Nursing Management of the
Potential Organ and Tissue
Donor
Susan Ulit, RN, BS, MSN, CNRN
Clinical Nurse Specialist
Dina Elias, RN,BSN,CCRN
Clinical Nurse Educator
Objectives
• Understand the role of the critical care nurse in the
referral of potential organ donor patients
• Recognize the importance of the critical care nurse
in partnering with OPO representatives
• Describe in brief the pathophysiology of brain death
and the management goals for the organ donor
patient
• Understand the role of the critical care nurse as a
patient and family advocate during the transition
phase of organ donation
• Understand the importance of collaboration of
healthcare team members in referral and conversion
rates and outcomes
Referring the Potential Donor
• Identify the potential donor in your unit
• Be familiar with the hospital’s criteria for
clinical triggers
• Refer the potential donor to the OPO
promptly
• Understand the great influence the
CCRN has on the process
Clinical Triggers
Partnering with your OPO
• Introduce self to the OPO coordinator
assigned to the referral
• Encourage collaboration with the OPO
member, as they are now an integral
member of the health care team
• LCSW, Pastoral care, physicians, nursing team
• Ask your OPO member to share
information and resources
• T-4
• Articles in support of donor management
Educate Yourself / Team
• Policy and Procedures
• Become knowledgeable about the different
types of donation
• Donation after Cardiac Death vs. Brain Death
• Become well-informed about organ donation
and the pathophysiological effects of brain
death
• Patient management goals
• Realizing the positive impact organ donation
brings to all those involved – the “U-turn”
Pathophysiology of
Brain Death
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Elevated ICP
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Profound catecholamine response
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Sustaining CPP
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Increases afterload
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LV ischemia/ Myocardial necrosis
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Decreased LVF
Pathophysiology of
Brain Death
• Herniation of the brain stem
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• Ischemia (sympathetic denervation)
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• Profound vasodilation
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Brain Death =  cardiac function + vasodilation
Management goals
What are the goals?
•Organ Perfusion
•Organ Oxygenation
When does it start?
Immediately!
Management Goals
• Obtain accurate height and weight if not
already done (admission)
• Line em up!!
• Temperature measurement
• No tympanic temps (will be inaccurate)
• Initial Labs:
• CMP
• CBC
• UA
• Coags
• Type and cross
Management Goals
• Timely hemodynamic management
• Cornerstone of successful donor management
• Management includes:
• Ensuring adequate intravascular volume
• Maintaining appropriate CO with possible use of
vasoactive drips
• Initiating T-4 protocol as appropriate
• Early recognition and treatment of DI, SIADH,
HHNS
• Tight glycemic control
• Coagulopathy correction
Management Goals
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SBP 90-110 mmHg
U/O 1-3 cc/kg
HR 60-140
PAWP 7-12 mmHg
Serum electrolytes WNL
CBC and coags WNL
SPO2 >95%
PaO2 90-110
pH 7.35-7.5
PCO2 25-45
PF ratio >300
NORMAL PARAMETERS!!
Making The “U-Turn”
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When a patient dies, despite best efforts, organ donation becomes a
positive outcome to a tragic situation.
• Hope for Recovery… can become… Hope Through Donation
Patient and Family Advocate
• Gate keeper
• Honor your patients’ and families’
wishes
• Uphold a family’s right to be offered the
opportunity of organ donation
• Do not take that opportunity away by making
that decision for them
• All health care team members
• Leave your personal opinions to yourself
Patient and Family Advocate
• Promote compassionate communication
• Promote collaboration
• Be the bridge that links the health care team to
patients and their families
• Avoid conflict of interest
• DO NOT mention organ donation
• What is the message we are sending?
• What if the family asks about donation?
Transition
• Brain Death pronouncement
• Communicate early and often with the
family
• Facilitate communication between
physicians and the family
• Re-iterate prognosis given by physician to
ensure understanding
• Second Brain Death note is official TOD
Team Huddle
•Team huddle occurs before
discussion of pronouncement with
family
•Team huddle members include:
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OneLegacy
Physician
Bedside RN
LCSW’s
Pastoral Care
Transition
•Brain death discussion
•Patient is DEAD (don’t equivocate)
•Transition & decoupling
•How to respond to “What’s Next?”
•“A specialist will talk with you about the next
steps…”
•How to introduce OneLegacy
•“A member of our healthcare team…”
•Donation conversation (OneLegacy)
E.O.L. Family Discussion
PHASE 1
• MD informs family of grave prognosis
DO NOT MENTION DONATION TO FAMILIES
“I will get a dedicated family specialist to speak with you”
Family must be given time alone to process
this new information
National HRSA Collaborative Best Practices
CMS / Joint Commission Mandate 42. CFR 482.45
HUCLA Policy 316, Data accessed Nov. 24, 2009
PHASE 2
Family is presented with donation options
by trained designated requestor only!
Collaboration = Higher Consent Rate
• Organ donation consent rate highest when hospital
staff and OPO approach together
Source: “Improving the Request Process to Increase Family Consent for Organ Donation”;
Gortmaker, et.al. (Journal of Transplant Coordination 1998; 8:210-217)
Summary
• Educate!
• Advocate!
• Collaborate!
• What you say and do can make the
difference between a yes and a no.