6/13/18. Objectives. Who is the NJ Sharing Network?

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1 The Gift of Life: Organ and Tissue Donation Amanda Trabilsy Hospital Services Manager Objectives Understand what an Organ Procurement Organization (OPO) is and how they are involved with donation Recognize the role of respiratory therapists in the donation process Understand the importance of donor lung management 2 Who is the NJ Sharing Network? 3 1

2 Our Mission: To Save and Enhance Lives 5 Regulatory Agencies CMS Department of Health The Joint Commission 6 2

3 Hospital Conditions of Participation Organ donation: all imminent deaths are referred within 1 hour Tissue donation: all deaths are referred within 1 hour NJ Sharing Network must determine medical suitability Any approach must be done by NJ Sharing Network staff Every family must be offered the opportunity to donate. 7 Tissue Donation: Sight, Mobility & Healing Tissue Donation can impact the lives of 50+ recipients Why Donation Matters 9 3

4 The Rare Opportunity for Organ Donation 1% One Organ Donor Can Save 8 Lives Christopher Kidney Recipient James Kidney/Pancreas Recipient Aliyah Heart Recipient Denise Double-lung recipient Anthony Liver Recipient Kelly Heart Recipient Mike Kidney Recipient Jim Liver Recipient Organ Referral Process Severe neurological injury Ventilator Dependent GCS of 5 or less Loss of 2+ Cranial Nerve Reflexes Family discussion of End of Life Options Please call within 1 hour regardless of age or diagnosis 4

5 Two Pathways to Organ Donation Donation after Brain Death Donation after Cardiac Death 13 Maximizing the Gift Working together to maintain: Optimal Organ Function Hemodynamic Stability Adequate Oxygenation Key Management Parameters: CVP 5-10 Urine output ml/kg/hr SBP > 100 & MAP > 65 Sodium < 155 Glucose < 140 ph O2 Sats > 95 % Goals Stabilize potential donor Manage the potential donor Address multiple complex clinical issues simultaneously Collaboration amongst hospital, OPO and transplant Center Maximize availability of transplantable organs 5

6 Donation is a Conversation - Not a Question Per hospital policy NJ Sharing Network is the Designated Requestor and must initiate donation discussion. 16 United Network for Organ Sharing (UNOS) Allocation Using 3 Main Criteria: ABO / Size Compatibility / Tissue Typing Degree of Medical Urgency Waiting Time History of Lung Transplants 1940 s - First lung transplants in animals First human lung transplant in Mississippi First successful double lung transplant 6

7 Why the Shortage of Lung Donors? Only 15-25% of lungs are recovered from donors Trauma Resuscitation maneuvers Neurogenic Edema Aspiration Ventilator Associated Trauma Pneumonia Donor Lung Management Strategies CT scan chest, abdomen, pelvis CXR ETT hyperinflation reduces aspiration and protects lungs Sputum culture and gram stain ABG s every 4 to 6 hours Zosyn every 6 hours Bronchoscopy O 2 Challenge 100% FiO2 with PEEP of 5cm for 30 minutes then obtain ABG (Association of Organ Procurement Organizations, AOPO) RT s Role in Organ Donation Donation after Brain Death Donor Donation after Circulatory Death Pulmonary Management Patient Transport Hand off to Anesthesia Pulmonary Management Patient Transport Assist in terminal extubation (depending on hospital policy) 21 7

8 Recovery: Organ & Tissue Donation Utilize Hospital Operating Room Moment of Silence Surgical recovery & reconstruction Medical Examiner/Funeral Home 22 Flag Raising Ceremony Family Support & Follow Up Next Day Call Wrapped In Love Annual Remembrance Donor Family & Recipient Correspondence Connecting Families Quilts of Love 8

9 25 26 Join Our Mission to Save & Enhance Lives! Register to be a donor & share your decision with your family Spread the message that donation saves lives Get Involved: Like Us! On Facebook at NJ Sharing Network, Follow Us! On or become a Volunteer! 9