Donate Life Louisiana Hospital Campaign Clinical Champion Training - - PowerPoint PPT Presentation

donate life louisiana hospital campaign
SMART_READER_LITE
LIVE PREVIEW

Donate Life Louisiana Hospital Campaign Clinical Champion Training - - PowerPoint PPT Presentation

Donate Life Louisiana Hospital Campaign Clinical Champion Training Donate Life Louisiana Hospital Campaign Our vision was to create a campaign that every hospital, regardless of size or type, could implement and have an impact on the


slide-1
SLIDE 1

Donate Life Louisiana Hospital Campaign

Clinical Champion Training

slide-2
SLIDE 2

Donate Life Louisiana Hospital Campaign

  • Our vision was to create a campaign that every

hospital, regardless of size or type, could implement and have an impact on the waiting list.

  • Campaign was launched at the 2008 LHA

Summer Conference.

  • We wanted to increase the registry list while

educating our communities.

slide-3
SLIDE 3

Original Campaign Goals

To increase the Donate Life Louisiana Registry by 10% or 160,676 new registrations by the end of 2009.

– Met the first goal in August 2009 – Set a second goal to reach 200,000 by July, 2010 which was achieved in February, 2010

slide-4
SLIDE 4

New Goal for Registry Campaign

  • Increase the Louisiana Donor Registry

by another 50,000 by July 2010 (total of 250,000)

– Increase number of hospitals participating in registry campaign

slide-5
SLIDE 5

Campaign Support and Resources:

  • Electronic Toolkits
  • LHA Website – Campaign Section
  • LOPA/LHA Staff
  • Donate Life Louisiana Materials
  • HHS Resources
  • Champion Network
slide-6
SLIDE 6

Hospitals Recognized for Successful Campaigns

  • Bunkie General Hospital
  • CHRISTUS St. Francis

Cabrini

  • Lafayette General

Medical Center

  • Ochsner Medical Center
  • Opelousas General

Health System

  • Our Lady of the Lake
  • Our Lady of Lourdes
  • Terrebonne General
slide-7
SLIDE 7

Indirect Benefits

  • Referrals from Hospitals that Were

Not Referring

  • Organ Donors from Previously

“Non-Donor Hospitals”

  • Increase in Hospital Staff Education
  • Willingness to Perform Pre-Donor

Management

slide-8
SLIDE 8

Taking the Campaign to the Next Level

  • New challenge issued by LHA board for

2010

  • Increase the conversion rate in all organ

donor hospitals in Louisiana to 75% or greater by the end of 2011

– This goal is consistent with Joint Commission and CMS guidelines

slide-9
SLIDE 9

Hospital Conversion Rate

  • Defined as the number of actual
  • rgan donors divided by the

number of eligible donors

slide-10
SLIDE 10

Clinical Champion

  • Provide active leadership and support of
  • rgan and tissue donation
  • Share best practices with hospital staff

members

  • Work collaboratively with LOPA Hospital

Resource Coordinators to establish a hospital wide commitment to donation

slide-11
SLIDE 11

Factors Directly Impacting Conversion Rates

  • Timely Notification
  • Family support and treatment at the hospital
  • Open communication
  • Physician support through donation process
  • Using Effective Requestors
  • Timeliness and appropriateness of the approach
  • Maintaining organ function prior to consent and

throughout the donor process

slide-12
SLIDE 12

The Need

  • As of March 30th there are:

– 106,618 waiting in the US – 1,859 waiting in Louisiana

  • In 2009 we had 152 organ donors and

transplanted 488 organs

  • We had a 66% conversion rate; increasing to

75% would result in 20 more donors and approximately 64 more lives saved

slide-13
SLIDE 13

Donate Life Month

  • Flag Raising Ceremonies
  • Remembrance Day/Donor Drive
  • Donor Drive with Blood Bank in Park
  • Health Network Featuring Donor

Awareness Month

  • Viral Campaigns
slide-14
SLIDE 14

Regulatory Agencies and Partnerships

slide-15
SLIDE 15

Agencies

  • Joint Commission

– Accrediting – Active in promoting organ donation – Standards guided by CMS and best practices

  • CMS

– Regulatory – Active in promoting performance improvement in organ donation – Conditions guided by best practices, other regulations and desire to reduce payments

slide-16
SLIDE 16

Joint Commission

“Our shared vision must be to narrow (significantly) the organ donation gap and save lives!”

slide-17
SLIDE 17

Joint Commission

  • Organ donation desired future state:
  • 1. No one dies while waiting for a life-saving
  • rgan
  • 2. The number of transplants performed each

year exceeds new demand, resulting in a sustained decrease in the Waiting List for Life

  • 3. Organ yield will increase from 3.06 organs per

donor to over 3.75 organs per donor

slide-18
SLIDE 18

Joint Commission

  • Organ donation desired future state:
  • 4. Cardiopulmonary criteria for determining

donation potential are well-established in hospitals

  • 5. Hospitals will consistently maintain organ

donation conversion rates that exceed 75%

  • 6. The disparity in available organs for racial and

ethnic minorities will be eliminated

slide-19
SLIDE 19

Joint Commission

  • Organ donation desired future state:

7. The donation wishes and advance directives of deceased potential donors will be respected and carried out 8. The opportunity for individuals to make a living donation will be facilitated through changes in employment and insurance policies and practice 9. The increase in demand for organ transplantation will slow as a result of more effective health promotion and disease prevention programs

slide-20
SLIDE 20

Joint Commission Latest Updates

  • In March 2009, the standards addressing
  • rgan and tissue donation moved from

the Leadership chapter to Transplant Safety to make it easier to reference.

slide-21
SLIDE 21

Overview of Joint Commission Changes

  • TS.01.01.01 EP 3
  • The hospital has a written agreement

with at least one tissue bank and at least

  • ne eye bank to cooperate in retrieving,

processing, preserving, storing and distributing tissue and eyes.

slide-22
SLIDE 22

Overview of Joint Commission Changes

  • Note 1: This process should not interfere with organ

procurement.

  • Note 2: It is not necessary for a hospital to have a

separate agreement with a tissue bank if it has an agreement with its OPO to provide tissue procurement services; nor is it necessary for a hospital to have a separate agreement with an eye bank if its OPO provides eye procurement services. The hospital is not required to use the OPO for tissue or eye procurement, and is free to have an agreement with the tissue bank or eye bank of its choice.

slide-23
SLIDE 23

Overview of Joint Commission Changes

  • TS.01.01.01 EP 9
  • The hospital notifies the OPO of patients who have

died or whose death is imminent according to the following: Clinical triggers defined jointly with its medical staff and the designated OPO present. Within the time frames jointly agreed on by the hospital and the designated OPO (ideally, within one hour). Prior to the withdrawal of life-sustaining therapies, including medical or pharmacological support.

slide-24
SLIDE 24

Overview of Joint Commission Changes

  • TS.01.01.01 EP7
  • The individual designated by the hospital to

notify the family regarding the option to donate

  • r decline to donate organs, tissues, or eyes is

an OPO representative, an organizational representative of a tissue or eye bank, or a designated requestor.

slide-25
SLIDE 25

Overview of Joint Commission Changes

  • EP 7 cont.
  • Note: A designated requestor is an

individual who has completed a course

  • ffered or approved by the OPO. This

course is designed in conjunction with the tissue and eye bank community to provide a methodology for approaching potential donor families and requesting organ and tissue donation.

slide-26
SLIDE 26

Joint Commission 10 C’s for Success

1. Champion for the cause! 2. Commitment of leadership 3. Culture of priority for organ donation 4. Collaborative effort 5. Communicate rapidly (call within 1 hour) 6. Clinical trigger for call to OPO 7. Conversion rate improvement 8. Counsel potential donor families to increase consent 9. Clarify procedures

  • 10. Consider establishing DCD protocols
slide-27
SLIDE 27

CMS

  • CoP §482.45(a)(3): Ensure, in collaboration with the

designated OPO, that the family of each potential donor is informed of its options to donate organs, tissues, or eyes, or to decline to donate. – Interpretive Guideline:

  • OPO screens for medical suitability
  • Family must be informed of the family’s donation options
  • Ideally, the OPO and the hospital will decide together how

and by whom the family will be approached

slide-28
SLIDE 28

CMS

  • CoP §482.45(a)(3): The individual designated by the

hospital to initiate the request to the family must be an

  • rgan procurement representative or a designated

requestor.

– Interpretive Guideline:

  • A designated requestor is a hospital-designated individual

who has completed a course offered or approved by the OPO and designed in conjunction with the tissue and eye bank community

slide-29
SLIDE 29

CMS

  • CoP §482.45(a)(5): Maintaining potential donors while

necessary testing and placement of potential donated

  • rgans, tissues, and eyes take place.

– Interpretive Guideline:

  • The hospital must have policies and procedures,

developed in cooperation with the OPO, that ensure that potential donors are maintained in a manner that maintains the viability of their organs

  • The hospital must have policies in place to ensure that

potential donors are identified and declared dead within an acceptable time frame

slide-30
SLIDE 30

CMS

Important Changes to OPO CoP

  • Definition of an eligible donor

– For brain dead patients aged 70 and younger, everyone is eligible unless and until we can document otherwise

  • Declaration in accordance with hospital policy or

state law

  • Documentation must be of a specific diagnosis
  • Medical record reviews

– Level I or Level II trauma center or – 150 beds, a ventilator, and an ICU

slide-31
SLIDE 31

Transition from end of life care to the gift of life.

slide-32
SLIDE 32

Don't think of organ and tissue donation as giving up part of yourself to keep a total stranger alive. It's really a total stranger giving up almost all of themselves to keep part

  • f you alive. ~Author Unknown
slide-33
SLIDE 33

Family support following a catastrophic brain injury

slide-34
SLIDE 34

Circumstances of clinical brain death in organ donors, 1999-2009. MVA = motor vehicle accident. Source: United Network for Organ Sharing (UNOS), 2009.

slide-35
SLIDE 35

Mechanism of death in organ donors, 1999-2009. SIDS = sudden infant death syndrome. Source: United Network for Organ Sharing (UNOS), 2009.

slide-36
SLIDE 36

Assess the Situation

  • What has the family been told about the patients

condition?

  • What does the family understand about the patients

condition?

  • Who can best provide them support at this time?
slide-37
SLIDE 37

How is the Family Reacting?

  • Numbness/Denial/Shock
  • Depression
  • Elation
  • Anger
  • Guilt
  • Irritability
  • Confusion/Bewilderment
  • Avoidant Behavior and Withdrawal
slide-38
SLIDE 38

How to Support the Family

  • Respond to emotions with empathy
  • Validate family’s feeling and concerns
  • Provide clear, consistent, timely communication about

the patients condition

  • Respond to questions and concerns promptly.
  • Remember: a family’s in crisis only hears about 20% of

the information provided

slide-39
SLIDE 39

Things Not To Say or Do:

  • Do not say “It will be alright”
  • Do not push for details
  • Do not say “I know how you feel”
  • Never blame the patient or family for what happened
  • Avoid telling a survivor “It was not your fault”
  • Avoid giving advice
slide-40
SLIDE 40

The transition from cure to comfort care

slide-41
SLIDE 41

Process for healthcare providers

Redirect hope from cure to comfort Provide information about illness or injury “Plant seeds” about prognosis Develop a trusting relationship with the patient’s family Provide Consistent perspective on patient’s prognosis Hold meetings with the family Involve other disciplines (pastoral care, social services) Continue supportive relationship with the family Reiterate information as needed Face the question to forgo life- sustaining therapies Take on role of surrogate decision maker Come to terms with what this illness or injury means for the patient:

  • Suffering
  • Values
  • Quality of life
  • Life story

Understand the critical illness Recognize futility or probably bleak outcome

Process of family members

slide-42
SLIDE 42

The Process for Family Members

1. The families begins to understand the critical illness by seeking information about the irreversible physiological process that are

  • ccurring. The family recognizes the futility of the situation or

probable bleak outcome. 2. The family comes to terms with the reality of what the illness or injury means for the patient. 3. The family recognizes they are responsible for making decisions and is ready to face the question of forgoing life-sustaining therapies

Thelen, M., (2005). End-of-life decisions making in intensive care.

slide-43
SLIDE 43

The Process for Health Care Providers

1. Laying the groundwork:

  • Develop a trusting relationship with the family
  • Provide information about the illness or injury
  • Plant seeds about prognosis

2. Shifting the picture

  • Provide consistent perspective of patients prognosis
  • Hold family meetings
  • Involve other disciplines

3. Accepting a new picture:

  • Continue supportive relationships with the family
  • Reiterate information as needed
  • Redirect hope from cure to comfort

Thelen, M., (2005). End-of-life decisions making in intensive care.

slide-44
SLIDE 44

Behaviors That are Helpful:

  • Providing timely communication
  • Providing consistent care providers
  • Treating the family with compassion and respect
  • Acting as an arbitrator between family members
  • Providing spiritual, emotional and grief support
  • Providing access to the patient

Thelen, M., (2005). End-of-life decisions making in intensive care.

slide-45
SLIDE 45

Behaviors That Hinder:

  • Avoiding or postponing discussions about a poor prognosis
  • Being reluctant to use the words “death” or “dying”
  • Using medical terms
  • Not knowing the patient
  • Giving inconsistent messages
  • Placing full responsibility for decision making on one person
  • Defining death as a failure
  • Withdrawing from interactions with the family

Thelen, M., (2005). End-of-life decisions making in intensive care.

slide-46
SLIDE 46

Relationship and Communication

  • Developing a trusting relationship
  • This helps families feel safe and supported in the decision-making

process

  • Listening
  • Helps decrease feelings of guilt and burden
  • Communication with the family
  • Must happen early and often
  • Must be clear, direct and honest

Thelen, M., (2005). End-of-life decisions making in intensive care.

slide-47
SLIDE 47

Is it brain death or death?

Recent studies show:

  • Of 195 physicians and nurses who care for patients with catastrophic brain injury:

– only 35% correctly recognized the legal and medical criteria for determining brain death – 58% did not use a coherent concept of death consistently

  • Of 164 brain dead patients, the next of kin was queried about their understanding of

brain death: – 28% stated brain death was the same as coma – 9% did not know

Sullivan, J., Seem, D. L., & Chabalewski, F., (1999). Determining brain death.

slide-48
SLIDE 48

Supportive Language

  • “ Despite our best efforts it appears that his condition has
  • deteriorated. The physician is coming to evaluate your loved
  • ne and we will update you as soon he is here”
  • “There has been a change to his neurological condition, It

appears to me that he has lost significant neurological

  • responses. However, we need the physician to confirm my

assessment”

slide-49
SLIDE 49

Steps for a Family Meeting

1. Preparation – review chart, clarify goals and check emotions 2. Establish proper setting with seating available for everyone present 3. Introductions / Goals / Relationship of all present 4. Determine family understanding of condition 5. Summarize the situation avoiding jargon and answering questions 6. Silence / Respond to reactions 7. Present goal-oriented options and stress priority of comfort regardless of goal 8. Translate goals into plan of care 9. Document and discuss with team caring for patient and check emotions

  • 10. Managing Conflict:

– Listen

  • Use empathetic statements

– Determine source of conflict

  • Clarify misconceptions

– Set time-limited goals with specific benchmarks

slide-50
SLIDE 50

Palliative Care Care that aims to relieve suffering and improve quality

  • f life for patients with life-

threatening illness and their families

slide-51
SLIDE 51

Organ and tissue donation should be a continuation

  • f end of life care
slide-52
SLIDE 52

Organ donation should be integrated into quality end-of-life care. Patients and their families should be

  • ffered the opportunity to donate as standard end-of-

life care, and information on organ donation processes should be an integral part of the many

  • ther decisions that are faced at that time.

Institute of Medicine, 2006.

slide-53
SLIDE 53

Variables that impede the consent process

  • Early mention of donation
  • Late referral
  • Trauma vs. non-trauma

– sudden death without underlying history

  • Infrequent updates to family
  • Coupling the news of death with the request of

donation

  • Rigid visitation during the patients end of life
slide-54
SLIDE 54

Variables that support the consent process

  • Timely referral
  • LOPA is inclusive in the end of life plan
  • Collaborative effort to support the family
  • Donation is introduced at the appropriate time
slide-55
SLIDE 55

In all situations we must diligently try to relate to family members on a human level and meet their informational and emotional needs

slide-56
SLIDE 56

The Opportunity

  • The opportunity to donate is the family’s right and if

donor designated - the patients right

  • Donation is proven to be beneficial for families going

through the grieving process

  • Over 105,000 people are counting on us to get it right
slide-57
SLIDE 57

What a difference a word can make

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. ~~Leo Buscaglia

slide-58
SLIDE 58

Quote From a Donor Family

As I sat there...holding his hand, begging him to wake up, pleading with God to spare my child... I realized...Justin wasn't going home with me, his purpose on earth was complete, mine was yet to be revealed. Justin Harrison saved the lives of five people in 1997, when he was 15 years old. He did it without fanfare, through an act of quiet heroism.

slide-59
SLIDE 59

Marilyn Thorn - Justin’s heart recipient Libby Harrison - donor mom

Justin Harrison-Hero

Marilyn Thorn - heart recipient Sue Acaldo – kidney & pancreas recipient

slide-60
SLIDE 60

Stephanie

When we were approached by the LOPA people in the hospital my first reaction was "no way", I'm not burying my daughter cut to pieces. My ex-husband did the listening and when I came to grips that she was not going to make it I realized that this would've been what Stephanie wanted and she probably would’ve said “Oh Mom, I want to do this.”

  • It turned out to be a very good thing for us and it saved 5 peoples lives that

night.

  • God bless everyone who makes this decision and the ones that are on the

receiving end.

slide-61
SLIDE 61
  • After Eleven years, Stephanie’s

family(pictured) finally meets her heart recipient, Elizabeth (far left). They now consider themselves to be family and plan to visit often.

slide-62
SLIDE 62

All of us are potential organ recipients as well as potential

  • rgan donors, each of us has a

stake in the system.

Institute of Medicine, 2006

slide-63
SLIDE 63

References:

  • Alexander, D. A., & Klein, S., (2000). Bad news is bad news: Let’s not make it worse. Trauma, 2, 11-18.
  • Cooper, A., (2008). Palliative Care and the trauma patient. Journal of Hospice and Palliative Nursing, 10(5), 262-264.
  • Coyne, P., Bobb, B. T., & Campbell, M. L., (2009). Role of palliative care nursing in organ and tissue donation: HPNA

position paper. Journal of Hospice and Palliative Nursing, 11(2), 127-128.

  • Institute of Medicine, (2006). Organ donation: Opportunities for action. Washington, DC: National Academies Press.
  • Owens, D. A., (2006). The role of palliative care in organ donation. Journal of Hospice and Palliative Nursing, 8(2), 75-76.
  • Shafer, T. J., Wagner, D., Chessare, J., Zampiello, F. A., McBride, V., & Perdue, J., (2006). Organ donation breakthrough

collaborative: Increasing organ donation through system redesign. Critical Care Nurse, 26(2) 33-49.

  • Sullivan, J., Seem, D. L., & Chabalewski, F., (1999). Determining brain death. Critical Care Nurse, 19(2), 37-46.
  • Thelen, M., (2005). End-of-life decisions making in intensive care. Critical Care Nurse, 25(6), 28-37.
  • Truog, R. D., Campbell, M. L., Curtis, R., Haas, C. E., Luce, J. M., Rubenfeld, G. D., et al., (2008). Recommendations for

end-of-life care in the intensive care unit: A consensus statement by the American Academy of Critical Care

  • Medicine. Critical Care Medicine, 36(3), 953-962.
  • Valdes, M., Johnson, G., & Cutler, J. A., (2002). Organ donation after neurologically unsurvivable injury: A case study with

ethical implications for physicians. Baylor University Medical Center Proceedings, 15(2),129-132.

slide-64
SLIDE 64

Organ Donation: The Clinical Processes

slide-65
SLIDE 65

The Organ Referral Process:

Identification of a Potential Donor

All patients on a ventilator with a GCS < 5. Patients that do not meet brain death criteria but have suffered a non-survivable head injury. Patient’s life-sustaining support is being withdrawn.

slide-66
SLIDE 66

Organ Referrals

Organ Referral Potential Organ Donor Rule Out Brain Death Donation after Cardiac Death

slide-67
SLIDE 67

Brain Death

Increased intracranial pressure sufficient to impede the flow of blood into the brain causing cellular death of the brain tissue and/or herniation

slide-68
SLIDE 68

Donation after Cardiac Death (DCD)

The patient must have suffered a non- survivable brain injury or an anoxic event such that death would be imminent subsequent to the removal of ventilator and vasopressor support

slide-69
SLIDE 69

Supporting the Potential Organ Donor

  • Avoid DECELERATION in care

– Clinical support – Family support

  • Understanding the consequences of

cerebral herniation

  • Preserves the option of donation
slide-70
SLIDE 70

Avoiding “Deceleration in Care”

Resuscitation

  • f the patient

Identification of the potential

  • rgan donor

Continued resuscitation and declaration of brain death Consent and donor management Avoidance of deceleration in care

slide-71
SLIDE 71

Predictable Consequences

  • f Herniation
  • Loss of brain stem vasomotor

centers – hypotension

  • Loss of hypothalamic – pituitary

connection – Diabetes Insipidus

  • Inflammatory mediators are

released causing worsening lung function

  • Autonomic storm of herniation

can cause impaired heart function

slide-72
SLIDE 72

Predictable Consequences

Consent

Cr & LFTs/ option for donation lost

Injury

Volume Depletion

Herniation

Blood Pressure Blood Pressure

Brain Death Declaration

Diabetes insipidus

slide-73
SLIDE 73

Preserving the Preserving the Option of Donation Option of Donation

Injury Consent

LOPA starts active management Support Orders

Herniation Brain Death

slide-74
SLIDE 74

Consequences of Herniation

  • Loss vasomotor control +

Intravascular Volume Decrease = HYPOTENSION

Causes:

– Diuretics – Diabetes Insipudus – Traumatic Blood Loss

slide-75
SLIDE 75

Consequences of Herniation

  • Endocrine

Dysfunction

– Caused by pituitary hypoxia – ↓amount or absence of antidiuretic hormone (ADH) from post. pituitary – Diabetes Insipidus – ↓in ACTH (cortisol)

slide-76
SLIDE 76

Consequences of Herniation

  • Catecholamine Surge

– Increase in adrenaline (epinephrine) which is a potent alpha and beta agonist – ↑HR and BP – Neurogenic pulmonary edema

  • Inflammatory mediator are

released causing worsening lung function

– Systemic vasodilation

slide-77
SLIDE 77

7 liters

5 liters

10 liters 10 liters

Mannitol Blood loss DI

Brain death Catecholamine squeeze

Catecholamine Surge

slide-78
SLIDE 78

The Results…

  • Hypovolemic Shock
  • Catecholamine Resistance
  • Hormonal Deficiencies
  • Hypoxia
  • Hypothermia
  • Electrolyte Abnormalities
slide-79
SLIDE 79

Resuscitation

  • Maintain MAP> 65

– SBP-DBP/3 + DBP

  • CVP 4-12
  • Rule of 100’s

– U/O – SBP – HR – PaO2 – Temp

slide-80
SLIDE 80

Resuscitation

  • Crystalloids

– Maintenaince fluid @ 100 cc/hr with D5W with KCl (as needed) – ½ NS or ¼ NS CC:CC urine output replacement q1h

  • Colloids and Blood Products

– At physician discretion

slide-81
SLIDE 81

Vasopressors

  • Dopamine
  • Neosynephrine
  • Levophed (Norepinephrine)
  • Dobutamine
  • Vasopressin
  • Epinephrine
slide-82
SLIDE 82

Hormonal Deficiencies: Antidiuretic Hormone (ADH)

  • A.K.A Vasopressin
  • Secreted from Pituitary
  • Helps with:

– Hypovolemia – Hypotension – Hypernatremia

slide-83
SLIDE 83

Vasopressin

  • Treatment for Diabetes Insipidus

– If urine output >500 cc/hr for 2 hrs, begin Vasopressin gtt. – Mix Vasopressin 5 units in D5W 500 cc, and run at 10 cc/hr (0.1 units/hr). – Titrate to keep urine output 100-300 cc/hr. – May use DDAVP q 12 hours if preferred

slide-84
SLIDE 84

Ventilation and Oxygenation

  • Maintain adequate O2 delivery to organs
  • Respiratory Treatments

– CPT, Turn Q2h – Atrovent and Ventolin

  • ABG

– Correct acid/base imbalances – Optimize oxygentation : +5 PEEP

slide-85
SLIDE 85

Thermal Regulation: Hypothermia

  • Due to interruption of the

temperature-regulating center in the hypothalamus.

  • ↓ cardiac function
  • ↓ amount of O2 supplied to organs

–Maintain Temp of 37°F with warming blanket and/or warm fluids

slide-86
SLIDE 86

Electrolyte Abnormalities

Why balance?

Fluid and electrolyte imbalances directly effect the hemodynamic stability of the donor and the ultimate viability of the organs for transplant.

slide-87
SLIDE 87

Electrolyte Abnormalities:

Hypernatremia

  • Normal Na+ level 137-150
  • Treat if Na+ > 157

– Free water to NGT – Hypotonic IV bolus (D5W or ¼ NS) – Vasopressin if U/O is > 500 – Lasix/Diuril if U/O is < 200 with absence of hypovolemia

slide-88
SLIDE 88

Electrolyte Abnormalities:

Hyper/Hypokalemia

  • Hyperkalemia

– Lasix IV – Insulin IV (usually accompanied with D50W) – CaCl or Ca gluconate – NaHCO3 Remember to use caution when using one

electrolyte to correct another. They often have reciprocal effects on each other.

slide-89
SLIDE 89
  • Hypokalemia

– KCl: 20-40 meq over 1-2 hours – KPhos: 27 mmols = 40 meq K+ Use if phosphorous is low May give K acetate if Cl and Phos high Kidneys excrete 20-40 meq K+ in each liter

  • f urine

Electrolyte Abnormalities:

Hyper/Hypokalemia

slide-90
SLIDE 90

Electrolyte Abnormalities:

Hypocalcemia –1-2 amps of CaCl or Ca gluconate –Ca binds with albumin therefore are often given at the same time

slide-91
SLIDE 91

Organs Recovered for Transplant: Brain Dead Donor

Kidneys Lungs Liver Pancreas Small I ntestine Heart

slide-92
SLIDE 92

Donation after Cardiac Death

  • Many families that have loved ones who

have suffered non-survivable injuries and wish to discontinue life support.

  • DCD gives these families the opportunity

to save lives through organ donation

slide-93
SLIDE 93

Identification of a Potential DCD Donor

  • GCS of 5 or less, on a ventilator
  • Patient who cannot sustain life without

continued medical intervention

(ventilator support, vasopressors etc)

  • Poor neurological prognosis, does not meet

brain death criteria.

  • A discussion regarding “DNR” or withdrawal
  • f support is anticipated
slide-94
SLIDE 94
  • Medical Suitability
  • Life Support Dependence

Identification of a Potential DCD Donor

slide-95
SLIDE 95
  • Medical Suitability

– All patients under 70 with GCS 5 or less are initially considered for DCD – medical history and labs/diagnostic tests are utilized to determine first if the patient is medically suitable

Identification of a Potential DCD Donor

slide-96
SLIDE 96
  • Life Support Dependence

– If medically suitable, an evaluation is done to determine whether or not the patient will cardiac arrest in less than 1 hour – Ventilatory dependence assessed – Pharmacologic dependence assessed

Identification of a Potential DCD Donor

slide-97
SLIDE 97

Organs Recovered for Transplant: DCD

Kidneys Lungs Liver Pancreas

slide-98
SLIDE 98

Avoiding “Deceleration in Care”: Potential Organ Donor

  • Continuous clinical support and

management prior to approach for donation

– Allows families the opportunity to say “yes” – Donor stability – Increase conversion rate – Increase the number of potential lives saved through organ donation

slide-99
SLIDE 99

Potential Donor Family Support: Avoiding “Deceleration in Care”

  • Recognizing the Family’s Needs

– Education at the Bedside – Participation in Bedside Care – Personal Items at Bedside

  • Supportive Language
  • Frequent Updates
  • Spiritual Support
  • Palliative Care
slide-100
SLIDE 100

Avoiding “Deceleration in Care”: Potential Organ Donor Family

  • Supporting potential donor families is a

process that begins at time of admission

  • Supportive language enhances family

understanding of brain death

  • Supportive communication and

education are key elements to a family support plan

slide-101
SLIDE 101

Tissue Donor Referral

Every Death is a Potential Tissue Donor

  • Report the death to LOPA within 4 hours

@ 1.800.833.3666

  • Notification of death paperwork must be

completed and placed in patient chart

slide-102
SLIDE 102

Tissue Donor Referral

Clinical Support Center (CSC) will:

– Screen patient for suitability and check the Donor Registry – Need Legal Next of Kin (LNOK) information such as name, phone number, and relationship to deceased – Give hospital a referral number to place on appropriate paperwork

slide-103
SLIDE 103

Tissue Donor Referral

LOPA will:

– Contact Coroner for clearance – Complete paperwork with family – Set Operating Room Time or arrange for transport to LOPA Tissue Recovery Suite – Recover Tissue and Post-Recovery Care – Contact Funeral Home and Coroner once recovery is completed

slide-104
SLIDE 104

Tissues Recovered for Transplant

Eyes/corneas - restore sight Heart Valves – valve replacement surgeries Fascia – bladder suspension surgeries; dura replacement for craniotomies Saphenous Veins – cardiovascular/ coronary by-pass surgeries Tendons & Ligaments – reconstructive joint surgeries Bones of Upper and Lower Extremities – spinal surgeries; limb salvage; cancer treatment; correction of birth defects Skin – used for facial reconstruction and surgical repairs

slide-105
SLIDE 105

Questions?????