1. The Organ Donation Process
Lisa Seymour, RN
Learning Specialist
New York Organ Donor Network
12/30/2018
L. Seymour, New York Organ Donor Network

2. L. Seymour, New York Organ Donor Network
Objective
Understanding of the process of donation from consent to recovery of the organs
12/30/2018
L. Seymour, New York Organ Donor Network

3. L. Seymour, New York Organ Donor Network
Topics of Discussion
Overview of the consent process
Brain Death protocol
Evaluation and screening
Organ specific testing
Allocation of the organs
Recovery process
Post recovery
12/30/2018
L. Seymour, New York Organ Donor Network

4. OVERVIEW OF THE CONSENT PROCESS
CANNOT HAPPEN WITHOUT EACH COMPONENT, MAY TAKE TIME, TIMING !!
12/30/2018
L. Seymour, New York Organ Donor Network

5. L. Seymour, New York Organ Donor Network
TIMING IS CRUCIAL
12/30/2018
L. Seymour, New York Organ Donor Network

6. WORKING WITH THE FAMILY
Assessment of family
Introductions
Identification of NOK
Identification of decision makers, family support
Eliciting family understanding of brain death
Discussion of donation with the family
Explanation of process of donation
Addressing concerns and questions
Meeting needs of the family
FAMILY SERVICE COUNSELORS, TRANSPLANT COORDINATORS, SOCIAL WORK
12/30/2018
L. Seymour, New York Organ Donor Network

7. L. Seymour, New York Organ Donor Network
CONSENT PROCESS
Consent forms
Medical and Behavioral History
Explanation of “what comes next?”
Constant updates for the family
12/30/2018
L. Seymour, New York Organ Donor Network

8. WORKING TOGETHER TO SUPPORT THE FAMILY
Family includes supports not only NOK, rabbi, pastor, priests, extended family
12/30/2018
L. Seymour, New York Organ Donor Network

9. L. Seymour, New York Organ Donor Network
BRAIN DEATH PROTOCOL
Full understanding of hospital plans for protocol
Assisting family with understanding
Explanation how protocol affects the timeline and donation process
12/30/2018
L. Seymour, New York Organ Donor Network

10. BRAIN DEATH PROTOCOL cont.
Based on NYS Guidelines
Clinical Exams by physicians
Supportive or confirmatory testing
Possible delays in protocol being completed
12/30/2018
L. Seymour, New York Organ Donor Network

11. SCREENING AND EVALUATION
Serology testing (HIV, Hepatitis, etc)
Blood type
Medical Suitability
Behavioral History
HLA (tissue typing, histocompatability)
Review of CT scans, chest x-rays, etc
12/30/2018
L. Seymour, New York Organ Donor Network

12. ORGAN SPECIFIC TESTING
HEART
EKG
Echocardiogram
Cardiac catheterization
Lab values
12/30/2018
L. Seymour, New York Organ Donor Network

13. ORGAN SPECIFIC TESTING cont.
LUNGS
Bronchoscopy
Chest X rays
Culture results
Arterial blood gases
Accurate measurements
12/30/2018
L. Seymour, New York Organ Donor Network

14. ORGAN SPECIFIC TESTING cont.
LIVER
Lab testing
CT scans or ultrasound
Lab values
12/30/2018
L. Seymour, New York Organ Donor Network

15. L. Seymour, New York Organ Donor Network
ORGAN PLACEMENT cont.
KIDNEYS
Lab testing
HLA (tissue typing)
Ultrasound or CT scan
Kidney anatomy (post recovery)
Pump numbers (post recovery)
12/30/2018
L. Seymour, New York Organ Donor Network

16. L. Seymour, New York Organ Donor Network
ORGAN PLACEMENT cont.
PANCREAS
HLA
Ha1C
Lab testing
CT or ultrasound
Insulin dosing in hospital
12/30/2018
L. Seymour, New York Organ Donor Network

17. L. Seymour, New York Organ Donor Network
ALLOCATION BEGINS
UNOS specific guidelines and generation of the “list”
Performed by Transplant Coordinator in field, Organ Placement Coordinators and/or UNOS
Time frame
**describe listing of patients, equity, directed donation
ONE HOUR RULE
12/30/2018
L. Seymour, New York Organ Donor Network

18. L. Seymour, New York Organ Donor Network
During this time of consent, screening and evaluation and allocation stability of the donor and support the family is CRUCIAL
12/30/2018
L. Seymour, New York Organ Donor Network

19. L. Seymour, New York Organ Donor Network
ORGAN ALLOCATION
All information in hand at this point (few exceptions)
Multiple people may be involved
Very time consuming process
Multiple offers at once
ALL information must be given for informed decision by surgeon
Deciding surgeon may want more information
Decision made to accept or decline
12/30/2018
L. Seymour, New York Organ Donor Network

20. A RECIPIENT IS FOUND
Backup placing begins~ We understand that ANYTHING can happen
12/30/2018
L. Seymour, New York Organ Donor Network

21. ORGANIZATION OF RECOVERY
Operating room availability at the hospital
Organizing potentially up to 8 surgical teams to arrive AT THE SAME TIME, IN THE SAME PLACE, to work together to successfully recover these live saving organs
ONE OF THE BIGGER CHALLENGES
WE HAVE LITTLE CONTROL OVER
12/30/2018
L. Seymour, New York Organ Donor Network

22. RECOVERY Abdominal teams (liver team) begins
All teams do extensive “prep work” needed for expedition of recovery post cross clamp
Heart and lungs are procured first
Liver, pancreas and intestine next
Kidneys are recovered last.
This process takes between 4-6 hours
12/30/2018
L. Seymour, New York Organ Donor Network

23. WHY WOULD AN ORGAN BE REFUSED IN THE OR?
Suspicious mass or lesions found
Evidence of infection
Biopsies performed are incompatible with donation
Donor instability
Recipient instability or death
12/30/2018
L. Seymour, New York Organ Donor Network

24. WHAT HAPPENS IF THE ORGAN IS REFUSED?
Immediately the backup is called
Aggressive placement continues
If, unfortunately, no recipient is found
THE ORGANS WILL BE KEPT IN THE BODY OR RETURNED TO THE BODY BEFORE CLOSURE (if already procured)
12/30/2018
L. Seymour, New York Organ Donor Network

25. L. Seymour, New York Organ Donor Network
POST RECOVERY
Tissue typing to include lymph nodes, blood clot, spleen are obtained for secondary typing for kidneys, pancreas, intestine and heart
Preservation of the organs after initial anatomy documented
Kidneys placed on pumps
12/30/2018
L. Seymour, New York Organ Donor Network

26. THE RUSH TO TRANSPLANT IMMEDIATE TRANSPORTATION
IMMEDIATE TRANSPLANTATION
WHAT IS THE RUSH?
THESE ORGANS ARE NOT FOR “WHAT IF?”
A LIFE IS IN JEOPARDY
12/30/2018
L. Seymour, New York Organ Donor Network

27. POST RECOVERY KIDNEY ALLOCATION MAY CONTINUE WHY?
Benefits of waiting to pumping kidneys
Use of kidney pumps gives more detailed information
Can “turn around” kidneys
Ultimately provides for best recipient
12/30/2018
L. Seymour, New York Organ Donor Network

28. L. Seymour, New York Organ Donor Network
POST RECOVERY cont.
Surgical teams “close” the donor in the same manner as any other surgery
Respect for the body continues
Carrying through the wishes of the family for arrangements for the body
Family called
12/30/2018
L. Seymour, New York Organ Donor Network

29. A QUITE COMPLICATED PROCESS
Begins with working with the hospital to assess the situation, the family and the initial suitability
The process of working with the family and obtaining consent
Further screening
Organ specific testing
Allocation to find the right recipient
Logistics of recovery
12/30/2018
L. Seymour, New York Organ Donor Network

30. L. Seymour, New York Organ Donor Network
IN SUMMARY
Organ transplantation is proven
The entire goal of organ transplantation is
TO SAVE ANOTHER HUMAN LIFE
Organs are NEVER “wasted”
Intent is always to find the best recipient
Family wishes are ALWAYS respected
12/30/2018
L. Seymour, New York Organ Donor Network

31. Respect for the donor and their family
12/30/2018
L. Seymour, New York Organ Donor Network

32. L. Seymour, New York Organ Donor Network
While… assuring that all is possibly done to save another human being’s life
12/30/2018
L. Seymour, New York Organ Donor Network