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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 (1-866-894-2676). Perspective. Remembering why we’re here. Save lives through transplantation

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organ donation end of life care in the operating room matthew bock surgical recovery coordinator

Organ DonationEnd of Life care in the Operating RoomMatthew BockSurgical recovery coordinator

University of Wisconsin

Organ Procurement Organization

1-866-UWHC OPO

(1-866-894-2676)

remembering why we re here
Remembering why we’re here
  • Save lives through transplantation
  • Supporting the family’s choice
  • Honoring the patient’s wishes
uniform determination of death act 1980
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
two ways to donate deceased organ donation
Donation After

Brain Death

Donation After

Cardiac Death (DCD)

Two ways to donateDeceased Organ Donation
slide7
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

slide8
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

clinical diagnosis of brain death
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
apnea test
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
apnea test1
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
slide12
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

slide13
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

severe neurologic injury
Severe Neurologic Injury
  • Trauma
    • MVA, Fall
  • SDH
  • Anoxia
    • Cardiac Arrest, near drowning
slide15
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

two ways to donate
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.
two ways to donate1
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.
two ways to donate2
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.
slide20
ICU nurse

RT

OPO staff

No family yet

who is involved

Who is involved?

Hospital

Anesthesia

Surgical Technician/Scrub Nurse

Circulating Nurse

Abdominal Transplant Team

- Surgeon

- Physician Assistant

- Surgical Recovery Coordinator

Cardiothoracic Team

- Surgeon

- Surgical Fellow

- Surgical Recovery Coordinator

paperwork
Paperwork
  • Consent x2
  • Time out
  • Post Op disposition
  • Death packet
slide23
Prep & drape
  • Femoral cutdown
  • Cover patient and back table
  • Unnecessary staff exits the room
dcd withdrawal in the or
DCD Withdrawal in the OR

Accommodating the Family

organ preservation time
Organ Preservation Time
  • Heart: 4-6 hrs
  • Lungs: 4-6 hrs
  • Liver: 12 hrs
  • Pancreas: 18 hrs
  • Kidneys: 24 hrs