Organ and Tissue Donation: An Overview

Transcription

1 Organ and Tissue Donation: An Overview E-learning module revised by LifeSource, 2012 This learning module is part of a series of e-learning modules designed to meet hospital education requirements for compliance agencies such as CMS, the Joint Commission and the State Department of Health. Learners are responsible for reviewing the information, completing the post-test, printing the Certificate of Completion, and providing evidence of completion to their hospital Education Coordinator or other designated compliance officer. Nurses licensed in the State of MN may also retain the Certificate of Completion and apply to continuing education credit. Completion of three e-learning modules is equivalent to one (1) credit. Learning Objectives Upon completion of this e-learning module, learners will be able to: Identify the need for transplantable organs and tissues Describe the referral process for ventilated patients Recognize donor designation as legal authorization for organ, tissue and eye donation Differentiate between organ donation after brain death and organ donation after circulatory death (DCD) Approach every opportunity with the belief that donation is possible and take steps to ensure that families are treated with respect and care, regardless of their grief, race, religion, ethnicity, or socioeconomic status.

2 Organ and Tissue Donation The Need The national transplant waiting list holds the names of more than 116,000 men, women and children. More than 3,400 of our neighbors in the Upper Midwest are waiting for a life-saving organ transplant. Every day 100 people pin their hopes on the generosity of strangers as they are added to the transplant waiting list. Each day 18 people are removed from the transplant waiting list by death. Additionally, one million individuals will receive a tissue transplant to repair injuries and restore mobility and approximately 50,000 people in the United States will have their vision restored through corneal transplantation. The Benefits of Organ and Tissue Donation Organ and tissue donation provides hope for thousands of people with organ failure or tissue diseases and injuries. Improved surgical techniques and new antirejection drugs permit the successful transplantation of organs and tissues. In addition to the benefits that the transplant recipient receives, the donor family is presented with opportunities that may help them cope with the loss of someone special. One of the benefits for families whose loved one is able to donate organs and tissues includes knowing that their loved one s gift has provided an extension or improvement of the quality of life for another person. One organ donor can potentially help up to eight people. Recipients often return to healthy, active lifestyles after organ transplantation. For instance, kidney recipients live free of dialysis; pancreas recipients are cured of diabetes; heart, lung and liver recipients are able to return to work ; and small intestine recipients are cured of digestive disorders. One tissue donor can potentially help up to 50 people and sometimes many more. Accident or cancer patients may receive bone to replace damaged bone or prevent the loss of a limb; patients requiring ACL or other reconstructive repair often require donated tendon; skin recipients could be a burn victim or woman

3 who requires extensive reconstructive surgery post mastectomy; small children and women of childbearing age live free of anti-coagulants after receiving a donor heart valve; and up to ten people will have their vision saved or restored through corneal and sclera transplantation. Most tissue transplants take place at community hospitals during surgeries to repair injuries sustained by trauma or disease. Triggers for Donation Referrals The donation process begins when your patients meet the trigger(s) for referral to the donation agencies. The triggers to call SHARE are: If family mentions or has questions about donation or if you have questions Ventilated and o Severe neurological injury o GCS < 5 or meets two or more of the following neuro indicators (no pain, no triggering the vent, no pupil response, no corneal reflex, no cough, no gag, no doll s eyes, no response to cold calorics) After the initial referral call, if a decision is made to withdraw support, call prior to extubation or discontinuation of life-sustaining therapies Patient suffers cardiac death, even if the patient has been previously referred The call to SHARE must be completed within one hour of the patient meeting the trigger. Should I mention donation to the family before I make the call? No. Donation is not mentioned prior to the referral call unless the family initiates the topic. In that case, please explain to the family: I am not the expert in donation but will contact the donation agencies right now to ensure that your questions are answered quickly and accurately. What happens next?

4 At the time of the referral call, the donation agencies will work closely with hospital staff to: 1. Evaluate for organ, tissue and eye donation potential 2. Determine donor designation status 3. Develop an appropriate communication plan What is donor designation? Donor designation refers to the practice of honoring the donor s designation of gift after their death. This may be documented on: A driver s or chauffeur s license; A state-issued identification card; A will; An advanced directive; A donor card or other writing, signed by the individual, intended to make an anatomical gift. Minnesota, North Dakota and South Dakota have all adopted legislation which specifies that the donor designation on a driver s license represents legal authorization to donate at the time of death. This means that no one can overturn the decision to be a donor. The hospitals and donation agencies have an obligation to do everything possible to ensure that the individual s wishes regarding donation are fulfilled. Donation may proceed with a properly documented donor designation that has not been revoked by the decedent. If a minor has the opportunity to be a donor and has registered on their permit or driver's license, their parents or guardians must affirm their decision. If a patient is a resident in a state outside of the LifeSource service area, LifeSource can access the state s donor registry and will work with the family to honor their loved one s wishes.

5 What are the criteria for organ donation? Potential organ donation candidates will have the following: Severe neurological injury with grave prognosis, i.e. brain death or nonsurvivable injury Ventilator support Perfusing heart beat What is brain death? Brain death is the irreversible cessation of all functions of the brain, including the brain stem. Causes of brain death include intracerebral hemorrhage, head trauma, anoxia and brain tumors. Brain death is death. The Determination of Death Act (1980) defines two legal ways to determine death: 1. Cardiac death = heart dies 2. Brain death = brain dies If a patient is declared brain dead in your hospital, that is the official time of death that will appear on the death certificate. The heart only continues to beat because of chemical and mechanical support. Testing to determine brain death is conducted by physicians according to your hospital BD Declaration policy. Tests may include apnea testing, cerebral angiogram, EEG, cerebral blood flow studies and much more. Familiarize yourself with your hospital s BD Declaration policy. The donation agencies do not have a role in declaring brain death. They will however, ensure that the documentation for brain death is completed according to your hospital policy prior to proceeding to organ recovery.

6 What if my patient doesn t meet the criteria for brain death but the family is interested in organ donation? In some instances, a person may donate organs after circulatory death has occurred; this is called donation after criculatory death or DCD. For organ donation after circulatory death to occur the following circumstances must exist: A patient has suffered devastating and unrecoverable illness or injury and is ventilator dependent, Patient does not meet brain death criteria, The family has decided to withdraw support, Death from circulatory and respiratory arrest is likely to occur within 90 minutes following withdrawal of mechanical support. The topic of donation is not introduced to families until after their decision to withdraw support. In this situation, organ recovery would occur only after support is withdrawn and after circulatory death is pronounced. Withdraw of support typically occurs in the operating room and often times the family is present until death has been declared, just as they may be if the patient were in the intensive care unit. Declaration of death is conducted by the attending physician or his/her designee. The triggers for donation after cirulatory death referrals are the same. At the time of the referral, the LifeSource donation coordinator will work with you to determine if the patient has DCD opportunities. LifeSource staff will work closely with hospital staff to coordinate DCD cases and support both hospital staff and donor families. Because the patient is not dead, medical management will remain the responsibility of the patient s physician. The donation coordinator collaborates with the medical staff to discuss treatment options to maintain hemodynamic stability and obtain tests required to determine organ suitability. Refer to your hospital s donation after circulatory death policy as your most important resource for donation after circulatory death cases.

7 Who talks to the family about donation? Only someone who is trained to speak with families about donation opportunities can do so. This is a CMS regulation and also your hospital s policy. Very few hospital staff in our service area are trained as designated requestors to speak with families, so it is likely that your hospital relies on the donation agencies to discuss donation opportunities with the next of kin. Prior to any donation discussion, the donation coordinator will huddle with hospital staff to develop an appropriate communication plan. If you are not present for the discussion, the donation agencies will inform you of the family s decision. What if I know the patient s religion does not support donation? Never assume that a particular segment of the population will not donate, even if that has been your experience in the past. Hospital staff should approach every opportunity with the belief that donation is possible and should take steps to ensure that families are treated with respect and care. Your perception that a family s grief, race, ethnicity, religion or socioeconomic background would prevent donation should never be used as a reason not to discuss donation with a family. All potential donor families must be informed of their donation opportunities. My patient is going to be a donor. What happens next? If your patient is going to be an organ donor, the LifeSource donation coordinator will work closely with you to manage the patient in order to maximize all donation opportunities. They may be ordering special tests such as a biopsy, a bronchoscope and/or an echo in order to determine the organ s function. Simultaneous to management of the patient, the donation coordinator is also placing the organs with the appropriate recipients.

8 How are donors and recipients matched? The United Network for Organ Sharing, or UNOS, houses the database for all waiting recipients. This is what is commonly referred to as the list. Recipient information is placed in the system when the patient is placed on the list. The donation coordinator places specific information about the donor into the same system which generates the best match. UNOS determines these matches based on patient s blood type, body size and severity of illness. This system is in place to ensure that organ allocation is conducted fairly. Where does the recovery occur? After the organs have been placed, an operating room (OR) time will be scheduled for the recovery of organs. The LifeSource donation coordinator will arrange for all transplant surgeons to be in the OR at the same time. The organs will be recovered and taken back to the recipient at their transplant center. This could be a local transplant center or a transplant center in another part of the country. If your patient is an organ, tissue and eye donor, the tissue and eye recoveries will occur after the organ recovery. Because a different team recovers tissue and eyes, the patient will generally be moved to the morgue and the donation agencies will coordinate an operating room time for the tissue and eye recoveries at a later time. What if our patient is a tissue and eye donor but not an organ donor? If your patient is a tissue and eye donor and not an organ donor, the patient will need to be moved to the morgue as soon as possible. If your hospital does not have a cooled morgue, the donation agency will give you specific instructions for cooling the patient. The cooling process is necessary to prevent bacterial growth and ensure safety of the recovered tissue.

9 What about eye care? Regardless of whether the potential donor has been moved to the morgue, it s always appropriate to complete eye care. This is done by gently closing the eyes so there is no exposure to the air; elevating the head; and placing light ice packs or gloves filled with ice over the eyes. This is also beneficial to the funeral director in preparing the body for a viewing. The patient s family has left the hospital. Will they get any more information? The donation agencies will send the family a letter containing generic information about their loved one s recipients. The donation agency acts as the middle man if either party wants to exchange information. Donor and recipient information remains anonymous unless both parties agree to disclose more. In addition to managing this information, providing compassionate and sensitive care to donor families in the months and years after a loss is an important component of the donation process. Through the Donor Family Services program, LifeSource staff provides bereavement support and information to donor families, helping to ensure that the family continues to feel supported after their loved one s gifts of donation. The Donor Family Services Program includes: Bereavement literature Grief support program referrals Follow-up letters and phone calls Gatherings and events to honor and remember loved ones Opportunities to share their story and volunteer in LifeSource activities

10 Organ and Tissue Donation: An Overview Post Test Instructions: Please print this page and answer the following questions. After completion of the post test proceed to the Certificate of Completion for evidence of completion of this e-learning module and post test answers. 1. How many people wait for a solid organ transplant in the United States: a. 18 b. 3,400 c. 10,000 d. 116, How many people will receive some type of tissue transplant this year? a. 2,600 b. 200,000 c. One million d. 40, True or False. If a patient has donor on their driver s license, they have already given legal authorization for donation to occur after their death and their family does not have a decision to make. 4. A ventilated patient with no neuro responses should be referred to SHARE: a. Within one hour of meeting the trigger, i.e. losing the neuro responses b. After brain death has been declared c. At the time of withdraw of support d. When the physician indicates it s time to refer the patient 5. True or False. A man commits suicide and his family is shocked and grief stricken. It is okay to mention donation prior to the call to SHARE to prepare them for another difficult conversation. 6. Donation after circulatory death (DCD): a. Is an opportunity to donate organs for patients who do not deteriorate to brain death b. Can occur even if the patient has never been on a vent c. Is discussed only after the family has decided to withdraw support. d. a and c

11 This certifies that has completed: Organ and Tissue Donation: An Overview E-learning module revised by LifeSource, contact hours Description: This e-learning module provides learners with information about the need for transplantable organs and tissues and the donation process. Learning Objectives: Upon completion of this e-learning module, learners will be able to: Identify the need for transplantable organs and tissues Describe the referral process for ventilated patients Recognize donor designation as legal authorization for organ, tissue and eye donation Differentiate between organ donation after brain death and organ donation after cardiac death (DCD) Approach every opportunity with the belief that donation is possible and take steps to ensure that families are treated with respect and care, regardless of their grief, race, religion, ethnicity, or socioeconomic status. Kathy Hicks, MPH, Education Coordinator Instructor Date This e-learning module was created by LifeSource, Organ and Tissue Donation 2550 University Avenue West, Suite 315 South, Saint Paul, MN / Phone: Print this certificate as record of completion of this e-learning module. Completion of this certificate acknowledges that the participant has completed the education module in its entirety and understands the information presented. Post Test Answers: 1) d. 2) c. 3) True. 4) a. 5) False. 6) d. Contact LifeSource with any questions.