9/19/2018

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Dave Mattox, RN, CPTC

Manager, Family Services

Community Education

Donor Hospitals

TransplantCenters

Donor Families/Recipients

INDIANA TRANSPLANT CENTERS

Indiana University Health Transplant – Indianapolis

Heart | Lungs | Liver | Kidneys | Pancreas | Intestines

St. Vincent Transplant – Indianapolis

Heart | Kidneys | Pancreas

Lutheran Transplant – Fort Wayne

Heart | Kidneys

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The Transplant Wait List

• Approximately 123,000 people are awaiting transplants in the United States, of which approximately 1,400 are in Indiana

• Every 10 minutes someone is added to the waiting list

TODAY, 22 PEOPLE WILL DIE WAITING FOR A LIFESAVING

TRANSPLANT

Indiana Donor Choice LawUniform Anatomical Gift Act

• Over 70% of all Licensed Drivers in Indiana are donor designated (DD)

• Supports the right for an individual’s decision to become a donor

• DD status is verified by Indiana Donor Network via BMV/Registry Records

• DD is shared with hospital staff & family

• The donor’s decision is carried out

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Types of Donation

SAVE EIGHT LIVES AT ONE BEDSIDE

Chronic hepatitisLiver tumorsCirrhosis

HypertensionDiabetesPolycystic disease

COPDEmphysemaCystic fibrosis

Type 1 diabetes

Heart disease

- Congenital

- Coronary- Hypertensive

cardiomyopathy

Short-bowelsyndrome

Liver

Lungs

Kidneys

Heart

Intestine

Pancreas

BRAIN DEATH

• Defined as total & irreversible destruction of the brain & brainstem

• Occurs when an injury to the brain causes it to swell and fill the capacity of the skull, thus preventing blood flow to the brain

• Artificial support may maintain body function temporarily

BRAIN DEATH IS NOT A COMA

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Injuries That Can Lead To Brain Death

• Hemorrhagic/Ischemic Stroke, Aneurysm

• TBI caused by GSW or MVA

• Smoke inhalation

• Strangulation

• Cardiac Arrest with prolonged “downtime”

• Drug Overdose

• Any Anoxic Injury

BRAIN DEATH DECLARATION

Minimum requirements by Indiana Donor Network:

Declaration of brain death will be verified per hospital policy

• Clinical exam and apnea test

• Confirmatory testing (i.e. CBF, EEG, transcranial Doppler, etc.)• Hypothermic protocol• CNS depressants• Clinical exam or apnea not performed

Cerebral Brain Flow Study(these results indicate that there is no flow)

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Cerebral Arteriogram

Team Huddle

• Occurs with RN, physician, IN Donor Network FSC, Chaplain etc.

• Will take place prior to: EOL discussion, Brain Death testing/discussion of results, or donation discussion

• Supports best practices

Donation After Circulatory Death (DCD)

• DCD donors must have significant neuro injury but will not progress to brain death

• Family must 1st decide to withdraw care before we would approach for donation or they must initiate donation conversation

• Recovery of organs for transplantation from asystolic donor

• 90 minutes

• Prior to acceptance of brain death DCD is the way donation would happen

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ORCs Responsibilities

ICU

Donor Management

Collections of Typing Material

Documentation & Charting

Generate Organ Lists

Allocation of Organs

Logistics of Transportation

O.R.

Transport

Preservation Solution

Removal of Organs for Research

Removal of Tissue Specimens

Obtain Signatures & Organ Anatomy

Donor Management Goals

• Sodium <155

• Mean Arterial Pressure >60

• 1 or no pressors (excludes Vasopressin)

• pH 7.35 – 7.45

• CVP <10

• PaO2 > 300 or 3:1 ratio during O2 challenge

• Urine 1-2 ml/kg/hr

• Creatinine <2.0

Cardiac Evaluation

Echocardiogram & Cardiac Enzymes

• Electrolytes Normalized

• Adequate Volume Status

• Complete 2D with Doppler• Measurements

• Visualization Chambers and Valves

• Ejection Fraction %

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Abdominal Organ Evaluation

Labs• BMP - Q4 hours

• CMP

• LFTs

• Pancreatic Specific Markers

Imaging

Resources

• Standing Orders

• Management Protocols

• CMO – Transplant Nephrologist

• Medical Director – Transplant Pulmonologist

• Medical Director – Neurosurgeon

• Local Transplant Surgeons

• Hospital RN, RT, Physicians

Pulmonary Work Up

Imaging Chest X-ray

• Lung Measurements

Bronchoscopy

• Anatomy

• Clear Secretions or Foreign Matter

Chest CT

only when requested*

Arterial Blood Gases O2 Challenge

Gram Stain & Culture

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Donor Management

• IN Donor Network works collaboratively with nursing staff

and MDs

• Organ Recovery Coordinators will be on site for the entire process: working to optimize organ donation potential.

• Coordinate with transplant centers to place organs

Donor Management-Logistics

• Once all organs are placed ORC will confirm OR time

• Coordinate travel arrangements for transplant teams to arrive at hospital

• OR times can change for many reasons i.e. complications with recipients, weather.

• We will update nursing staff and family during entire process

TISSUE DONATION

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MORE THAN 1 MILLION TISSUE TRANSPLANTS ARE DONE

EACH YEAR*

*UNOS - 2015

LIVES HEALED BY HOOSIER TISSUE DONORS

January – December 2016

30,729

IMPACT OF DONATION

• In 2016, 33,598 organs were transplanted in the U.S. • 616 of those were in Indiana

• One organ and tissue donor can save and heal the lives of 75 or more people

• Most families say donation turns tragedy into hope

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IN Donor Network’s Care of the Family Continues

Baby Mason

Baby Mason

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Baby Mason

Mighty Mason

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"We were anxious to meet Mason in person. Just from photos and videos, he

has Alaiya's energy. He has her spunk now. It was emotional hearing her heart in someone else ... but we are grateful

that we have an opportunity to hear what made her so amazing."

“Through donation, we help recipients

and donors to live on. Recipients live on

through the selfless act of donors. Donors live on through a legacy made even stronger

as a result of their donation, and they

live on through others."