1. ORGAN DONATION …And what it means for the RN

2. A Few Stats Currently, the number of names on the UNOS National Organ Transplant Waiting List exceeds 110,000. Nationally, 18 people die each day awaiting a transplant. A new name is added to the list every 13 minutes. One donor can save up to 8 lives and improve the lives of up to 50 others

3. Transplantable Organs

4. Transplantable Tissues

5. Critical Care Implications Nearly 70% of the 13,500 patients experiencing brain death (annually and nationwide) are suitable candidates for organ and tissue transplantation In almost 90% of instances, only patients experiencing brain death may donate organs

6. The Bottom Line January – November 2005: Organ transplantations totaled 19,621 while 91,000 remained on the waiting list 2002: Of the 14,000 potential donors, only 6,671 became actual donors Only 2 organ procurements have taken place at MMC in the last decade

7. Shortage Culprits Knowledge and attitudes of health professionals Processes for donor Identification Timing of request for organ donation Refusal of family members to Consent to donation Cultural considerations

8. Saving Lives Takes Many Forms Sooooo…… How can the role of the Registered Nurse help to alleviate the organ transplant shortage?

9. Educate: Yourself And Your Colleagues Become knowledgeable about organ donation, procurement, and hospital policy and procedure Initiate conversation about and advocate for EBP on your unit Update or edit policy and procedure Initiate in-service training for your unit with the local Organ Procurement Organization (OPO) Be Gracefully Assertive, not aggressive

10. Assess, Assess, Assess! Then… ICP GCS Posturing Prognosis Inoperable? Do not consider: age, tox screen, disease history, ethnicity, socioeconomic status

11. ACT!!! ER and ICU nurses are in a prime position Suspect a good candidate for donorship? Contact your local OPO or donor network ASAP Let them take the reigns and continue highest standard of care for your patient

12. Keep Assessing!!!!!!!!! Brain stem functions are absent when there is no response to the following: ◦Pupillary light reflex (PERRLA) ◦Corneal reflex (cotton swab) ◦Oculocephalic (dolls eyes) ◦Oculovestibular (cold caloric test) ◦Oropharyngeal (gag and cough) ◦Respiratory (may require apnea test) Change in Baseline? REPORT IMMEDIATELY

13. Ethical Considerations Autonomy- respect family decisionmaking Beneficence-patient is still a whole person Maleficence-no place for negligence Veracity-family deserves only truth (within the RN scope of practice) Justice- Standards of Care are upheld

14. After Consent to Donorship Who is your primary patient now? Debrief yourself Be a change agent: “after-action” review ◦Focus on systems ◦Discuss process and outcomes Know you helped to save and improve human lives

16. Resources Earle, B. (2012). Determination of brain death. Sutter Health Memorial Medical Center Interdisciplinary Policy and Procedure Manual California Transplant Donor Network. (2013). Current data and basics in California. Retrieved from http://www.ctdn.org/current-data-basics-in-ca.html New York State Nurses Association (NYSNA). (2004). Role of the registered professional nurse in organ and tissue donation. Retrieved from http://www.nysna.org/practice/positions/position10_ 04.htm Tamburri, L. (2006). The role of critical care nurses in the organ donation breakthrough collaborative. Critical Care Nurse, 26, 20-23 retrieved from http://ccn.aacnjournals.org/content/26/2/20.full.pdf+ html