powerpoint presentation alaiya's energy. he has her spunk now. it was emotional hearing her...
TRANSCRIPT
9/19/2018
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Dave Mattox, RN, CPTC
Manager, Family Services
Community Education
Donor Hospitals
TransplantCenters
Donor Families/Recipients
INDIANA TRANSPLANT CENTERS
Indiana University Health Transplant – Indianapolis
Heart | Lungs | Liver | Kidneys | Pancreas | Intestines
St. Vincent Transplant – Indianapolis
Heart | Kidneys | Pancreas
Lutheran Transplant – Fort Wayne
Heart | Kidneys
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The Transplant Wait List
• Approximately 123,000 people are awaiting transplants in the United States, of which approximately 1,400 are in Indiana
• Every 10 minutes someone is added to the waiting list
TODAY, 22 PEOPLE WILL DIE WAITING FOR A LIFESAVING
TRANSPLANT
Indiana Donor Choice LawUniform Anatomical Gift Act
• Over 70% of all Licensed Drivers in Indiana are donor designated (DD)
• Supports the right for an individual’s decision to become a donor
• DD status is verified by Indiana Donor Network via BMV/Registry Records
• DD is shared with hospital staff & family
• The donor’s decision is carried out
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Types of Donation
SAVE EIGHT LIVES AT ONE BEDSIDE
Chronic hepatitisLiver tumorsCirrhosis
HypertensionDiabetesPolycystic disease
COPDEmphysemaCystic fibrosis
Type 1 diabetes
Heart disease
- Congenital
- Coronary- Hypertensive
cardiomyopathy
Short-bowelsyndrome
Liver
Lungs
Kidneys
Heart
Intestine
Pancreas
BRAIN DEATH
• Defined as total & irreversible destruction of the brain & brainstem
• Occurs when an injury to the brain causes it to swell and fill the capacity of the skull, thus preventing blood flow to the brain
• Artificial support may maintain body function temporarily
BRAIN DEATH IS NOT A COMA
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Injuries That Can Lead To Brain Death
• Hemorrhagic/Ischemic Stroke, Aneurysm
• TBI caused by GSW or MVA
• Smoke inhalation
• Strangulation
• Cardiac Arrest with prolonged “downtime”
• Drug Overdose
• Any Anoxic Injury
BRAIN DEATH DECLARATION
Minimum requirements by Indiana Donor Network:
Declaration of brain death will be verified per hospital policy
• Clinical exam and apnea test
• Confirmatory testing (i.e. CBF, EEG, transcranial Doppler, etc.)• Hypothermic protocol• CNS depressants• Clinical exam or apnea not performed
Cerebral Brain Flow Study(these results indicate that there is no flow)
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Cerebral Arteriogram
Team Huddle
• Occurs with RN, physician, IN Donor Network FSC, Chaplain etc.
• Will take place prior to: EOL discussion, Brain Death testing/discussion of results, or donation discussion
• Supports best practices
Donation After Circulatory Death (DCD)
• DCD donors must have significant neuro injury but will not progress to brain death
• Family must 1st decide to withdraw care before we would approach for donation or they must initiate donation conversation
• Recovery of organs for transplantation from asystolic donor
• 90 minutes
• Prior to acceptance of brain death DCD is the way donation would happen
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ORCs Responsibilities
ICU
Donor Management
Collections of Typing Material
Documentation & Charting
Generate Organ Lists
Allocation of Organs
Logistics of Transportation
O.R.
Transport
Preservation Solution
Removal of Organs for Research
Removal of Tissue Specimens
Obtain Signatures & Organ Anatomy
Donor Management Goals
• Sodium <155
• Mean Arterial Pressure >60
• 1 or no pressors (excludes Vasopressin)
• pH 7.35 – 7.45
• CVP <10
• PaO2 > 300 or 3:1 ratio during O2 challenge
• Urine 1-2 ml/kg/hr
• Creatinine <2.0
Cardiac Evaluation
Echocardiogram & Cardiac Enzymes
• Electrolytes Normalized
• Adequate Volume Status
• Complete 2D with Doppler• Measurements
• Visualization Chambers and Valves
• Ejection Fraction %
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Abdominal Organ Evaluation
Labs• BMP - Q4 hours
• CMP
• LFTs
• Pancreatic Specific Markers
Imaging
Resources
• Standing Orders
• Management Protocols
• CMO – Transplant Nephrologist
• Medical Director – Transplant Pulmonologist
• Medical Director – Neurosurgeon
• Local Transplant Surgeons
• Hospital RN, RT, Physicians
Pulmonary Work Up
Imaging Chest X-ray
• Lung Measurements
Bronchoscopy
• Anatomy
• Clear Secretions or Foreign Matter
Chest CT
only when requested*
Arterial Blood Gases O2 Challenge
Gram Stain & Culture
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Donor Management
• IN Donor Network works collaboratively with nursing staff
and MDs
• Organ Recovery Coordinators will be on site for the entire process: working to optimize organ donation potential.
• Coordinate with transplant centers to place organs
Donor Management-Logistics
• Once all organs are placed ORC will confirm OR time
• Coordinate travel arrangements for transplant teams to arrive at hospital
• OR times can change for many reasons i.e. complications with recipients, weather.
• We will update nursing staff and family during entire process
TISSUE DONATION
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MORE THAN 1 MILLION TISSUE TRANSPLANTS ARE DONE
EACH YEAR*
*UNOS - 2015
LIVES HEALED BY HOOSIER TISSUE DONORS
January – December 2016
30,729
IMPACT OF DONATION
• In 2016, 33,598 organs were transplanted in the U.S. • 616 of those were in Indiana
• One organ and tissue donor can save and heal the lives of 75 or more people
• Most families say donation turns tragedy into hope
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"We were anxious to meet Mason in person. Just from photos and videos, he
has Alaiya's energy. He has her spunk now. It was emotional hearing her heart in someone else ... but we are grateful
that we have an opportunity to hear what made her so amazing."
“Through donation, we help recipients
and donors to live on. Recipients live on
through the selfless act of donors. Donors live on through a legacy made even stronger
as a result of their donation, and they
live on through others."