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All Hands On Deck!

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All Hands On Deck!. Objectives. Review indications for rapid organ recovery Identify resources needed Describe challenges and solutions. Why rapid recovery?. Family time constraints Critically unstable donor Hospital/Medical examiner requirements. Resources. Required:

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All Hands On Deck!

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  1. All Hands On Deck!

  2. Objectives • Review indications for rapid organ recovery • Identify resources needed • Describe challenges and solutions

  3. Why rapid recovery? • Family time constraints • Critically unstable donor • Hospital/Medical examiner requirements

  4. Resources • Required: • Authorization, UNOS ID, death, surgeon, OR • Useful: • Additional ORC • Hospital development support • Family services support • Supplies • Kidney pumps

  5. Process • Establish what’s possible • Hospital location and capabilities • Staff availability • Surgeon availability • Discuss with family • Call in the troops!

  6. Process—ORC • Draw blood • Serologies • HLA • Organ/tissue requirements • Medical examiner requirements • Send labs • CMP, UA, PT/PTT, CBC, cultures • Donor assessment • Photos? • OME clearance

  7. Process—DFA • Authorization • MSHQ • Family support • Planning for withdrawal process

  8. Process—HDC • Notify hospital administration • Notify OR • Identify & coordinate declaring physician

  9. Process—AOC • Assist • Remind • Respond?

  10. Our case • 52/M/C s/p MVC into canal, 7 minutes in water, +CPR • Referred ~2 hours after admission • On HD#2, family decided to withdraw, asked about donation • Patient was requiring 3 pressors and boluses, MAP ~40 • CBF showed flow • 3 other donor cases in progress

  11. Action • ORC and DFA responded, established plan with ICU staff • ORC called for reinforcements • Additional ORC, ORT, HDC • Authorization at 1530 • To OR at 1730 • Kidneys recovered, pumped and transplanted

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