Nursing Management of Nursing Management of the Potential Organ the Potential Organ and Tissue Donor and Tissue Donor Susan Ulit, RN, BS, MSN, Susan Ulit, RN, BS, MSN, CNRN CNRN Clinical Nurse Specialist Clinical Nurse Specialist Dina Elias, RN,BSN,CCRN Dina Elias, RN,BSN,CCRN Clinical Nurse Educator Clinical Nurse Educator
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Nursing Management of the Potential Organ and Tissue Donor
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Nursing Management of Nursing Management of the Potential Organ and the Potential Organ and
ObjectivesObjectives• Understand the role of the critical care nurse in the Understand the role of the critical care nurse in the
referral of potential organ donor patientsreferral of potential organ donor patients• Recognize the importance of the critical care nurse in Recognize the importance of the critical care nurse in
partnering with OPO representativespartnering with OPO representatives• Describe in brief the pathophysiology of brain death and Describe in brief the pathophysiology of brain death and
the management goals for the organ donor patientthe management goals for the organ donor patient• Understand the role of the critical care nurse as a Understand the role of the critical care nurse as a
patient and family advocate during the transition phase patient and family advocate during the transition phase of organ donationof organ donation
• Understand the importance of collaboration of Understand the importance of collaboration of healthcare team members in referral and conversion healthcare team members in referral and conversion rates and outcomesrates and outcomes
Referring the Potential Referring the Potential DonorDonor
• Identify the potential donor in your Identify the potential donor in your unitunit
• Be familiar with the hospital’s Be familiar with the hospital’s criteria for clinical triggerscriteria for clinical triggers
• Refer the potential donor to the Refer the potential donor to the OPO promptlyOPO promptly
• Understand the great influence the Understand the great influence the CCRN has on the process CCRN has on the process
Clinical TriggersClinical Triggers
Partnering with your Partnering with your OPOOPO
• Introduce self to the OPO coordinator Introduce self to the OPO coordinator assigned to the referral assigned to the referral
• Encourage collaboration with the OPO Encourage collaboration with the OPO member, as they are now an integral member, as they are now an integral member of the health care team member of the health care team
• LCSW, Pastoral care, physicians, nursing teamLCSW, Pastoral care, physicians, nursing team
• Ask your OPO member to share Ask your OPO member to share information and resources information and resources
• T-4T-4• Articles in support of donor managementArticles in support of donor management
Educate Yourself / TeamEducate Yourself / Team
• Policy and ProceduresPolicy and Procedures• Become knowledgeable about the different Become knowledgeable about the different
types of donationtypes of donation• Donation after Cardiac Death vs. Brain DeathDonation after Cardiac Death vs. Brain Death
• Become well-informed about organ donation Become well-informed about organ donation and the pathophysiological effects of brain and the pathophysiological effects of brain death death
• Patient management goalsPatient management goals• Realizing the positive impact organ donation Realizing the positive impact organ donation
brings to all those involved – the “U-turn”brings to all those involved – the “U-turn”
Pathophysiology of Pathophysiology of Brain DeathBrain Death
• Cornerstone of successful donor Cornerstone of successful donor managementmanagement
• Management includes:Management includes:• Ensuring adequate intravascular volumeEnsuring adequate intravascular volume• Maintaining appropriate CO with possible use Maintaining appropriate CO with possible use
of vasoactive dripsof vasoactive drips• Initiating T-4 protocol as appropriate Initiating T-4 protocol as appropriate • Early recognition and treatment of DI, SIADH, Early recognition and treatment of DI, SIADH,
HHNSHHNS• Tight glycemic control Tight glycemic control • Coagulopathy correction Coagulopathy correction
When a patient dies, despite best efforts, organ donation When a patient dies, despite best efforts, organ donation becomes a positive outcome to a tragic situation. becomes a positive outcome to a tragic situation.
Hope for Recovery… Hope for Recovery… can become can become… Hope Through Donation… Hope Through Donation
Patient and Family Patient and Family AdvocateAdvocate
• Gate keeperGate keeper• Honor your patients’ and families’ Honor your patients’ and families’
wisheswishes• Uphold a family’s right to be offered Uphold a family’s right to be offered
the opportunity of organ donation the opportunity of organ donation • Do not take that opportunity away by Do not take that opportunity away by
making that decision for them making that decision for them • All health care team membersAll health care team members• Leave your personal opinions to yourselfLeave your personal opinions to yourself
Patient and Family Patient and Family AdvocateAdvocate
• Promote compassionate Promote compassionate communication communication
• Promote collaboration Promote collaboration • Be the bridge that links the health care Be the bridge that links the health care
team to patients and their familiesteam to patients and their families
• Avoid conflict of interestAvoid conflict of interest• DO NOT mention organ donationDO NOT mention organ donation• What is the message we are sending?What is the message we are sending?• What if the family asks about donation?What if the family asks about donation?
TransitionTransition
• Brain Death pronouncementBrain Death pronouncement• Communicate early and often with the Communicate early and often with the
familyfamily• Facilitate communication between Facilitate communication between
physicians and the familyphysicians and the family• Re-iterate prognosis given by Re-iterate prognosis given by
physician to ensure understandingphysician to ensure understanding
• Second Brain Death note is official Second Brain Death note is official TODTOD
Team HuddleTeam Huddle
•Team huddle occurs before Team huddle occurs before discussion of pronouncement discussion of pronouncement with familywith family
•Team huddle members include:Team huddle members include:• OneLegacyOneLegacy• PhysicianPhysician• Bedside RNBedside RN• LCSW’sLCSW’s• Pastoral CarePastoral Care
TransitionTransition
•Brain death discussionBrain death discussion•Patient is DEAD (don’t equivocate)Patient is DEAD (don’t equivocate)
•Transition & decouplingTransition & decoupling•How to respond to “What’s Next?”How to respond to “What’s Next?”
•““A specialist will talk with you about the A specialist will talk with you about the next steps…”next steps…”
•How to introduce OneLegacyHow to introduce OneLegacy•““A member of our healthcare team…”A member of our healthcare team…”
• Organ donation consent rate highest when Organ donation consent rate highest when hospital staff and OPO approach togetherhospital staff and OPO approach together
Source: “Improving the Request Process to Increase Family Consent for Organ Donation”; Gortmaker, et.al. (Journal of Transplant Coordination 1998; 8:210-
217)
Summary Summary
• Educate!Educate!
• Advocate!Advocate!
• Collaborate!Collaborate!
• What you What you saysay and and dodo can make the can make the difference between a yes and a no.difference between a yes and a no.