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Non-Heart Beating Organ Donation

  1. Discuss the patient's prognosis with the health care team and identify whether the patient has a grave prognosis.
  2. Collaborate with the physician when he or she discusses the patient's prognosis with the family.
  3. Contact the OPO coordinator to determine whether the patient is eligible for organ donation.
  4. If it is determined that the patient is not a suitable candidate for organ donation, complete and place the OPO referral form on the patient's chart.
  5. If, after initial consultation between the OPO coordinator and the health care team, it is determined that the patient might be an appropriate donor, the donation process will commence.
  6. If the patient is a possible candidate for donation, coordinate a meeting between the family, designated requestor, and/or OPO coordinator.
  7. If there is an appropriate designation by the patient indicating a desire not to be an organ donor, or the same stated in a valid advance directive or by an appropriate surrogate decision maker, further approaches for donation should not be made.
  8. The OPO coordinator discusses the option of organ donation with the patient's family.
  9. If the decision is made by the family to consider organ donation, the OPO coordinator coordinates the process with the health care team.
  10. Allow the family to spend as much time as they desire with the patient prior to discontinuation of life-sustaining therapy.
  11. Administer medications as needed to promote the patient's comfort (e.g., manage pain, dyspnea, and anxiety).
  12. Determine the approximate time that the patient will be taken to the OR.
  13. Determine the roles of various personnel when the patient is taken to the OR:
    * a.  OPO coordinator
    * b.  Anesthesiologist
    * c.  Critical care nurse
    * d.  OR nurse
    * e.  Physician
    * f.  Respiratory therapist
    * g.  Family support (e.g., clergy, grief counselor)
  1. Determine in advance who will withdraw life-sustaining therapy.
  2. Determine the family's preference for being physically present or absent during the process of withdrawing life-sustaining therapy (e.g., mechanical ventilation).
  3. Transport the patient to the OR.
  4. When the patient arrives in the OR, the patient may be prepped and draped by the organ recovery team. This team then leaves the room. In some cases, the draping is done after death has been declared.
  5. When the entire health care team and family are ready, life-sustaining therapy will be withdrawn.
  6. If ventilatory and hemodynamic support have been discontinued, there must be an interval of at least 5 minutes of cessation of circulatory function (evidenced by ECG and blood pressure monitoring via an arterial catheter) before death is pronounced and the organ removal process begins.
  7. After discontinuation of life-sustaining therapy, but prior to the 5-minute interval, a femoral cannula may be inserted if prior consent has been obtained from the individual consenting for organ donation.
  8. If the patient continues to breathe or has a pulse and blood pressure for more than 30 minutes after the discontinuation of ventilatory and hemodynamic support, the donation is canceled; assist in transfer of the patient back to the original room.
  9. The patient's attending physician should be present and should pronounce death when it occurs.
  10. Provide family support.