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Welcome!. Donation B & B: Basics and Burning Questions. Mary Nachreiner, Community/Family Services UW OPO. Objectives. Understand the Donor Referral Process Understand Clinical Triggers and Apply Appropriately

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mary nachreiner community family services uw opo

Donation B & B:

Basics and Burning Questions

Mary Nachreiner, Community/Family Services


  • Understand the Donor Referral Process
  • Understand Clinical Triggers and Apply Appropriately
  • Identify the Difference Between Donation After Cardiac Death (DCD) and Donation After Brain Death (DBD)
  • Appreciate the Personal Impact of Donation and Care of the Donor Family
  • Clarify “Burning Questions”
what is the uw organ procurement organization opo
What is the UW Organ Procurement Organization (OPO)?
  • One of 58 OPOs
  • Service 104 Hospitals in Wisconsin, Illinois, and Michigan
  • Regulated by the Federal Government
  • 30+ Staff Members
    • Hospital Development
    • Procurement Coordinators
    • Recovery Team
    • Family Support
    • Community Education
what are the recovery agencies
What are the Recovery Agencies?

Solid Organ Recovery

  • University of Wisconsin Organ Procurement Organization

Tissue Recovery

  • Musculoskeletal Transplant Foundation (MTF)
  • Wisconsin Tissue Bank
  • RTI Donor Services
  • ATSF

Whole Eyes/Corneal Recovery

  • Lions Eye Bank of Wisconsin
the difference between organ and tissue donation
The Difference Between Organ and Tissue Donation

Tissue/Eye Donation

  • Occurs in the First 24 Hours After the Heart Has Stopped Beating
  • The Tissues Can Be Preserved and Used at a Later Date
  • Life-Enhancing Procedure
  • No Mechanical Ventilator Needed
  • One Donor Can Help From 50 to 100 People

Organ Donation

  • The Patient Must be Maintained by a Mechanical Ventilator
  • Organs Must be Properly Preserved and Transplanted Quickly
  • Life-Saving Procedure
  • One Donor Can Help 8 People

Kelly Nachreiner Bill (AB-764)

  • Signed by Governor Tommy Thompson on May 9, 2000
  • Requires all Driver’s Education Programs in Wisconsin to Give at Least 30 Minutes of Instruction on Organ Donation
  • The First of Its Kind in the Country


Double Lung Recipient

why is donation so important
Why is Donation so Important?
  • Every Day…
    • 18 People in the U.S. Die Waiting
    • 111 People are Added to the National Wait List
  • Only 2-4% of Deaths are Eligible for Solid Organ Donation
the national story
The National Story

Type of TransplantWaiting

Kidney 88,314

Liver 16,159

Lung 1,777

Heart 3,176

Heart-Lung 65

Kidney-Pancreas 2,223

Pancreas 1,383

Intestines 264

Totals 110,693

Source: Organ Procurement and Transplant Network 04/13/2011

our local stories
Our Local Stories

Wisconsin 1780

Illinois 4937

Michigan 2976

80-85% Awaiting Kidneys

Source: Organ Procurement and Transplant Network 4/8/2011

your role in donation
Your Role in Donation

● Provide Care to Families

● Recognize Clinical Triggers

● Make the Referral Within 1 Hour of Clinical Triggers

● Understand How the Donation Process Works

● Effective Requesting (Consent)

● Sign Consent with Family

● Be an Advocate for Donation in Your Community

clinical triggers what and why
Clinical Triggers: What and Why?

What are Clinical Triggers?

  • Specific Medical Patient Parameters Requiring Notification to the OPO (Referral)

Why are Clinical Triggers Important?

  • Preserve the Option of Organ Donation for the Patient and Family
  • Ensures Adequate Time for Potential Donor Screening, Medical Management, and Allocation of Organs
  • Follow Requirements of Joint Commission and CMS
clinical triggers
Clinical Triggers

Are Met When a Patient:

  • Is Mechanically Ventilated


  • Has a Severe Neurologic Insult/Injury


ONE of the Following:

  • A Physician is Evaluating for Brain Death


  • Has a Glasgow Coma Scale (GCS) < 5


  • Plans to Discuss Withdrawal Life-Sustaining Therapies
clinical triggers17
Clinical Triggers

Severe Neurological Injuries:

  • Trauma
  • CVA
  • Primary CNS Tumor
  • Anoxia
    • Cardiac Arrest/MI
    • Drug Overdose
    • Drowning/Hanging
clinical triggers18
Clinical Triggers
  • Simply a “Heads Up”
  • Notification Does NOT Mean:
    • That the Patient is Going to be an Organ Donor
    • That the OPO is Going to Arrive at Your Hospital
  • All Life Saving Efforts are Pursued as They Are With Any Patient
Jack is a 68 yr old WM with prostate cancer,

pancreatitis, renal failure, and liver failure due to

ETOH abuse. He is hepatitis B+. He has hepatic

encephalopathy and was intubated in the ER to

maintain his airway. His GCS is 3.

Refer? Not Refer?


Henry is a sixty-nine year old male who arrived at the hospital unresponsive due to a CVA. He was intubated on admission and then weaned off of the vent. A week later his condition declined and was re-intubated. The physician had a meeting with the family and they decided to extubate the patient.Refer? Not Refer?


The Referral Process

Statline Pages On Call

OPO Coordinator

Referral From






Is Patient


Statline Refers to

Tissue Agency


reminder all deaths and imminent deaths must be reported
Reminder: All Deaths and Imminent Deaths Must be Reported


Statline Triage Center

  • 1 Phone Number
    • Imminent Deaths: OPO Paged
    • Deaths: Tissue and Eye Banks Paged
how does donation occur
How Does Donation Occur?

Two Opportunities…

Donation After Brain Death (DBD)

Donation After Cardiac Death (DCD)

Brain Death

Irreversible cessation of all functions of the entire brain, including the brain stem

Cardiac Death

Irreversible cessation of circulatory and respiratory function

Brain Death vs. Cardiac Death

brain death
Brain Death

Brain Death Is…

  • Irreversible
  • Usually a Result of Direct Insult to the Head

(Trauma, Anoxia, Stroke, etc.)

  • Declared Only by Patient’s MD/Donor Hospital Designee (NOT OPO)
  • Declared Through Clinical Exams, Apnea Testing, and Confirmatory Exam*

*Additional Details Available


Normal Blood Flow

No Blood Flow

donation after brain death
Donation after Brain Death

The Process

● Patient is Declared Brain Dead; This is the Legal Time ofDeath

● Patient is Maintained on Ventilator Throughout the Organ Recovery

● Organs are Dissected in situ (Naturally Situated in Body)

● 3-4 Hour Surgery

● Heart, Lungs, Liver, Kidneys, Pancreas, and Intestines Can be Recovered

donation after cardiac death dcd
Donation After Cardiac Death (DCD)

For Donation After Cardiac Death to Occur:

  • Severe Neurologic Insult or Injury
  • Trauma (MVA, GSW)
  • Cerebral Vascular Accident (CVA)
  • Anoxia (MI, Drug Overdose, Drowning, Hanging)

Patients Do Not Meet the Criteria For Brain Death

  • Gives Family the Option of Organ Donation for the Severely Brain Injured (but Not Brain Dead) Patient.
    • US DCD Donors Average: 10%
    • UW OPO DCD Donors Average: 30%
donation after cardiac death dcd34
Donation After Cardiac Death (DCD)

For Donation After Cardiac Death to Occur:

  • All Medical Treatments are Futile and Long-Term Prognosis Poor
  • Family and Physician Elect to Withdraw Support
  • Referral is Made to OPO
  • Withdrawal of Ventilated Support in OR vs. ICU
  • Cardiac Death Occurs
  • Surgery Begins 5 Minutes After Cessation of Cardiac Function and Declaration by Patient’s Physician
  • Rapid Recovery with Organs Procured en bloc
  • 1-2 Hour Surgery
  • Lungs, Liver, Kidneys, and Pancreas Can Be Recovered
key differences between dbd and dcd
Key Differences Between DBD and DCD

Donation After Cardiac Death (DCD)

  • Patient Extubated in OR vs. ICU
  • Surgery Begins 5 Minutes After Cessation of Cardiac Function and Declaration by Patient’s Physician
  • Rapid Recovery With Organs Procured en bloc (as a Whole)
  • 1-2 Hour Surgery

Donation After Brain Death (DBD)

  • Patient is Maintained on Ventilator During Organ Recovery
  • Organs Dissected in situ
  • 3-4 Hour Surgery
fyi sensitive terminology
FYI: Sensitive Terminology

Please UseInstead of

“Recover” “Harvest”

“Deceased Donor” “Cadaver”

“Mechanical or “Life Support”

“Ventilated Support”

bq how long are each of the organs viable after being recovered
BQ: How Long Are Each of the Organs Viable After Being Recovered?

Organ Preservation Time

  • Heart: 4-6 Hours
  • Lungs: 4-6 Hours
  • Liver: 8 Hours
  • Pancreas: 12-18 Hours
  • Kidneys: 72 Hours
  • Small Intestines: 4-6 Hours

BQ: How Do You Determine Who Receives The Organs?

UNOS (United Network for Organ Sharing)

Allocation Criteria

  • Blood Type
  • Medical Urgency
  • Tissue Match
  • Waiting Time
  • Organ Size
  • Immune Status
  • Geographic Distance
how can a patient become a donor if they have no family
How Can a Patient Become a Donor if They Have No Family?
  • Healthcare Agent or Power of Attorney – But only if given the responsibility of making an anatomical gift. Most POA and living wills in use cover only the power to make health care decisions – not anatomical gifts. We are working with the WI Dept. of Health to have their standard forms changed as soon as possible.
  • Spouse
  • Adult Children
  • Parents
  • Adult Siblings
  • Adult Grandchildren
  • Grandparents
  • Adults Who Exhibited Special Care or Concern, Except as a Compensated Health Care Provider for That Individual
  • Legal Guardian
  • Whomever Would be Responsible for the Disposal of the Body

NOK Hierarchy

donation after brain death46
Donation after Brain Death

Brain Death Criteria

Clinical Diagnosis of Brain Death

● Unresponsive to All Stimuli

● No Spontaneous Respiratory Activity

● All Brain Stem Reflexes are Absent

  • Pupillary Response to Light
  • Corneal/Lash Reflexes
  • Oculo-Vestibular Reflex (Cold-Caloric Response)
  • Oculocephalic Reflex (Doll’s Eye Phenomenon)
  • Gag/Cough Reflex
  • Response to Intense Central Pain
donation after brain death47
Donation after Brain Death

Brain Death Criteria

Apnea Test

  • Make Sure Patient Has Normal BodyTemp, Blood Pressure, Volume Status, ABGs
  • Disconnect From Ventilator
  • Monitor Continuous Pulse Oximetry
  • Administer 100% O2 at 6 L/min Into The Trachea
  • Monitor Closely for Respiratory Movements
  • Check Serial ABGs 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
donation after brain death48
Donation after Brain Death

Criteria for Brain Death

Confirmatory Exams

  • Cerebral blood flow (CBF) studies
  • 4 Vessel Angiogram
  • Transcranial Doppler
  • EEG