1. Case Study 24 y/o overdose with history of IVDA, found with needle in arm, & pronounced within 24 Hours of admission. Sharing Our Current Practices
Hospital:
What is your initial referral process after evaluating the patient?
What is your social and clinical management pathway of this patient?
What is your process of updating the OPO on the clinical status of changes neurologically, and progression toward brain death, with plans for testing?
What is your process for pronouncement of brain death?

2. UMC Process:
Once the patient meets clinical triggers, a call is placed to NDN. If this patient was vented with a GCS of 5 or less with a suspected neuro injury (Anoxia? Bleed?), the call should be made within ONE hour of arrival to the hospital and recognition of these triggers.
Social work would be included in finding family and providing support. Clinically, pt would be optimized for potential recovery.

3. Case Review, UMC
Pronouncement within 24 hour of arrival is very fast– especially with drugs on board. Our Hospital Policy requires drugs to be cleared prior to pronouncement, so conversations with physicians would be held to hold on pronouncement until any drugs are out of the patient’s system.
We work closely with the OPO (Nevada Donor Network) and have an on-site In-House Clinical Coordinator who we can call with any status changes during office hours and who can respond immediately. After hours, we would call the main NDN phone number with status updates.

4. Case Review, UMC
Once brain death testing is discussed/ planned, we call Nevada Donor Network. The In-House Clinical Coordinator, Procurement Transplant Coordinator and Family Services work with our staff to ensure pronouncement is done according to hospital policy and that family and the potential donor are adequately supported.
Brain death is pronounced with one clinical exam and an apnea exam. If any part of these cannot be done, we will do ancillary testing.