Karen Samartan, RN, BSN, CNOR, CCPT

1
Strategy for Success Collaborating to Bring the
Donation Process to Completion

• Karen Samartan, RN, BSN, CNOR, CCPT
• Surgical Recovery Coordinator
• OneLegacy

2
OneLegacy Team Members

• HSCHospital Services Coordinator. Handles all
  Administrative issues, Death Record Reviews,
  Reports, Educational opportunities
• FCCFamily Care Coordinators. Guide families of
  potential donors through grief process and
  decision making.
• PTCProcurement Transplant Coordinator. Manages
  donor on ICU after consent is obtained

3
OL Team Members (contd)

• SRCSurgical Recovery Coordinator. Plans the OR
  procedure with OR staff and manages the donor in
  the Operating Room.
• TRCTissue Recovery Coordinator. Obtains consent
  for tissue donation. Recovers donated tissue
  after cardiac death or organ donation takes
  place.

4
OneLegacy Issues When Booking the OR

• Have all organs been placed with potential
  recipients?
• When will an OR room be available?
• When will the incoming teams be able to get to
  the donor hospital
• Are the recipients/donor stable?

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Hospital Issues When Booking the OR

• What does the board look like?
• How many add-ons are there?
• What is our staff availability?
• How long will the Organ Recovery take?
• Who ARE these people, and what are they doing in
  our OR?

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When is an Add-On Not an Add-On?

• Donor cases MUST have a target time, even when on
  the Add-On list
• In-coming teams need to coordinate the recipient
  moving into the OR at the transplant center
• When organ recovery case is placed on the add-on
  list, every effort must be made to accommodate
  that time
• Donor cases are extremely time sensitive
• Planning involves many phone calls
• Once the OR time is set it is difficult to change
  it earlier or later
• Surgical teams will plan to arrive at OR time,
  however, OneLegacy will be on site in the OR at
  least 1-2 hours to help prepare OR

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More Considerations

• We are very aware that the Donor Hospital must
  provide for their Staff or Attending surgeons,
  however
• Affiliation Agreement grants privileges to organ
  recovery surgeons to practice surgery at the
  donor hospital
• Organ recovery surgeons should be given the same
  consideration as staff or attending surgeon
• Donors Family has made a final decisionthey
  need to experience the closure which having a set
  OR time will give them.

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How Can the Donor Hospital Help Create a Smooth
Process?

• Integrate organ donation into the culture of the
  OR
• In-services, CME, posters, data updates, donor
  council
• Use the resources of the OPO to integrate organ
  donation into to the daily operations of the OR
  staff
• Assist the OPO with planning and setting OR time
• Advocate for both the OPO and the surgery
  schedule to find a time that fits everyones
  needs
• Accept the organ recovery team as hospital
  partners
• Provide scrubs, lounge, phone access

9
Case Scenario with Marginal Outcome

• Donor case booked as add-on 9 projected OR
  time is 1800
• Add-ons continue to be booked, donor case is
  repeatedly placed at end of line-up6 times
• Projected time is now moved to 0000 teams
  notified
• Donor finally moved to OR at 0330

10
End Result

• Hospital is not happy with this intrusion on
  their service to attending physicians, and the
  fact that OneLegacy was still there in the AM
  when they needed the room
• OR staff stressed and over-worked
• Recovery teams have had to delay the transplant
  and wait on site for OR opening

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Case Scenario with Good Outcome

• Hospital ICU and OR Staff is on board with the
  Donation process
• Pt is only 4.2 kg there are no local potential
  recepients
• Stanford University accepts the liver local
  Kidney surgeon will recover kidneys
• OR is booked for 1600
• Flight plans set for team to fly from Palo Alto

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Case Set Up, continued

• Family is made aware of plans and will remain at
  the babys bedside until OR
• Priest will remain with the parents
• OR staff was all volunteer, no one felt coerced
  to participate
• Extensive Huddling took place with the OR staff
• OR room is prepared prior to patients arrival
• All equipment is tested and ready

13
20 Minutes prior to OR time

• Liver team from Stanford experience an in-flight
  emergency
• Loss of electrical power forces the plane to
  return to ground immediately
• The departure air-field is now closed due to fog
  (San Francisco Bay area)
• Flight is diverted to land in Sacramento
  (opposite direction of OC)
• Family is informed of the 3-4 hr delay they are
  willing to wait

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How did this Affect the OR?

• OR Management agrees to accommodate this change
  staff will remain the same no need to re-orient
  relief staff
• OR staff is temporarily re-assigned to give
  dinner breaks, prepare other cases
• OR room remains Reserved for organ donation

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2000 Stanford team has arrived.

• The (frazzled) surgeons arrive, are shown to the
  lounge, given scrubs while the OR and ICU
  transport the donor to the OR
• Patient settled in the OR room, surgery begins
  and the liver and kidneys are successfully
  recovered

16
End Result

• OR and ICU staff are satisfied with the
  successful outcome
• Feel family was supported and respected
• Happy that a baby was able to be transplanted
• Level of trust for donor process is elevated

17
Thank You!!

• We at OneLegacy realize that managing the Organ
  Donor can be a challenging and stressful.
• We are committed to supporting you before,
  during, and after these cases.
• Please keep in mind that you are a vital
  component in ensuring that the final wishes of
  the grieving family will be realized through
  donation.

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