1. University of Wisconsin Organ Procurement Organization
Organ Donation End of Life care in the Operating Room Matthew Bock Surgical recovery coordinator
University of Wisconsin
Organ Procurement Organization
1-866-UWHC OPO
( )

2. Perspective

3. Remembering why we’re here
Save lives through transplantation
Supporting the family’s choice
Honoring the patient’s wishes

4. Donation after Cardiac Death (DCD)

5. Uniform Determination of Death Act, 1980
Irreversible cessation of circulatory and respiratory function OR-
Irreversible cessation of all functions of the entire brain, including the brain stem
Scientists began the process of redefining death and in 1980, the Harvard Medical School issued a report entitled the “Uniform Determination of Death Act” which revised the definition of death as follows:
An individual is considered dead, if sustaining: 1. Irreversible cessation of circulatory and respiratory function; or 2. Irreversible cessation of all functions of the entire brain, including the brain stem.
This definition allowed doctors to determine that a person’s brain had died even though machines were able to keep the heart and lungs working. This resulted in the term “brain death” as an additional term to “cardiac death.” Therefore, there are two ways in which death can be declared.

6. Two ways to donate Deceased Organ Donation
Donation After
Cardiac Death (DCD)
Donation After
Brain Death

7. DCD
Severe neurological injury
Does not meet criteria for brain death
Family has elected to withdraw support
Brain Death
Severe neurological injury
Meets Brain death criteria:
-Clinical exam
-Apnea test

8. DCD
Severe neurological injury
Does not meet criteria for brain death
Family has elected to withdraw support
Brain Death
Severe neurological injury
Meets Brain death criteria:
-Clinical exam
-Apnea test

9. Clinical Diagnosis of Brain Death
Unresponsive to all stimuli
No spontaneous respiratory activity
All brain stem reflexes are absent:
Pupillary response to light
Corneal reflexes
Oculo-vestibular reflex (caloric response)
Oculocephalic reflex (doll’s eye phenomenon)
Gag reflex

10. Apnea Test
Make sure patient has normal body temp, blood pressure, volume status, ABG’s
Disconnect from ventilator
Monitor continuous pulse oximetry
Administer 100% O2 at 6 L/min into the trachea
Monitor closely for respiratory movements
Check serial ABG’s, or at approx. 8 minutes
If no respiratory movement and arterial PCO2 is > 60 mm Hg, the apnea test supports the clinical diagnosis of brain death

11. Apnea Test
Make sure patient has normal body temp, blood pressure, volume status, ABG’s
Disconnect from ventilator
Monitor continuous pulse oximetry
Administer 100% O2 at 6 L/min into the trachea
Monitor closely for respiratory movements
Check serial ABG’s, or at approx. 8 minutes
If no respiratory movement and arterial PCO2 is > 60 mm Hg, the apnea test supports the clinical diagnosis of brain death

12. Brain Death
Severe neurological injury
Meets Brain death criteria:
-Clinical exam
-Apnea test
DCD
Severe neurological injury
Does not meet criteria for brain death
Family has elected to withdraw support

13. DCD
Severe neurological injury
Does not meet criteria for brain death
Family has elected to withdraw support
Brain Death
Severe neurological injury
Meets Brain death criteria:
-Clinical exam
-Apnea test

14. Severe Neurologic Injury
Trauma
MVA, Fall
SDH
Anoxia
Cardiac Arrest, near drowning

15. Brain Death
Severe neurological injury
Meets Brain death criteria:
-Clinical exam
-Apnea test
DCD
Severe neurological injury
Does not meet criteria for brain death
Family has elected to withdraw support

16. Two ways to donate Donation After Brain Death
Patient is maintained on ventilator for organ recovery
Organs dissected insitu
3-4 hour surgery
Donation After Cardiac Death
(DCD)
Patient is extubated in the Operating Room or ICU
Surgery begins 5 minutes after cessation of cardiac function and declaration by patient’s physician
Rapid recovery with organs procured en bloc.

17. Two ways to donate Donation After Brain Death
Patient is maintained on ventilator for organ recovery
Organs dissected insitu
3-4 hour surgery
Donation After Cardiac Death
(DCD)
Patient is extubated in the Operating Room or ICU
Surgery begins 5 minutes after cessation of cardiac function and declaration by patient’s physician
Rapid recovery with organs procured en bloc.

18. Two ways to donate Donation After Brain Death
Patient is maintained on ventilator for organ recovery
Organs dissected insitu
3-4 hour surgery
Donation After Cardiac Death
(DCD)
Patient is extubated in the Operating Room or ICU
Surgery begins 5 minutes after cessation of cardiac function and declaration by patient’s physician
Rapid recovery with organs procured en bloc.

19. “We don’t do that here”

20. ICU nurse RT
OPO staff
No family yet

21. Who is involved? Cardiothoracic Team Hospital
Anesthesia
Surgical Technician/Scrub Nurse
Circulating Nurse
Abdominal Transplant Team
- Surgeon
- Physician Assistant
- Surgical Recovery Coordinator
Cardiothoracic Team
- Surgical Fellow

22. Paperwork
Consent x2
Time out
Post Op disposition
Death packet

23. Prep & drape
Femoral cutdown
Cover patient and back table
Unnecessary staff exits the room

24. DCD Withdrawal in the OR
Accommodating the Family

25. Meds, Withdrawal & Declaration

26. How long can we wait?

27. Rapid En-bloc recovery

28. Organ Preservation Time
Heart: 4-6 hrs
Lungs: 4-6 hrs
Liver: 12 hrs
Pancreas: 18 hrs
Kidneys: 24 hrs

29. A wedding story