ORGAN DONATION in the ED

Presented by:Robert D. Kerns, NREMT-P, CPTCAdvanced Practice CoordinatorUWHC In-House CoordinatorUWHC Organ Procurement Organization

Lee Faucher, MDDirector of Trauma ServicesUWHC

OBJECTIVES

Identify potential emergent and/or uncontrolled DCD candidates Define Uncontrolled DCD Define the process of successful Uncontrolled DCD Identify the resources needed to support an Uncontrolled DCD

candidate Identify the staff needed for a successful Uncontrolled DCD Demonstrate that the care received in the ER directly impacts

Donation even if the patient makes admission to the ICU Identify barriers to Uncontrolled DCD in the ER Identify strategies to overcome barriers to Uncontrolled DCD Identify key members of hospital staff that can champion

Uncontrolled DCD Define communication strategies for hospital staff that will

facilitate the Uncontrolled DCD process Define communication strategies that will support families

when presenting the option of Uncontrolled DCD

OBJECTIVES

Identify potential emergent and/or uncontrolled DCD candidates Define Uncontrolled DCD Define the process of successful Uncontrolled DCD Identify the resources needed to support an Uncontrolled DCD

candidate Identify the staff needed for a successful Uncontrolled DCD Demonstrate that the care received in the ER directly impacts

Donation even if the patient makes admission to the ICU Identify barriers to Uncontrolled DCD in the ER Identify strategies to overcome barriers to Uncontrolled DCD Identify key members of hospital staff that can champion

Uncontrolled DCD Define communication strategies for hospital staff that will

facilitate the Uncontrolled DCD process Define communication strategies that will support families

when presenting the option of Uncontrolled DCD

CASE 1

0209: Patient arrived at ED ~20 Year old male in high speed MVC Long extrication w/ deaths on scene ETT upon arrival Patient had severe closed head injury Left femoral head dislocation

0345: Patient to OR for Craniotomy Patient has bilat SDH Left > Right Hematoma evacuated spontaneously Bone flap left out and closed

CASE 1

0601: Admitted to TLC CVP placed Patient began bleeding profusely from

all open areas ICP remained elevated Patient maxed on Epi, Norepi, and Neo Requiring continuous FFP and PRBC’s

CASE 1

0802: Family Discussion Family decides to WLS Family agrees to Organ Donation OPO Activated

CASE 1

0830: OPO arrived on TLC Received report from Attending MD Met with patient’s parents

CASE 1

0845: Activated OPO recovery team to UW Scheduled OR for 0930 0900: Written consents completed Serology blood drawn Family services arrives at TLC

CASE 1

0930: OPO recovery team in TLC 0945: Patient to OR with TLC Attending 1030: Extubation 1051: CTOD 1057: Organ recovery begun

CASE 1

Kidneys recovered for transplant– 2 patients are transplanted

Eye and tissue recovered– 2 patients’ sight restored– 100’s of patients benefited from tissue

transplants

CASE 1 - Outcome

0802: OPO activated 0830: OPO arrives in TLC 0845: OPO recovery team activated & OR set 0900: Written consent completed 0930: OPO recovery team arrives 0945: Patient to OR 1030: Extubation

CASE 1 – Emergent DCD

Emergent DCD

Can this happen at your hospital?

YES!!

CASE 2

0942: Patient arrives at ED ~ 10 year old male w/ GSW to head Patient in full arrest & ETT upon arrival to ED Patient stabilized in ED and then to CT Head CT shows non survivable injury No NOK available yet Pt to be supported and admitted to PICU

1007: OPO activated from ED 1032: Patient arrives in PICU 1035: OPO arrives in PICU Patient is being supported NO NOK yet Police in PICU attempting to locate NOK ME notified and clears case for donation

CASE 2

1037: Activated OPO recovery team Reserved OR for emergency DCD Pt stabilized on pressors and albumin No NOK yet

CASE 2

1101: OPO recovery team onsite OR suite ready Serology blood drawn No NOK yet

CASE 2

1137: Patient’s mother on phone w/ PICU 1140: Mother decides to WLS & consents for DCD

Mother is over an hour away 1141: Patient is moved to OR w/ PICU staff

and Police 1142: CPR begun 1147: arrive in OR 1201: Extubation & CPR stopped 1206: CTOD 1208: Organ recovery begun

CASE 2

Kidneys recovered for transplant– 2 patients are transplanted

Eye and tissue recovered– 2 patients’ sight is restored– 100’s of patients benefited from tissue

transplants

CASE 2 - Outcome

1007: OPO activated from ED 1035: OPO arrives in PICU 1037: Recovery team activated & OR set 1101: Recovery team onsite 1140: Consent obtained for DCD 1141: Patient to OR and CPR begun 1201: Extubation

CASE 2 – Uncontrolled DCD

Uncontrolled DCD

Can this happen at your hospital?

YES!?!?

ORGAN DONATION in the ED

Lee Faucher, MD

Director of Trauma Services UWHC

Disclosure

Started my medical career as an EMT in East-Central Wisconsin

Worked as a Surgical Technician at the UW while in college– Member of the transplant team

Faculty member of the Division of General Surgery since 2004– Director of Trauma since 2006

CASE 3

22 year old male involved in a motor vehicle crash.– Unconscious– Intubated for airway control and diminished

mental status– Blood pressure and pulse present and stable– Obvious external injury to head, without

other signs of trauma

CASE 3

Social worker has contact information for mother about two hours away.

Mother said she wanted him to be a donor if nothing else could be done.

DISCUSSION

UNCONTROLLED DCD EMERGENT DCD

THANK YOU!!