1. Olivia Stoddart RN, BSN, CPTC
Case Study
Region 5 Collaborative
Fall 2017
Olivia Stoddart RN, BSN, CPTC

2. Demographics 24 y/o Male Found pulseless and apneic – unknown downtime
ROSC after 15 min of CPR, epi x 3, and defib x 1
Multiple previous admissions for drug related issues
Tox screen positive for benzos, opiates, amphetamines, and THC.

3. Admission Course 11:30 – Presented to the ED areflexic
MD pre-mentions donation to family in ED
Family positive towards donation – make pt a DNR
14:00 – Hospital notifies Lifesharing
15:10 – Lifesharing onsite for initial evaluation
17:00 – CBFS findings consistent with brain death
21:00 – Family asking to speak with Lifesharing
authorize for donation (pt was not registered)
blood sent for serologies
Pt officially declared BD by two MDs on the following day

4. PHS Increased Risk Previous admissions make mention of pt with IVDA
Family confirms on DRAI (Donor Risk Assessment Interview) that pt was using needles
Needles used day prior to admission
No track marks identified on physical assessment
Lifesharing indicates pt as PHS increased risk on UNET
Note placed in donor highlights stating pts specific behaviors of IVDA

6. Donor Management – Day 1
Pts BP and HR very labile → on T4 using pressors/vasodilators as needed
Vent settings: PRVC 100% FiO2 PEEP 12 → started APRV → Q1H PEEP
Metabolic acidosis with pH 7.18 → started bicarb gtt
Oliguric with admit Cr 1.94, peak 2.3
LFTs elevated
In DI → started vaso gtt and free water flushes to lower Na
Insulin gtt for glucose > 200
WBCs increasing – on 3 abx

7. Donor Management – Day 2
All labs start to trend in the right direction
TEE shows EF 69% with no abnormalities
HR and BP still labile
CT abd normal, CT chest shows patchy opacities in BLL
ABGs improving, but not perfect
ABO and serologies result: blood group B, +CMV IgG
Decision made to give donor 1 more day to work up organs
Allocate in the morning to have best chance at placing all organs

8. Allocation – Day 3
Heart: 3 recipients a 3 centers declined due to PHS increased risk
Lung: 6 recipients at 2 centers declined due to PHS increased risk
Liver: no declines due to PHS increased risk
K/P: 4 recipients at 4 centers declined due to PHS increased risk
Kidney: 2 recipients at 2 centers declined due to PHS increased risk
Research: 1 program declined to back up organs due to PHS increased risk
Able to get regional acceptance for all organs

9. OR – Day 4 Heart declined in OR
Was able to re-allocate heart in OR to lung recipient who was listed for both heart and lung.
Upon arrival of K/P team, recipient called and changed mind, now declining PHS increased risk organs
Was able to re-allocate K/P intra-op to another regional center

10. Outcome Heart/Lung transplanted in 48 F Liver transplanted in 57 F
K/P transplanted in 45 M
Kidney transplanted in 56 F

11. Best Practices
Clear and accurate communication of PHS increased risk behaviors
Will attempt to complete DRAI with family/friend who knows the donor the best
Will complete multiple DRAIs if necessary
If donor will be PHS increased risk due to hemodilution of sample, will re-send blood for serologies once pt is no longer hemodiluted
Any behaviors that don’t meet PHS increased risk criteria, but are of interest, will be listed in the donor highlights

12. THANK YOU!