ORGAN DONATION in the ED Presented by: Robert D. Kerns, NREMT-P, CPTC Advanced Practice Coordinator UWHC In-House Coordinator UWHC Organ Procurement Organization Lee Faucher, MD Director of Trauma Services UWHC
OBJECTIVES u u u 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
OBJECTIVES u u u 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
CASE 1 u 0209: Patient arrived at ED u ~20 Year old male in high speed MVC u Long extrication w/ deaths on scene u ETT upon arrival u Patient had severe closed head injury
CASE 1 u 0345: u Patient to OR for Craniotomy u Patient has bilat SDH Left > Right u Hematoma evacuated spontaneously u Bone flap left out and closed
CASE 1 u 0601: Admitted to TLC u CVP placed u Patient began bleeding profusely from all open areas u ICP remained elevated u Patient maxed on Epi, Norepi, and Neo u Requiring continuous FFP and PRBC’s
CASE 1 u 0802: Family Discussion u Family decides to WLS u Family agrees to Organ Donation u OPO Activated
CASE 1 u 0830: OPO arrived on TLC u Received report from Attending MD u Met with patient’s parents
CASE 1 u 0845: u Activated OPO recovery team to UW u Scheduled OR for 0930 u 0900: u Written consents completed u Serology blood drawn u Family services arrives at TLC
CASE 1 u 0930: OPO recovery team in TLC u 0945: Patient to OR with TLC Attending u 1030: Extubation u 1051: CTOD u 1057: Organ recovery begun
CASE 1 - Outcome u Kidneys recovered for transplant – 2 patients are transplanted u Eye and tissue recovered – 2 patients’ sight restored – 100’s of patients benefited from tissue transplants
CASE 1 – Emergent DCD 0802: OPO activated u 0830: OPO arrives in TLC u 0845: OPO recovery team activated & OR set u 0900: Written consent completed u 0930: OPO recovery team arrives u 0945: Patient to OR u 1030: Extubation u
Emergent DCD u Can this happen at your hospital? YES!!
CASE 2 0942: Patient arrives at ED u ~ 10 year old male w/ GSW to head u Patient in full arrest & ETT upon arrival to ED u Patient stabilized in ED and then to CT u Head CT shows non survivable injury u No NOK available yet u Pt to be supported and admitted to u
CASE 2 1007: OPO activated from ED u 1032: Patient arrives in PICU u 1035: OPO arrives in PICU u Patient is being supported u NO NOK yet u Police in PICU attempting to locate NOK u ME notified and clears case for donation u
CASE 2 u 1037: u Activated OPO recovery team u Reserved OR for emergency DCD u Pt stabilized on pressors and albumin u No NOK yet
CASE 2 u 1101: u OPO recovery team onsite u OR suite ready u Serology blood drawn u No NOK yet
CASE 2 u u 1137: Patient’s mother on phone w/ PICU 1140: Mother decides to WLS & consents for DCD Mother is over an hour away u u u 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 - Outcome u Kidneys recovered for transplant – 2 patients are transplanted u Eye and tissue recovered – 2 patients’ sight is restored – 100’s of patients benefited from tissue transplants
CASE 2 – Uncontrolled DCD 1007: OPO activated from ED u 1035: OPO arrives in PICU u 1037: Recovery team activated & OR set u 1101: Recovery team onsite u 1140: Consent obtained for DCD u 1141: Patient to OR and CPR begun u 1201: Extubation u
Uncontrolled DCD u Can this happen at your hospital? YES!? !?
ORGAN DONATION in the ED Lee Faucher, MD Director of Trauma Services UWHC
Disclosure u Started my medical career as an EMT in East-Central Wisconsin u Worked as a Surgical Technician at the UW while in college – Member of the transplant team u Faculty member of the Division of General Surgery since 2004 – Director of Trauma since 2006
CASE 3 u 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 u Social worker has contact information for mother about two hours away. u Mother said she wanted him to be a donor if nothing else could be done.
DISCUSSION u UNCONTROLLED u EMERGENT DCD
THANK YOU!!
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