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Donation After Cardiac Death

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If the patient does not arrest within a time deemed suitable by the organ ... New Jersey 6 (3.85) New York 6 (2.3%) 2003 OneLegacy. Important Facts to Remember ... – PowerPoint PPT presentation

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Title: Donation After Cardiac Death


1
Donation After Cardiac Death
  • Dr. William Meyer
  • Neurosurgeon
  • Kern Medical Center

2
History and Facts
  • Prior to the acceptance of the brain death
    criteria in the mid-1970s, all organ donations
    were performed after cessation of cardiopulmonary
    function (NHBD).
  • In 1999, 68 of Donation After Cardiac Death
    (DCD) cases were accomplished across the United
    States.
  • In 2006, 322 DCD cases were accomplished.

3
History and Facts (contd)
  • More than 97,000 people are on the waiting list
    for an organ transplant
  • 17 - 20 people die waiting every daynew name
    added to the list approximately every 15 minutes
  • Organ recovery following cardio-pulmonary death
    can positively impact the shortage of
    transplantable organs

4
(No Transcript)
5
Fundamentally…
  • The family should make the decision to withdraw
    life support independent of, and prior to, any
    discussion regarding organ donation.

6
Criteria
  • The patient has a non recoverable illness or
    injury and has suffered neurologic devastation.
  • The family, in conjunction with the medical
    staff, has decided to withdraw life support.
  • Death will likely occur within one hour of
    withdrawal of life support.

7
Potential DCD Donor
  • Patients with severe neurological injury
  • Intracranial hemorrhage, stroke, anoxia, trauma
  • Patients without neurological injury
  • Degenerative neuromuscular diseases
  • End-stage cardiopulmonary diseases
  • Do not meet the criteria for brain death
  • No chance for survival off the ventilator
  • Family elects to deescalate care or withdraw
    support (DNRs)

8
OneLegacy Clinical Triggers
  • Meets one of the following
  • Irreversible Brain injury
  • End stage musculoskeletal disease
  • High spinal cord injury
  • Ventilator dependent
  • Family has made patient DNR or plans to withdraw
    all life support
  • Family inquired or initiated discussion about
    organ donation

9
Process
  • Refer the patient to OneLegacy.
  • A coordinator will come on site and evaluate the
    patient to determine suitability.
  • In conjunction with the health care team, the
    family will be informed of the patients
    suitability.
  • If suitable, the family will be fully informed
    about all procedures relating to the
    pronouncement of death and the organ recovery
    process by OneLegacy.

10
Patient Management
  • The patient will continue to be supported
    hemodynamically and on a ventilator until
    withdrawal of support.
  • Standard comfort measures will be given at the
    discretion of the attending physician or their
    designee.
  • OneLegacy will provide parameters for donor
    management and lab studies to be approved by the
    attending physician or their designee.

11
Withdrawal of Support
  • A OneLegacy DCD consent form will be signed by
    the next-of-kin. The original copy will remain in
    the patients chart.
  • Removal of life support usually takes place in
    the O.R.
  • Organ recovery occurs 5 minutes after asystole/
    pronouncement of death

12
Pronouncement of Death
  • The adult patient will be pronounced dead after 5
    minutes of asystole or 5 minutes of ventricular
    fibrillation measured by electrical activity and
    arterial pulse monitoring.
  • Death will be pronounced by a physician or
    designated nursing staff.
  • The physician certifying death may not be
    involved in the recovery or transplantation of
    the organs.
  • The physician will record the date and time of
    death in the medical record and, if applicable,
    complete the death certificate.

13
What Happens if the Patient does not Expire?
  • Occurs in approximately 5-10 of DCD cases
  • If the patient does not arrest within a time
    deemed suitable by the organ recovery team, the
    patient will be returned to a prearranged room
    and provided with comfort measures.
  • OneLegacy will be responsible for the costs
    relating to the evaluation and recovery of organs
    regardless of whether the organs are recovered.

14
OPO Performance 2003-2004 DCD Donors

  • 2003 2004
  • OPOs without DCD donors 27
    16
  • OPOs with at least 1 DCD donor 32
    42
  • OPOs with gt 5 DCD donors 12
    20
  • Total number of DCD donors 264 (4.1)
    395 (5.5)

15
Impact of DCD upon DBD
  • 16 DSAs accounting for 80 of DCD donation in
    2004 increased DCD, SCD, and ECD donor recovery
  • from 2003 to 2004
  • 49.3 increase for DCD
  • 9.4 increase for SCD
  • 3.8 increase for ECD
  • Donation rate increased from 50 to 53.9
  • In 2004, non-DCD recovery positively associated
    with DCD recovery among the 59 DSAs.

16
Organ Transplant Breakthrough Collaborative
Goals Organs Transplanted per Donor
  • Standard Criteria Donors 4.3
  • DCD Donors 2.75
  • ECD Donors 2.5
  • Total
    3.75
  • At Least 10 of all Donors Are DCD

17
OPO Performance 2004 DCD Donors
  • Gift of Life 47 (12.1)
  • NEOB 38 (19.5)
  • Gift of Hope 36 (12.1)
  • Life Center 33 (19.0)
  • Midwest 28 (18.2)
  • UW 27 (20.3)
  • Lifequest 18 (16.7)
  • Michigan 14 (5.1)
  • Core 14 (9.3)
  • Washington 12 (10.0)
  • Finger Lakes 11 (20.8)
  • TRC 10 (9.9)
  • Mid America 8 (7.1)
  • LOPA 8 (5.0)
  • Carolina 7 (5.1)
  • Golden State 7 (15.2)
  • One Legacy 7 (2.0)
  • Iowa 6 (15.4)
  • New Jersey 6 (3.85)
  • New York 6 (2.3)

18
Important Facts to Remember
  • The family should make the decision to withdraw
    life support independent of the decision to
    donate organs.
  • This procedure should not be viewed as a way to
    circumvent brain death criteria but as a means to
    provide families with an additional option of
    donation that complies with the patient or
    authorized family directives.
  • The Institute of Medicines evaluation of the
    ethics of DCD stated that the procedure should
    be considered a reasonable source of organ
    donors.

19
References
  • California Health and Safety Code, sections
    7150-7156.5, 7180-7184.5 and 7188-7195.
  • Medical and Ethical Issues in Procurement
    Division of Health Care Services, 1997 (IOM).
  • Conditions of Participation for Hospitals, Part
    482, Federal Register, 1998.
  • Gift of Life Sample Hospital Policy and
    Procedure Non Heart-Beating Organ Donation
  • University of Pittsburgh Medical Center
    Presbyterian Hospital Policy and Procedure Manual
    Non-Heart Beating Organ Donation
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