INTERDISCIPLINARY CLINICAL MANUAL Policy & Procedure

Transcription

1 INTERDISCIPLINARY CLINICAL MANUAL Policy & Procedure TITLE: Organ and Tissue Donation NUMBER: CC Section: Special Procedures Date Issued: October 2007 Source: Distribution: MAC Sub Committee Organ and Tissue Donation Holders of CDHA Interdisciplinary Clinical Manual Date To Be Reviewed: Issuing Authority: October 2010 Cathy Ann Casault Interim Health Services Director; District Medical Advisory Committee POLICY: 1. When a patient/client who dies in hospital has the potential to be an organ and/or tissue donor, the substitute decision-maker, in accordance with the Nova Scotia Human Tissue Gift Act is to be offered the option of organ and tissue donation by the attending physician. 2. Physicians and Nursing staff have a responsibility to identify and refer appropriate patients/clients for donation. DEFINITIONS: Attending Physician: Brain Death: Eligible Organ Donor: Organ: includes physician at time of death or that physician s delegate the irreversible cessation of all brain and brain stem function as per Procedure # 3.0. a potential organ donor who meets eligibility criteria as determined by donation and transplantation screening process. a vital organ requiring perfusion by the circulatory system until time of retrieval. The organs for donation may include: kidneys, liver, heart, small bowel, pancreas, and lungs. Organ Donor: Patient/client pronounced dead on the basis of neurological evidence (brain death), but with respiratory and circulatory function supported, Organ and Tissue Donation CC Page 1of 7

2 who donate organs. Potential Organ Donor: a patient who has suffered severe and irreversible brain injury and is mechanically ventilated and for whom the decision has been made to withdraw life support. Substitute Decision- Maker: Tissue: Tissue Donor: Roles: Critical Care Organ Donation Coordinator: Tissue Bank Specialist: those persons identified in section 6 of the Human Tissue Gift Act RSNS 1989, c.215 (amended). Refer to the CDHA policy Consent to Treatment CH Procedure # 16 or the Consent for Organ/Tissue Donation (CD0741MR ) for order of priority. a part of the body that does not require perfusion by the circulatory system until time of retrieval. The tissues for donation may include: skin, veins, corneas, sclera, bone and related structures, heart valves and pericardium. Patient/client pronounced dead on the basis of cessation of cardiac function and/or neurological evidence (brain death), who donates tissues. Facilitates and coordinates the donation process which includes: screening potential organ donors, offering families the option of donation, supporting the medical management of organ donors, coordinating organ allocation and recovery, and providing donor family follow-up, educates health care professionals and the public about organ and tissue donation. Screens, procures, processes, preserves and distributes allograft tissue for transplantation from deceased donors. Supports autologous tissue transplantation, the bone marrow transplant program and provides perfusion services to the Multi-Organ Transplant Program procurement teams. PROCEDURE: 1. DONOR IDENTIFICATION 1.1. When a patient/client has experienced cardio-respiratory death, either/or both the attending Medical and Nursing staff, in collaboration with the Regional Tissue Bank Specialist, identify the potential for tissue donation as per Procedure # 2.1 and ensure that the option of tissue donation is offered to the patient s family as part of end of life care When a patient/client has experienced neurological death, the attending Medical staff as per Procedures # 2 and 3, and in collaboration with the Organ Donation Coordinator and 5.2 Organ and Tissue Donation CC Page 2of 7

3 intensivist, identify the potential for organ donation and ensure that the patient s family is offered the option of organ and/or tissue donation as part of end of life care Either/or both Medical and Nursing staff ensure that all potential tissue donors are referred to the Regional Tissue Bank Specialist on call, and that all potential organ donors are referred to the Organ Donation Coordinator on call, as per Procedure # Consult with the Regional Tissue Bank Specialist or the Organ Donation Coordinator through QEII Locating ( ) prior to offering the option of donation to a patient s family. 2. REQUIRED REQUEST OF ALL DEATHS FOR ORGAN AND TISSUE DONATION 2.1. The Attending Physician screens all deaths within Capital Health, including those deaths occurring in the Emergency Department, for organ and/or tissue donation potential Potential for tissue donation is considered in patients less than 81 years of age There is no age limit for organ donors Note the history of any of the following: ALS, Alzheimer s, Creutzfeldt-Jacob Disease, Hepatitis B or C, HIV, Leukemia, Melanoma, MS, MRSA, Parkinson s, Rabies, Septicemia, TB or VRE report this information to the Donor Coordinator or Tissue Bank Specialist to assist in assessing eligibility for donation The Attending Physician or delegate documents in the health record progress notes if the family of an eligible donor is not offered the option of organ and/or tissue donation, indicating the reason for same Refer potential organ donors to the 5.2 MSNICU Intensivist on call and the Organ Donation Coordinator on call (as per Procedure # 2.1 and in accordance with section 6A (2) of the Human Tissue Gift Act) Refer potential tissue donors to the Tissue Bank Specialist on call (as per Procedure # 2.1 and in accordance with section 6A (2)) of the Human Tissue Gift Act) If potential for donation is confirmed, the attending physician ensures that the option of organ and/or tissue donation is presented to the patient s family or Substitute Decision- Maker. If the option of donation is accepted, the Attending Physician or delegate obtains consent from the legal next of kin If the option of donation is not accepted by the family, the Attending Physician or delegate documents same in the health record progress notes, including the family s stated reason for same. 3. NEUROLOGICAL DETERMINATION OF DEATH Organ and Tissue Donation CC Page 3of 7

4 3.1. For the purpose of organ donation, TWO physicians in accordance with the Nova Scotia Human Tissue Gift Act 1991 determine and document the Neurological Determination of Death The two physicians participating in the Neurological Determination of Death (as per Procedures # ) must not have a conflict of interest. According to the Human Tissue Gift Act (HTGA): "No physician, who has had any association with the proposed recipient that might influence his judgment, shall take any part in the determination of death of the donor." "No physician, who took any part in the determination of the fact of death of the donor shall participate in any way in the transplant procedures." 3.2. Two fully licensed and independently practicing physicians perform the declaration of brain death. The physicians may perform the declaration concurrently or separately, with no fixed examination interval If the declaration is performed by two physicians separately, the first determination is the legal time of death In performing the Neurological Determination of Death, include a clinical examination and an Apnea Test If two separate declarations are performed, each physician completes the full clinical examination including the apnea test with each declaration Each Physician completes the Checklist for Declaration of Brain Death and documents according to the following criteria : Etiology of coma Absence of confounding factors precluding the diagnosis Absent motor responses bilaterally Brainstem reflexes tested and absent Apnea testing completed and positive Ancillary tests may be performed if minimum clinical criteria cannot be completed or unresolved confounding factors exist 4. ORGAN AND TISSUE DONATION SCREENING 4.1. When a potential organ and/or tissue donor is identified, contact the Organ Donation Coordinator or Tissue Bank Specialist on call and provide the following information: name age Organ and Tissue Donation CC Page 4of 7

5 cause of brain injury (organ donor) cause of death (tissue donor) Health card Number (HCN) 4.2. The Registered Nurse documents the referral for donation evaluation in the health record The donor coordinator or tissue bank specialist obtains additional information from the health record as required The donor coordinator consults the Transplant surgeon as to a patient/client s medical eligibility for organ donation 4.5. The Regional Tissue Bank Specialist determines medical eligibility for tissue donation in consultation with the Tissue Bank medical director as necessary If the patient is not an eligible donor, the Organ Donation Coordinator or Tissue Bank Specialist documents the referral and relevant exclusion criteria in the donor referral log The Organ Donation Coordinator or Tissue Bank Specialist: access the MSI donor registry to determine if the patient s donation wishes were documented on their health card provide this information to the family if they are not already aware of the patient s wishes. 5. CONSENT 5.1. When the eligibility for donation is confirmed, the option of organ and/or tissue donation is presented to the patient s family or Substitute Decision-Maker. If the option of donation is accepted, the Attending Physician or delegate (medical resident, organ donation coordinator) obtains consent from the legal next of kin, either in person or by telephone. Refer to Consent to Treatment CH Note - Consent for tissue donation may be obtained by the regional tissue bank specialist The Attending Physician documents in the progress notes that the option of donation was presented. The Organ Donation Coordinator and Tissue Bank Specialist on call are available at any point during the process to answer questions the staff or family may have about donation Consent By The Donor - The HTGA specifies that any person who has attained the age of majority (currently 19 years) may consent: In a writing signed by him/her at any time; on a CDHA consent form or orally in the presence of at least two witnesses during his/her last illness The consent is binding and is full authority for the use of the body or the removal and use of the specified part or parts for the purpose specified. Note - Under current legislation, a common-law spouse, same sex spouse and legal guardian cannot give consent. Organ and Tissue Donation CC Page 5of 7

6 6. Coordination Of Organ And Tissue Donation 6.1. The Organ Donation Coordinator or Tissue Bank Specialist coordinates a time to conduct the required donor medical/social questionnaire with the Substitute Decision-Maker or person most knowledgeable about the donor s medical and social history The Organ Donation Coordinator coordinates all logistics of organ donation and recovery The Tissue Bank Specialist coordinates all logistics of tissue donation and recovery. 7. ADMISSION OF DONORS FROM OUTSIDE HOSPITALS 7.1. The 5.2 MSNICU Physician receives and addresses consults about potential organ donors from all outside facilities, and, whenever possible, facilitates transfer to the QEII Health Sciences Centre. 8. MEDICAL EXAMINER 8.1. If the death is a medical examiner's case, refer to the information regarding medical examiner's cases in the Care of the Patient After Death CC policy The Attending Physician or their delegate obtains approval from the Medical Examiner before the retrieval of any organs or tissues The Medical Examiner identifies any necessary restrictions to organ or tissue retrieval The Donor Coordinator or the Tissue Bank Specialist arranges for the completion of a medical examiner consent form and files a copy on the donor record In medical examiner cases, do not complete the death certificate but send with the health record to the operating room for the retrieval surgery. 9. RECOVERY OF DONOR ORGANS AND/OR TISSUES 9.1. The Organ Donation Coordinator makes the necessary arrangements for organ recovery based on the medical status of the donor and in consultation with the operating room and transplant teams The Regional Tissue Bank Specialist makes arrangements with the operating room staff for tissue recovery. RELATED CAPITAL HEALTH DOCUMENTS Policies Care of the Patient After Death CC Consent to Treatment CH Organ and Tissue Donation CC Page 6of 7

7 Forms CD0741MR Consent for Organ/Tissue Donation REFERENCES Human Tissue Gift Act, Chapter 215 of the Revised Statutes, Amended 1991, c.13 HISTORICAL DATES Integrated October 2007 (Replaces ESMH Nursing Policy - Organ and Tissue Donations IIv-1, May 1998; MVMH Administrative Policy Organ donation, I-o-5, Aug 1993; TOMH Nursing Policy - Organ and Tissue Donations,I-o-14; DGH - Medical Policy and Procedure - Organ and Tissue Donation, Feb 1997; QEII Administrative policy Organ and Tissue Donation Q , Oct 2001 Organ and Tissue Donation CC Page 7of 7