Download - Center For Donation & Transplant
![Page 1: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/1.jpg)
Center For Donation & Transplant
Organ Donation for EMS Providers
January 9, 2007
by Barbara York, BA, OPC, EMTPThe Center for Donation & Transplant
Albany, New York
![Page 2: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/2.jpg)
Center For Donation & Transplant
Removing the Veil of Mystery About Organ &
Tissue DonationJanuary 9, 2007
by Barbara York, BA, OPC, EMTPThe Center for Donation & Transplant
Albany, New York
![Page 3: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/3.jpg)
Everyone has a personal story
![Page 4: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/4.jpg)
Center for Donation & Transplant
CDT is a Organ Procurement Organization (OPO)
5 OPO’s in New York
CDT service area (dark green)
46 Hospitals:6 in Vermont1 in Mass.39 in New York
![Page 5: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/5.jpg)
Trends in Organ Donation and Transplantation
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
1988 1990 1992 1994 1996 1998 2000 2002 2004
Transplant Recipients
Organ Donors
Patients on Waiting List
2005
![Page 6: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/6.jpg)
What Organs Can Be Transplanted
http://www.transplantliving.org/beforethetransplant/organfacts/default.aspx
Lungs
Heart & Heart Valves (Heart & Lung)
Kidneys (Kidney and Pancreas)
Liver
Pancreas (Kidney & Pancreas)
Intestine
![Page 7: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/7.jpg)
Factors Influencing the Potential Supply of Organs
Number of brain deaths annually: 20,000 - Only about 7,500 (38%) become organ donors- Estimated loss of transplantable organs: >56,000
Public willingness to donate:- 90% of people support organ and tissue donation- 56% likely to donate their own organs- 33% know the steps to take to ensure their wishes regarding donation are fulfilled
![Page 8: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/8.jpg)
Major Legislation
1968 Uniform Anatomical Gift Act.1978 Uniform Brain Death Act1980 Uniform Determination of Death Act1984 National Organ Transplant Act1986 Omnibus Budget Reconciliation Act 1996 Medicare/Medicaid Existing regulations
published May 2, 1996; Final rule, CMS-3064-F, published May 31, 2006
1998 Required Referral Law
![Page 9: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/9.jpg)
Required Referral
When the death of a person in a hospital has occurred or is imminent, the hospital shall contact the federally designated organ procurement organization in order to make a preliminary determination of the suitability of the person for organ donation.
![Page 10: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/10.jpg)
CMS: The Final Rule
In order for hospitals to participate in Medicare and Medicaid reimbursement, they must follow
the CMS Conditions of Participation. The Joint Commission for the Accreditation
of Healthcare Organizations (JCAHO) has adopted the provisions of the regulation
and these standards.
![Page 11: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/11.jpg)
Imminent Death
• Imminent death is a term that applies to patients who are on a ventilator and have had an insult or injury to the brain.
• When patients are on a ventilator and have a Glasgow Coma Scale of less than or equal to 5, or appear to have irreversible loss of brain function, death is considered to be imminent and CDT must be notified immediately.
• CDT must be notified before the patient is removed from the ventilator.
![Page 12: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/12.jpg)
People Die in Two Ways
Pre hospital BRAIN DEATH Head Trauma, CVA, asphyxia:
Patient has interrupted blood flow to the brain with no oxygen supply and cell death begins.
Pre hospital CARDIAC DEATH Patient has lethal cardiac
activity - no “pump” for oxygen supply and cell death begins.
The brain takes an anoxic hit, begins to swell and often leads to
brain death…… even if the cause of the
interruption of blood flow or oxygen is transient or cardiac
rhythm is restored.
![Page 13: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/13.jpg)
![Page 14: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/14.jpg)
The Storm
• Catecholimine Storm– Cushings Triad– Psuedo MI– Usually will progress in 24 – 48 hours
![Page 15: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/15.jpg)
Pathways to Donation
• Standard Path, Patient is Brain Dead– Declared brain dead but still with
cardiac function• Standard donor• Taken to OR• Never extubated• Aorta is cross clamped
![Page 16: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/16.jpg)
Clinical Criteria for Brain Death
• No response to external stimuli• No reflex activity except of spinal
cord origin• No pupillary response to light• No corneal reflex
![Page 17: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/17.jpg)
Clinical Criteria for Brain Death
• No gag reflex• No cough reflex• No eye movement with caloric
testing or doll’s eyes maneuver• Apnea in the presence of adequate
CO2 stimulation – Apnea Test
![Page 18: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/18.jpg)
Confirmatory Testing
EEG Cerebral Blood
Flow Studies– Nuclear Flow
Study– Cerebral
Angiography
![Page 19: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/19.jpg)
Pathways to Donation
• Donation After Cardiac Death (DCD) Path– NOT brain dead with cardiac function
• Extended criteria donor• They may have many of the clinical signs
that EMS has come to know as indicators of brain activity; pupils, cough, gag, etc.
• Remember, they are NOT brain dead
![Page 20: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/20.jpg)
Donation After Cardiac Death
• This is an option offered to families when all indications are that the patient has sustained fatal, non survivable injury and will remain in a vegetative state
• Taken to OR• Extubated and pray patient goes asystolic
very soon - within 60 minutes
![Page 21: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/21.jpg)
Donation After Cardiac Death
• Was original way donation occurred• Resurgence in popularity because of need
for organs for transplant• Organs have poor graft survival
rates due to increased anoxia hit to organs• Extubation & DCD is difficult to wrap your
arms around in hospital OR environment
![Page 22: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/22.jpg)
![Page 23: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/23.jpg)
Circling the Drain
• Bad things happen to good people• Bad things happen to bad people
You or I didn’t kill them…
![Page 24: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/24.jpg)
Chain of EMS
Or did we?
We are only as strong as our weakest link…
![Page 25: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/25.jpg)
EMS & Donor Connection
• Airway, airway, airway• Good BLS before ALS• Documentation. Do YOU leave it at
the hospital? Or do it at the end of the day?
Don’t answer that out loud!
![Page 26: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/26.jpg)
EMS & Donor Connection
• Just like you paint the picture for the ED, you are our eyes and ears on scene.
• Your documentation and description of any downtime and treatment is paramount to our ability to paint a picture of an organ donor to a transplant surgeon later.
![Page 27: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/27.jpg)
Which heart would you want your transplant surgeon to pick for you?
“18 YO F with unknown PMHX was found down at home yesterday by a family member with unknown downtime. EMS/ACLS was performed, but she never regained neuro status, CT showed ICH. This morning she deteriorated and was pronounced brain dead at 11:53.”
“18 YO F with a PMHX of PSVT was found slumped over on the couch unconscious by a family member after they came back into the living room from the bathroom. Per 911 she was breathing without a pulse. EMS was activated with a 3 min. response time. EMS found her in care of Father, chest compressions being done. No signs of drug or alcohol use on scene. Upon assessment, patient was found to be in SVT, breathing at 6 but pulseless and was transported to the ED with ACLS. #7 nasal ET confirmed by LS. – epigastric sounds and end tidal color change. Pt. converted to NSR with 12 mg. adenosine but had a GCS=3 upon arrival to the ED. She was PEARL and ocassionally clenching her mouth. CT showed ICH. This morning she deteriorated and was pronounced brain dead at 11:53.”
![Page 28: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/28.jpg)
Chain of Donation
• EMS gets the call and delivers patient to “definitive care.”• Attending MD. and neurology assesses patient• CDT is paged• Donor evaluation (often on site); serologies drawn• Family approached• Consent (hopefully)• Donor management by OPC that includes bedside
hemodynamic monitoring and node procurement for antigen matching if patient is a kidney donor
• Coordinate placement of organs and arrival of transplant teams
• Coordinate OR recovery, packaging of organs and transportation, delivery of organs to recipient transplant center
![Page 29: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/29.jpg)
The Operating Room
![Page 30: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/30.jpg)
Organ Hierarchy: Lungs & Heart First
![Page 31: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/31.jpg)
Small space, many hands
![Page 32: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/32.jpg)
Liver
![Page 33: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/33.jpg)
Kidneys
![Page 34: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/34.jpg)
Cardiac Allografts
• Aortic Valve• Pulmonary Valve
![Page 35: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/35.jpg)
Vascular Allografts
Saphenous Vein
Femoral Vein/Artery
Superficial Femoral Vein Valve
![Page 36: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/36.jpg)
Corneal Transplant
![Page 37: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/37.jpg)
Bone & Connective Tissues that CDT Recovers
• Humerus• Radius• Ulna• Ribs• Iliac Crest• Femur
• Tibia• Fibula• Tendons• Ligaments• Fascia Lata
![Page 38: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/38.jpg)
Uses for Bone and Tissue
• Skin for burn victims• Orthopedic surgery• Neurosurgery• Plastic surgery• Dentistry
![Page 39: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/39.jpg)
Center for Donation & Transplant
Q: Why isn’t there a policy or protocol for trauma/cardiac arrest and organ donation?
![Page 40: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/40.jpg)
Center for Donation & Transplant
A: Ethicists and the Department for Health and Human Services feel that the subject of organ donation should be addressed with families in a way that promotes consideration and consent, by trained personnel.
Interestingly, the myth that a hospital provider or EMS provider would be more likely NOT to provide life saving care in favor of creating an organ donor still exists in 2007.
![Page 41: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/41.jpg)
The Fast Track to Organ Donation
• Drive a motorcycle recklessly on a dark, gravel-filled back road
• Drive head on into a tree with or without your seat belt
• Dive from a tall bridge, play handgun roulette with your friends or
• Never visit your PCP and treat your HTN
![Page 42: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/42.jpg)
The Fast Track to Organ Donation
• Tell your loved ones what your wishes are
• Ask your loved ones what their wishes are
• Fill out a Health Care Proxy• Register when you renew your license • Go on the web to: • http://www.health.state.ny.us/nysdoh/donor/form.htm
![Page 43: Center For Donation & Transplant](https://reader035.vdocument.in/reader035/viewer/2022062309/56814e2d550346895dbb9295/html5/thumbnails/43.jpg)
Your Very Patient, Thanks!
Thank you for your time!
Barbara York, BA, OPC, EMTP
Center for Donation & Transplant
218 Great Oaks Blvd.
Albany, NY 12203
518-928-8387