Presentation is loading. Please wait.

Presentation is loading. Please wait.

A Priority Approach to Maximizing the Gift from Donation After Cardiac Death Martin D. Jendrisak, MD, FACS Medical Director Gift of Hope Organ and Tissue.

Published byWillis Booker Modified over 8 years ago

Similar presentations

Presentation on theme: "A Priority Approach to Maximizing the Gift from Donation After Cardiac Death Martin D. Jendrisak, MD, FACS Medical Director Gift of Hope Organ and Tissue."— Presentation transcript:

1 A Priority Approach to Maximizing the Gift from Donation After Cardiac Death Martin D. Jendrisak, MD, FACS Medical Director Gift of Hope Organ and Tissue Donor Network

2 SRTR Data

3

4

5 Donation Stats as of July 15, 2011 National Organ Waiting List 111,827 Illinois Organ Waiting List 4,912 Indiana Organ Waiting List 1,513 Illinois Organ Waiting List By Organ Kidney 4,111 Liver 495 Heart 141 Kidney/Pancreas 110 Pancreas 100 Lung 69 Intestine 10 Heart/Lung 1

6 DSA of 12 Million 9 Transplant Centers 180 Donor Hospitals Referral Transplant Allocation Consent Management Recovery Transplant Partners

7 Catastrophic Neurologic Injury Evaluation and Treatment in the Critical Care Setting Clinical Trigger to donation Referral Donation option is part of end of life care planning Ensures this option is not denied to families Timely notification of OPO is critical to process Futility of Continuation of Care Establish by health care providers Family understanding and acceptance Death Determination

8 By Neurologic Criteria (DBD) –Cessation of all brain activity (brain death) –Clinically established –Confirmatory testing when indicated By Circulatory – Respiratory Criteria (DCD) –Permanent absence of circulation and respiration –Hospital DCD policy followed

9 IOM Committee Recommendation: 2006 DNDD – Donation after a neurological determination of death DCDD – Donation after a circulatory determination of death

10 No Brain Death Determination Yes ME/Coroner Notification - Hospital Consent for Donation ME/Coroner Release - GOH YesNo 1.Implement donor management protocols 2.Donor Testing 3.Organ Evaluation 4.Organ Allocation 5.Coordinate Surgical Recovery OR Access 1.Implement donor management protocols 2.Donor Testing 3.Organ Evaluation 4.Organ Allocation 5.Coordinate Surgical Recovery OR Access Decision & Planning for Withdrawal of Care Consent for Donation YesNo Withdrawal of Care Death Pronouncement ME/Coroner Notification - Hospital Implement DCD Protocol: Time Critical ME/Coroner Release - GOH

11 Protein S-100 Brain Injury Biomarker Study DonorNs-100bp ValueInjury-> SampleBD-> Sample SCD346.54 +/- 7.29.000489.0 +/- 93.08.7 +/- 2.5 ECD389.14 +/- 11.0.000363.6 +/- 75.24.9 +/-3.0 DCD304.18 +/- 6.40.024381.2 +/- 66.5N/A DCD-A301.37 +/- 1.83-------136.3 +/- 114.9N/A

12 Donor Management Requires a Collaborative Approach between OPO and Donor Hospital Staff Phases: Identification Referral & Initial Evaluation Management of the Potential Donor Brain Death and Consent Donor Management Special Interventions Organ Specific Testing and Assessment

13 De-escalation of Care Definition: Strategic reduction in the level of care in the setting of patient non-recovery Examples: Withhold or reduce vasopressor support, transfusions, fluid and electrolyte resuscitation, pulmonary care, laboratory monitoring, etc. Consequence on Donation: Renders organs not transplantable Per CMS and Contractual Obligation: Hospitals and providers must provide adequate medical support to give families the option for organ donation. Best Practice: (1) Early contact with GOH and (2) Provide full medical care until GOH determines non-donor status.

14 Donor Management - Goals Optimize Organ Viability Proper Assessment of Organ Quality Maximize Organ Utilization Optimize Outcomes of Transplantation

15 Consequences of the Pathophysiology of Brain Death Myocardial Dysfunction Hemodynamic Instability Neurogenic Pulmonary Edema Diabetes Insipidus Organ Dysfunction

16 Detrimental Physiological Effects of Brain Death Hemodynamic: “Catecholamine storm” Cardiac dysfunction Increase SVR Capillary alveolar membrane damage Hormonal Endocrinopathy Pituitary – ADH, TSH, ACTH Immunologic Activation of inflammatory mediators IL-6, IL-10, ??? Upregulated HLA Class II Expression Upregulated Expression of Adhesion Molecules

17 GIK Study Cardiac OutputStroke VolumeSVR CaseAgeSexWeightPre-GIKPre-GIKPre-GIK Organs Transplanted 119M70kg8.86.88164727672lu/li/k/p 245M78kg4.54.6526512281236li/k/p 333F139kg4.67.238611549768lu/li/k/p 417M64kg2.59.22874 li/k/p 547M72kg4.012.946917401045li/k 634M68kg5.811.565108997482h/lu/li/k/p SVR = Systemic Vascular Resistance; lu= lungs; li= liver, k= kidneys; p = pancreas; h = heart

18 Plexmark Study IP - 10MIGOPG SCD125.3+/-182.945.5+/-85.3877.0+/985.5 ECD275.9+/-519.732.2+/-48.9801.6+/-662.4 DCD8.7+/-11.62.0+/-4.5280.4+/431.6

19 Cytokine Response to Steroids in DBD TimeIP - 10MIGOPG 0180.8+/-340.740.6+/-72.7849.2+/-860.9 635.0+/-33.413.0+/23.9434.3+/-382.9 1220.6+/23.05.93+/-13.8494.9+/-360.7 2448.5+/-63.40283.5+/-243.6

20 DCD PROCESS OPO evaluates donation candidacy OPO coordinates organ procurement/allocation Patient care team withdraws support, provides comfort measures and pronounces death Organ recovery initiated after death – time critical Adherence to “Dead Donor Rule” –Organ can be recovered only after death –Organ recovery process does not hasten death

21 DCD 90 minute time limit Warm ischemia limits transplant opportunity –Kidneys – generally transplanted –Liver, lungs, pancreas maybe transplanted if organ flush within 20 minutes and donor age<40 DCD evaluation tool

22 Donation After Cardiac Death Tool

23 Final Score% Probability of Expiration In <60 minutes % Probability of Expiration in <120 minutes 10826 111334 122042 132851 143859 155068 166275 177281 188186 198790 209295 2195 229796 239697

24 DCD TOOL LIMITATIONS 80% positive predictive value 20% donors missed Focused on uncertainty of the DCD process Clinician input may add complexity to the decision process

25 DCD PRACTICE CHANGE Started 3/1/2010 Omit DCD tool Omit reliance on clinician prediction ability Pursue all opportunities –Potential for transplantable organs –Maximize the gift –Family driven Monitor practice through data analysis

26 Impact of the DCD Evaluation Tool on Organ Procurement With ToolWithout Tool∆ Potential Cases21474 Exclusions82 (38%)16 (22%)16% Pursued Cases132 (62%)58 (78%) Expired117 (89%)38 (66%) DNE15 (11%)20 (34%)23% Missed Donors15 (18%)018%

27 Donation Patterns of DCD Expired Cases With ToolWithout Tool Time to CPA <90 min11738 <60 min111 (95%)38 (100%) <30 min98 (84%)32 (84%) <20 min85(73%)28(74%) Positive Donors Total118 (89%)29 (89%) Extra-renal39 (40%)11 (40%)

28 Conclusions New DCD Practice Paradigm Maximizes The Gift –No missed donor opportunity –20% increase in donation with transplantable organs –Meet donor/family wishes 100% of time Demand On Donation Resources Acceptable –Identifies/excludes futile efforts (age>60)

29 Conclusions (Cont’d) Adds Clarity About DCD Process/Manages Expectations –2 out of 3 attempts (on average), transplantable organs are recovered –3 out of 4 actual donors expire under 20 minutes to permit extra-renal organ recover/transplantation –Clarity of message benefits family/staff

Download ppt "A Priority Approach to Maximizing the Gift from Donation After Cardiac Death Martin D. Jendrisak, MD, FACS Medical Director Gift of Hope Organ and Tissue."

Similar presentations

The Donor Most organ donors are accident victims that have suffered severe and eventually fatal injuries-often a severe head injury. Death is pronounced.

The Donor Most organ donors are accident victims that have suffered severe and eventually fatal injuries-often a severe head injury. Death is pronounced.
Midlands Collaborative, November 2012 Timely Identification and Referral of Potential Organ Donors Paul Murphy National Clinical Lead for Organ Donation.

Midlands Collaborative, November 2012 Timely Identification and Referral of Potential Organ Donors Paul Murphy National Clinical Lead for Organ Donation.
Unit G: Organ Transplants. Basic facts related to organ transplants A.No age limits – under 18 requires parent or guardian consent A.No age limits – under.

Unit G: Organ Transplants. Basic facts related to organ transplants A.No age limits – under 18 requires parent or guardian consent A.No age limits – under.
Organ Donation. A.No age limits – under 18 requires parent or guardian consent B.To donate, indicate on driver’s license and carry donor card C.Assure.

Organ Donation. A.No age limits – under 18 requires parent or guardian consent B.To donate, indicate on driver’s license and carry donor card C.Assure.
THE PATIENT’S JOURNEY TO TRANSPLANT AND BEYOND

THE PATIENT’S JOURNEY TO TRANSPLANT AND BEYOND
Optimising the brain-stem dead donor

Optimising the brain-stem dead donor
Organ Donation Past, Present and Future Donor Identification and Referral Louise Davey, Team Manager Dr Alex Manara, RCLOD South West 26 th June 2013 1.

Organ Donation Past, Present and Future Donor Identification and Referral Louise Davey, Team Manager Dr Alex Manara, RCLOD South West 26 th June
ETHICAL ISSUES IN ORGAN DONATION Kate Payne, JD, RN Director, Ethics & Palliative Care Saint Thomas Hospital, Nashville, Tennessee Ascension Health.

ETHICAL ISSUES IN ORGAN DONATION Kate Payne, JD, RN Director, Ethics & Palliative Care Saint Thomas Hospital, Nashville, Tennessee Ascension Health.
Donation Process: Preparing for the Gift Breakout Session A Presenters: Jennifer Do, RN, Unit Director, Surgical Transplant ICU, Ronald Reagan UCLA Medical.

Donation Process: Preparing for the Gift Breakout Session A Presenters: Jennifer Do, RN, Unit Director, Surgical Transplant ICU, Ronald Reagan UCLA Medical.
Moderator: Thomas Nakagawa, MD, Wake Forest Baptist Health Presenters: Darren Malinoski, MD, Cedars-Sinai Medical Center Breakout Session A: Optimizing.

Moderator: Thomas Nakagawa, MD, Wake Forest Baptist Health Presenters: Darren Malinoski, MD, Cedars-Sinai Medical Center Breakout Session A: Optimizing.
Organ Donation End of Life care in the Operating Room Matthew Bock Surgical recovery coordinator University of Wisconsin Organ Procurement Organization.

Organ Donation End of Life care in the Operating Room Matthew Bock Surgical recovery coordinator University of Wisconsin Organ Procurement Organization.
Donation After Cardiac Death May 26, 2010 Margie Whittaker, RN MSN.

Donation After Cardiac Death May 26, 2010 Margie Whittaker, RN MSN.
Nevada Donor Network The Donation Process. Who is Nevada Donor Network (NDN)? Federally designated, not-for-profit organ, tissue, and eye procurement.

Nevada Donor Network The Donation Process. Who is Nevada Donor Network (NDN)? Federally designated, not-for-profit organ, tissue, and eye procurement.
Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Neonatal Organ Tissue Donation After Circulatory Determination of Death Stiers J,

Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Neonatal Organ Tissue Donation After Circulatory Determination of Death Stiers J,
A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES 2010 ONELEGACY CELEBRATING OUR PARTNERS May 26, 2010.

A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES 2010 ONELEGACY CELEBRATING OUR PARTNERS May 26, 2010.
Organ Donation 9.PCH.1.2: Summarize the procedures for organ donation, local and state resources, and benefits.

Organ Donation 9.PCH.1.2: Summarize the procedures for organ donation, local and state resources, and benefits.
The Need: What’s Being Transplanted? n Organs: –in adults & children with end- stage organ failure –Heart –Heart-Lung –Lung n single or double –Liver.

The Need: What’s Being Transplanted? n Organs: –in adults & children with end- stage organ failure –Heart –Heart-Lung –Lung n single or double –Liver.
We have achieved and sustained a 75% conversion rate nationally We continue to transplant more organs annually We continue to engage more partners to.

We have achieved and sustained a 75% conversion rate nationally We continue to transplant more organs annually We continue to engage more partners to.
ORGAN DONATION By: Aubree Malone. “When you’re not an organ donor when you die, you’re taking a lot of people with you.”

ORGAN DONATION By: Aubree Malone. “When you’re not an organ donor when you die, you’re taking a lot of people with you.”
` Division of Transplantation/OSP/HRSA Allocation of Pancreata for Whole Organ and Islet Transplantation James Burdick, M.D. Director Health Resources.

` Division of Transplantation/OSP/HRSA Allocation of Pancreata for Whole Organ and Islet Transplantation James Burdick, M.D. Director Health Resources.

Similar presentations

Ads by Google