1. ORGAN DONATION in the ED Presented by: Robert D. Kerns, NREMT-P, CPTC Advanced Practice Coordinator UWHC In-House Coordinator UWHC Organ Procurement Organization Lee Faucher, MD Director of Trauma Services UWHC

2. OBJECTIVES  Identify potential emergent and/or uncontrolled DCD candidates  Define Uncontrolled DCD  Define the process of successful Uncontrolled DCD  Identify the resources needed to support an Uncontrolled DCD candidate  Identify the staff needed for a successful Uncontrolled DCD  Demonstrate that the care received in the ER directly impacts Donation even if the patient makes admission to the ICU  Identify barriers to Uncontrolled DCD in the ER  Identify strategies to overcome barriers to Uncontrolled DCD  Identify key members of hospital staff that can champion Uncontrolled DCD  Define communication strategies for hospital staff that will facilitate the Uncontrolled DCD process  Define communication strategies that will support families when presenting the option of Uncontrolled DCD

3. OBJECTIVES  Identify potential emergent and/or uncontrolled DCD candidates  Define Uncontrolled DCD  Define the process of successful Uncontrolled DCD  Identify the resources needed to support an Uncontrolled DCD candidate  Identify the staff needed for a successful Uncontrolled DCD  Demonstrate that the care received in the ER directly impacts Donation even if the patient makes admission to the ICU  Identify barriers to Uncontrolled DCD in the ER  Identify strategies to overcome barriers to Uncontrolled DCD  Identify key members of hospital staff that can champion Uncontrolled DCD  Define communication strategies for hospital staff that will facilitate the Uncontrolled DCD process  Define communication strategies that will support families when presenting the option of Uncontrolled DCD

4. CASE 1  0209: Patient arrived at ED  ~20 Year old male in high speed MVC  Long extrication w/ deaths on scene  ETT upon arrival  Patient had severe closed head injury  Left femoral head dislocation

5.  0345:  Patient to OR for Craniotomy  Patient has bilat SDH Left > Right  Hematoma evacuated spontaneously  Bone flap left out and closed CASE 1

6.  0601: Admitted to TLC  CVP placed  Patient began bleeding profusely from all open areas  ICP remained elevated  Patient maxed on Epi, Norepi, and Neo  Requiring continuous FFP and PRBC’s CASE 1

7.  0802: Family Discussion  Family decides to WLS  Family agrees to Organ Donation  OPO Activated CASE 1

8.  0830: OPO arrived on TLC  Received report from Attending MD  Met with patient’s parents CASE 1

9.  0845:  Activated OPO recovery team to UW  Scheduled OR for 0930  0900:  Written consents completed  Serology blood drawn  Family services arrives at TLC CASE 1

10.  0930: OPO recovery team in TLC  0945: Patient to OR with TLC Attending  1030: Extubation  1051: CTOD  1057: Organ recovery begun CASE 1

11.  Kidneys recovered for transplant –2 patients are transplanted  Eye and tissue recovered –2 patients’ sight restored –100’s of patients benefited from tissue transplants CASE 1 - Outcome

12.  0802: OPO activated  0830: OPO arrives in TLC  0845: OPO recovery team activated & OR set  0900: Written consent completed  0930: OPO recovery team arrives  0945: Patient to OR  1030: Extubation CASE 1 – Emergent DCD

13. Emergent DCD  Can this happen at your hospital? YES!!

14. CASE 2  0942: Patient arrives at ED  ~ 10 year old male w/ GSW to head  Patient in full arrest & ETT upon arrival to ED  Patient stabilized in ED and then to CT  Head CT shows non survivable injury  No NOK available yet  Pt to be supported and admitted to PICU

15.  1007: OPO activated from ED  1032: Patient arrives in PICU  1035: OPO arrives in PICU  Patient is being supported  NO NOK yet  Police in PICU attempting to locate NOK  ME notified and clears case for donation CASE 2

16.  1037:  Activated OPO recovery team  Reserved OR for emergency DCD  Pt stabilized on pressors and albumin  No NOK yet CASE 2

17.  1101:  OPO recovery team onsite  OR suite ready  Serology blood drawn  No NOK yet CASE 2

18.  1137: Patient’s mother on phone w/ PICU  1140: Mother decides to WLS & consents for DCD Mother is over an hour away  1141: Patient is moved to OR w/ PICU staff and Police  1142: CPR begun  1147: arrive in OR  1201: Extubation & CPR stopped  1206: CTOD  1208: Organ recovery begun CASE 2

19.  Kidneys recovered for transplant –2 patients are transplanted  Eye and tissue recovered –2 patients’ sight is restored –100’s of patients benefited from tissue transplants CASE 2 - Outcome

20.  1007: OPO activated from ED  1035: OPO arrives in PICU  1037: Recovery team activated & OR set  1101: Recovery team onsite  1140: Consent obtained for DCD  1141: Patient to OR and CPR begun  1201: Extubation CASE 2 – Uncontrolled DCD

21. Uncontrolled DCD  Can this happen at your hospital? YES!?!?

22. ORGAN DONATION in the ED Lee Faucher, MD Director of Trauma Services UWHC

23. Disclosure  Started my medical career as an EMT in East-Central Wisconsin  Worked as a Surgical Technician at the UW while in college –Member of the transplant team  Faculty member of the Division of General Surgery since 2004 –Director of Trauma since 2006

24. CASE 3  22 year old male involved in a motor vehicle crash. –Unconscious –Intubated for airway control and diminished mental status –Blood pressure and pulse present and stable –Obvious external injury to head, without other signs of trauma

25. CASE 3  Social worker has contact information for mother about two hours away.  Mother said she wanted him to be a donor if nothing else could be done.

26. DISCUSSION  UNCONTROLLED DCD  EMERGENT DCD

27. THANK YOU!!