The Process 01:00 Consent/Authorisation obtained from siblings
DCD/DBD for all organs, including research and heart valves
PA1 completed
Family home, will return at approx 11:30 am.
Pt has become quite unstable
Several episodes of hypotension bp <50
Central line inserted and CVS support commenced
Patient now taking some spontaneous breaths
Lactate now 7 ?due to compartment syndrome of right arm
Bloods sent for virology and tissue typing
Trying to stabilise patient
Increase in donor management attempts and completion of donor characterisation forms

15. The Process Coroner / Procurator Fiscal consent given no restrictions
03:34 Eos completed following full donor characterisation, bloods, investigations of individual organ function
Full assessment of patient including detailed body map (without GP information at this time)
Earlier appeared to no longer fulfil criteria for BSD Testing however spont breaths stopped, so plan to wait for BSD tests to be done before organs are offered. Proceed as a DBD if able
ICU consultant aware of this and current progress
Not able to contact GP, for morning follow up
09:00 handover to morning SNOD
Family due at 11:00 am
BSDT to be done, ASAP.

16. The Process 14:00 BSDT tests still not complete
Patient’s condition now becoming more difficult to manage
Family present with patient. Waiting to hear what is going on
15:20 BSDT confirmed
Family still want to proceed
Pt requiring intensive donor management to stabilise and support required increasing.
19:00 Organ offering commenced
All centres decline cardiothoracic organs on function and high inotropic requirements
Kidney/pancraes accepted at Oxford, Rt Kidney Bristol
Liver accepted at Birmingham

17. Offering Process
Offering of organs, each centre has one hour to respond to the offer
Cardiothoracic organs declined
Liver accepted
Kidney/Panc accepted
Kidney only accepted
Heart valves to HV Bank

18. The Process Theatre and Organ Placement
Lt Kidney Leeds
Rt Kidney Bristol
Heart Valves to HV Bank
Offering complete NORS requested for retrieval expected at 22.00
23:10 Theatre
23:26 Knife to skin00:00
06:00 Donation complete and last offices performed.
09.00 Family contacted as requested once all was finished

19. Communicating with staff and family
Clear communication of the process, roles and responsibilities
Information updates regularly
Senior attending physician must be informed of progress
Family considerations and support
Comfort measures can be administered
Donor dignity and respect
Post donation follow up with staff and family

20. Questions?