1. The Logistics of Saving Lives as a Mass Exporter
Two OPOs and Their Experience
with the Timing of Donor Cases

2. Who Are We? Amanda “Mandi” Richard, RN, MSN, CCRN, CPTC
Clinical Manager, New Mexico Donor Services
Lisa Magaro, RN, BSN, CPTC
Organ Team Lead and Procurement Transplant Coordinator, Nevada Donor Network
Heather Osipowicz, BS, MSBS, CTBS
Hospital Services Educator, Nevada Donor Network

3. Knowing More About Our OPOs Nevada Donor Network
Demographics
Population – 2,198,000
DSA – 13 of 16 Counties in Nevada
12th largest by land, 52nd largest by population
Transplant Center
1 kidney center, located in Las Vegas
Recovery Surgeon
Local transplant surgeon is also the only local recovery surgeon currently

4. Knowing More About Our OPOs Nevada Donor Network

5. Knowing More About Our OPOs Nevada Donor Network
Nearly 2 million of our million population reside in one county
Led the country in 2016 in transplants (164 TPMP) and donors per million population (49 DPMP) *Per OPTN and US Census Data
All A-C level hospitals within 30 miles of each other
Transplant Center is also the Nevada’s only Level One Trauma Center, and produces our highest yield of organ donors
Transient Community
Las Vegas visitors
Temporary community presence

6. Authorization to Recovery Timeframes Nevada Donor Network

7. Knowing More About Our OPOs New Mexico Donor Services
Demographics
Population – 2,085,000
DSA – State of New Mexico
5th largest by land, 54th largest by population
Minority-Majority DSA
Transplant Centers
2 Kidney Centers in Albuquerque
1 Kidney Center just approved for pancreas
Recovery Surgeons:
1 kidney [and now pancreas] surgeon who is also a local transplant surgeon
Mandi to discuss geographical area logistics

8. Knowing More About Our OPOs New Mexico Donor Services

9. Knowing More About Our OPOs New Mexico Donor Services

10. Knowing More About Our OPOs New Mexico Donor Services
period of time with no recovery surgeon
August 2014 Dr. Hanna Choate came to our team!

11. Donor Management to Recovery Timeframes New Mexico Donor Services

12. Shared Allocation and Logistical Challenges of Region 5 Mass Exporters
No local liver or thoracic programs
Limited flight options
Accepting centers have ability to accept multiple organ offers for same recipient
Late decline by transplant centers
OR timing delays due to backup center needs when primary
Identifying recovery team if local recovery surgeon is unavailable
Serology testing
Difficulty offering rapid recovery or uncontrolled DCD to donor families

13. Case Studies

14. Case Study #1 New Mexico Donor Services
7 year old who collapsed at home related to a recent asthma exacerbation. Received CPR with 3 rounds of medications, estimated downtime 26 minutes.
PMH: asthma
Timeline
11/2: Admitted to hospital
11/5 1200: Physician discussed donation with family
11/5 1630: Sent ID testing
11/6 2236: Declared Brain Dead

15. Case Study #1 New Mexico Donor Services
Timeline Continued…
Following Brain Death Determination: T4 Protocol Initiated
11/7 0800: Levophed and Epinephrine drips weaned off completely
11/7 1200: ECHO Completed
11/7 1600: Heart, Liver, and Kidneys placed
Time to set the OR!

16. Case Study #1 New Mexico Donor Services
Time to set the OR…
2 teams coming
Liver team requests ASAP OR
Recipient in ICU, very ill, and “is going to die tonight if she doesn’t get transplanted”.
Heart team requests no sooner than 0800 the next morning
ICU patient, very unstable, may need ECMO overnight.
Surgeon cannot fly out as he would be the one to place the patient on ECMO
Could not agree on the OR time

17. Case Study #1 New Mexico Donor Services
Where do we go from here?
Think outside the box!
OPO directly connected the heart and liver surgeons
Liver center identified a heart surgeon at their hospital that would come and recover
Heart center discussed, and agreed
Liver center hospital’s heart surgeon recovered the heart
Heart center sent perfusion staff and charter plane to return with heart

18. Case Study #1 New Mexico Donor Services
A Successful Outcome! A 1 year old little girl and a 12 year old little girl were both successfully transplanted!

19. Case Study #2 New Mexico Donor Services
57 year old female found down at home. Bystander CPR initiated, and patient was asystolic when EMS arrived. Estimated downtime 45 minutes.
PMH: COPD, asthma, chronic pain, HTN, depression, insomnia
Timeline
Heart, Liver, and Kidney allocation started simultaneously
Exhausted Heart List to Zone C
Liver and Kidneys placed

20. Case Study #2 New Mexico Donor Services
Time to set the OR…
At 1400, OR set for 0200
Liver was backed up
Center was verified to be interested as a backup
At 2000, OPO Coordinator was notified primary team was coding out for a “closer offer”
Backup center also coded out – due to “closer offer”
0200 OR was cancelled, and Coordinator was back to liver allocation
At 0500, new OR set for 0900

21. Case Study #2 New Mexico Donor Services
Case Outcome
Timeframe of case totaled 70 hours
Liver successfully transplanted
Allocated as SLK
Kidney placed in local back up due to recipient stability
Right kidney placed with a high CPRA recipient
Declined one hour post-recovery, due to flight schedules
3 other mandatory shares with provisional code out
Ultimately placed at local transplant center

22. Case Study #3 Nevada Donor Network
28 year old male, who had been complaining of a headache and went to bed early. Wife found him snoring loudly, and later he was in cardiac arrest, with unknown total downtime. Cardiac arrest was secondary to suspected drug overdose.
PMH: HTN and previous suicide attempt with drug overdose (2 months prior)
Toxicology: Positive for opiates and THC
Timeline
10/ : Initial Referral called, patient is areflexic
10/ : Family wanting to WDLS, Family Services and Transplant Coordinator onsite.

23. Case Study #3 Nevada Donor Network
Timeline Continued…
10/ : Neurology examined patient, and first exam consistent with brain death (this hospital requires 2 exams to pronounce).
10/ : Authorization and DRAI obtained. Family places time constraints on case, want case completed no later than 10/25, but prefer by evening of 10/24.
10/ : Serologies drawn and sent, ETA for results 11:15 next day.
10/ : Brain death declaration completed with second exam and CBF.
10/ : Echo completed and results pending; allocation not yet started.
10/ : Family onsite; allowing more time for case to be allocated and completed.
10/ : Heart, Liver, Kidneys, and Pancreas placed. Lung allocation continues.

24. Case Study #3 Nevada Donor Network
Time to Set the OR…
10/ : OR scheduled for 10/
10/ : Accepting liver center calls to say their liver team and surgeon are delayed on another case… for the same recipient!
Currently getting biopsy, and if good, accepting that liver, and declining ours.
Urgent calls made to backup liver centers.
One center unable to accept due to timing of OR and could not get a team mobilized in time.
10/ : Liver accepted by regional center, and okay with local recovery. OR proceeded as scheduled.

25. Case Study #3 Nevada Donor Network
Final Outcome
Donor Family allowed us additional time outside of the original time constraints.
Backup Liver Center that ultimately accepted the liver was okay with local surgeon recovering, so OR time was not rescheduled.
4 lives were saved!
Heart transplanted into a 64 year old male
Liver transplanted into a 53 year old male
Right kidney transplanted into a 48 year old male
Left kidney transplanted into a 46 year old female

26. Table Discussion Questions
How can we, as OPOs and transplant centers, work collaboratively to decrease timeframes from the start of a case to organ recovery?
During cases in which a donor family has placed time constraints, what policies or procedures do you have in place to be able to maximize the donation potential?

27. Thank you!