ORGAN DONATION in the ED

1. ORGAN DONATION in the ED Presented by: Robert D. Kerns, NREMT-P, CPTC Advanced Practice Coordinator UWHC In-House Coordinator UWHC Organ Procurement Organization Lee Faucher, MD Director of Trauma Services UWHC

2. OBJECTIVES • Identify potential emergent and/or uncontrolled DCD candidates • Define Uncontrolled DCD • Define the process of successful Uncontrolled DCD • Identify the resources needed to support an Uncontrolled DCD candidate • Identify the staff needed for a successful Uncontrolled DCD • Demonstrate that the care received in the ER directly impacts Donation even if the patient makes admission to the ICU • Identify barriers to Uncontrolled DCD in the ER • Identify strategies to overcome barriers to Uncontrolled DCD • Identify key members of hospital staff that can champion Uncontrolled DCD • Define communication strategies for hospital staff that will facilitate the Uncontrolled DCD process • Define communication strategies that will support families when presenting the option of Uncontrolled DCD

3. OBJECTIVES • Identify potential emergent and/or uncontrolled DCD candidates • Define Uncontrolled DCD • Define the process of successful Uncontrolled DCD • Identify the resources needed to support an Uncontrolled DCD candidate • Identify the staff needed for a successful Uncontrolled DCD • Demonstrate that the care received in the ER directly impacts Donation even if the patient makes admission to the ICU • Identify barriers to Uncontrolled DCD in the ER • Identify strategies to overcome barriers to Uncontrolled DCD • Identify key members of hospital staff that can champion Uncontrolled DCD • Define communication strategies for hospital staff that will facilitate the Uncontrolled DCD process • Define communication strategies that will support families when presenting the option of Uncontrolled DCD

4. CASE 1 • 0209: Patient arrived at ED • ~20 Year old male in high speed MVC • Long extrication w/ deaths on scene • ETT upon arrival • Patient had severe closed head injury • Left femoral head dislocation

5. CASE 1 • 0345: • Patient to OR for Craniotomy • Patient has bilat SDH Left > Right • Hematoma evacuated spontaneously • Bone flap left out and closed

6. CASE 1 • 0601: Admitted to TLC • CVP placed • Patient began bleeding profusely from all open areas • ICP remained elevated • Patient maxed on Epi, Norepi, and Neo • Requiring continuous FFP and PRBC’s

7. CASE 1 • 0802: Family Discussion • Family decides to WLS • Family agrees to Organ Donation • OPO Activated

8. CASE 1 • 0830: OPO arrived on TLC • Received report from Attending MD • Met with patient’s parents

9. CASE 1 • 0845: • Activated OPO recovery team to UW • Scheduled OR for 0930 • 0900: • Written consents completed • Serology blood drawn • Family services arrives at TLC

10. CASE 1 • 0930: OPO recovery team in TLC • 0945: Patient to OR with TLC Attending • 1030: Extubation • 1051: CTOD • 1057: Organ recovery begun

11. CASE 1 - Outcome • Kidneys recovered for transplant • 2 patients are transplanted • Eye and tissue recovered • 2 patients’ sight restored • 100’s of patients benefited from tissue transplants

12. CASE 1 – Emergent DCD • 0802: OPO activated • 0830: OPO arrives in TLC • 0845: OPO recovery team activated & OR set • 0900: Written consent completed • 0930: OPO recovery team arrives • 0945: Patient to OR • 1030: Extubation

13. Emergent DCD • Can this happen at your hospital? YES!!

14. CASE 2 • 0942: Patient arrives at ED • ~ 10 year old male w/ GSW to head • Patient in full arrest & ETT upon arrival to ED • Patient stabilized in ED and then to CT • Head CT shows non survivable injury • No NOK available yet • Pt to be supported and admitted to PICU

15. CASE 2 • 1007: OPO activated from ED • 1032: Patient arrives in PICU • 1035: OPO arrives in PICU • Patient is being supported • NO NOK yet • Police in PICU attempting to locate NOK • ME notified and clears case for donation

16. CASE 2 • 1037: • Activated OPO recovery team • Reserved OR for emergency DCD • Pt stabilized on pressors and albumin • No NOK yet

17. CASE 2 • 1101: • OPO recovery team onsite • OR suite ready • Serology blood drawn • No NOK yet

18. CASE 2 • 1137: Patient’s mother on phone w/ PICU • 1140: Mother decides to WLS & consents for DCD Mother is over an hour away • 1141: Patient is moved to OR w/ PICU staff and Police • 1142: CPR begun • 1147: arrive in OR • 1201: Extubation & CPR stopped • 1206: CTOD • 1208: Organ recovery begun

19. CASE 2 - Outcome • Kidneys recovered for transplant • 2 patients are transplanted • Eye and tissue recovered • 2 patients’ sight is restored • 100’s of patients benefited from tissue transplants

20. CASE 2 – Uncontrolled DCD • 1007: OPO activated from ED • 1035: OPO arrives in PICU • 1037: Recovery team activated & OR set • 1101: Recovery team onsite • 1140: Consent obtained for DCD • 1141: Patient to OR and CPR begun • 1201: Extubation

21. Uncontrolled DCD • Can this happen at your hospital? YES!?!?

22. ORGAN DONATION in the ED Lee Faucher, MD Director of Trauma Services UWHC

23. Disclosure • Started my medical career as an EMT in East-Central Wisconsin • Worked as a Surgical Technician at the UW while in college • Member of the transplant team • Faculty member of the Division of General Surgery since 2004 • Director of Trauma since 2006

24. CASE 3 • 22 year old male involved in a motor vehicle crash. • Unconscious • Intubated for airway control and diminished mental status • Blood pressure and pulse present and stable • Obvious external injury to head, without other signs of trauma

25. CASE 3 • Social worker has contact information for mother about two hours away. • Mother said she wanted him to be a donor if nothing else could be done.

26. DISCUSSION • UNCONTROLLED DCD • EMERGENT DCD

27. THANK YOU!!