1. Donation after Cardiac Death Supporting Patients and Families during End of Life Care in the Operating Room Douglas T Miller Symposium Breakout Session April 23, 2009

2. Donation after Cardiac Death (DCD) What is DCD? What is DCD? What is the difference between DCD donation and donation after brain death? What is the difference between DCD donation and donation after brain death? What is my role in supporting the patient and family during end of life care in the operating room? What is my role in supporting the patient and family during end of life care in the operating room?

3. National Transplant Waiting List Type of Transplant Waiting Transplanted in ‘08 Kidney 78,95716,514 Liver 15,768 6,318 Lung 1,966 1,478 Heart 2,803 2,163 Heart-lung 83 27 Kidney-pancreas 2,266 836 Pancreas 1,552 437 Intestines 213 185 Totals 101,216 27,958 Source: Organ Procurement and Transplant Network - As of 03/20/09

4. Wisconsin Transplant Waiting List Type of Transplant Waiting Transplanted in ‘08 Kidney 1,057 445 Liver 206 155 Lung 64 40 Heart 79 29 Heart-lung 0 0 Kidney-pancreas 53 49 Pancreas 12 15 Intestines 2 0 Total 1,436 734 Source: Organ Procurement and Transplant Network, As of 03/20/09

5. What is DCD? DCD is a donation opportunity for families of patients who have a non-survivable injury or illness, as determined by their physician. These patients have the ability to save the lives of others by donating their organs after being declared dead.

6. Donation after Brain Death and Donation after Cardiac Death DONATION AFTER CARDIAC DEATH Severe brain injurySevere brain injury –Intracranial hemorrhage, stroke, anoxia, trauma Patients without brain injuryPatients without brain injury –Degenerative neuromuscular diseases –End-stage cardiopulmonary diseases –High spinal cord injury Do not meet the criteria for brain deathDo not meet the criteria for brain death Non-survivable injury/illness off the ventilatorNon-survivable injury/illness off the ventilator Family and physician elect to withdraw supportFamily and physician elect to withdraw support ~ 10 % of deceased organ donor nationally~ 10 % of deceased organ donor nationally 26 % of UWHC OPO deceased organ donors26 % of UWHC OPO deceased organ donors DONATION AFTER BRAIN DEATH Severe brain injury –Intracranial hemorrhage, stroke, anoxia, trauma Meets criteria for brain death –Clinical Exam –Confirmatory Testing ~ 90 % of deceased organ donors nationally 74% of UWHC OPO deceased organ donors

7. Who are the candidates for DCD? Non-survivable injury or illness as determined by the patient’s physician Medically eligible for organ donation as determined by OPO medical director The death is expected to occur within 2 hours after withdrawal of ventilator support by the patient’s health care team

8. Where will the Death Occur? ICU –Kidneys only –Extra-Renal--ICU in close proximity to the operating room –Family Preference Operating Room –Extra-Renal Organs

9. How long can we wait for the death to occur to recover organs? Lungs –30 minutes Liver –30 minutes Pancreas –30-45 minutes Kidneys –Up to 2 hours

10. Presenters Rene Escalante, Chaplain –St. Anthony Medical Center, Rockford, IL Libby Ferris, Operating Room RN –St. Joseph’s Hospital, Marshfield, WI Amy Kroos, Palliative Care RN –St. Anthony Medical Center, Rockford, IL James Anderson, ST, Recovery Coord. –UW OPO

11. THANK YOU QUESTIONS?