Donation After Brain Death vs - Home | UW Health



Donation After Brain Death vs. Donation After Cardiac Death | |

| |Donation After Brain Death (DBD) |Donation After Cardiac Death (DCD) |

|Injury |Severe brain injury from trauma, cerebral vascular accident, anoxic event, other – REFERRAL |Severe brain injury from trauma, cerebral vascular accident, anoxic event, other - |

| |TO OPO |REFERRAL TO OPO |

|Meets Criteria for Brain |Yes – |No – |

|Death |Clinical Exam (including apnea test) is consistent with Brain Death. If unable to fully |some neurological reflex is still present |

| |complete any part of the clinical exam, a confirmatory test is required (ie: Nuclear Flow | |

| |Scan). | |

|Prognosis |Brain death – this is the Legal Time of Death |Hospital physician determines patient has no chance of recovery; cannot survive |

| | |without mechanical ventilator. |

|Action |Brain death declaration is made by Hospital Physician (not OPO). |Family/NOK elects to withdraw support |

| |Signed brain death note and consent form are faxed to OPO. |Donation discussion with family – they consent. |

| |Once BD is declared, OPO and Hospital work cooperatively on medical management of the donor |Physician futility note, family signed WI consent and hospital surgical consent faxed |

| |patient. Orders come from OPO. |to OPO |

| |Patient remains on ventilator throughout organ recovery. |OPO/Hospital work on management of the donor pt. Orders signed by hospital physician |

| |Anesthesiology is present for intra-operative fluid and BP management |(no death declaration yet, so OPO offers guidelines, but can’t sign). |

| |Transplant team spends 3-4 hours recovering organs |Withdrawal of support can take place in OR or ICU |

| | |RT with a portable vent is used for OR w/d |

| | |ICU nurse to OR to administer meds for w/d and assist family if they choose to come to|

| | |OR |

| | |Cardiac Death |

| | |No BP, pulse, cardiac sounds or respirations |

| | |Family leaves /recovery team waits 5 minutes to ensure no auto-resuscitation. |

| | |After 5 minutes of ceased circulation, Hospital Physician (not OPO) declares death. |

| | |Transplant team begins rapid recovery; takes 1-2 hours |

|Possible Organs |Heart, lungs, liver, pancreas, kidneys, and intestine |Lungs, liver, pancreas, and kidneys |

|Key Points |The time of brain death is legal time of death |DCD is only discussed with families after decision to withdraw care has been made |

| |Brain death is not a coma, it’s irreversible – brain cells do not recover |Rapid recovery of organs |

| |Organs dissected in-situ |If patient does not expire within 2 hours, organ donation is no longer possible, and |

| |Maintained on ventilator throughout the organ recovery |the patient is returned to the unit. He/she is not re-intubated. RN to call with |

| | |CTOD to page Tissue/Eye agencies. |

| | |

|Make the Golden Hour Call |[pic] |

|UW Health - Organ Procurement Organization | |

|1-866-UWHC OPO |Time from recovery to transplantation: |

|1-866-894-2676 | |

|[pic] |Heart: 4-6 hours |

|Refer all deaths and imminent deaths regardless of age or diagnosis within one hour |Lungs: 4-6 hours |

| |Liver: 12 hours |

|Clinical triggers to call : |Pancreas: 12-18 hours |

| |Kidneys: up to 48 hours |

|A mechanically ventilated patient with a severe neurologic injury or insult and one of the following: |Small Intestines: 4-6 hours |

| |Tissues: up to 5 years |

|A patient whom a physician is evaluating for brain death |Corneas: up to 7 days |

|OR |________________________________ |

|A patient with a Glasgow Coma Score (GCS) of 5 or Less | |

|OR |[pic] |

|A plan to discuss withdrawal of life sustaining therapies | |

| | |

|Timely notification is defined as referral to the OPO within one (1) hour of patient meeting the | |

|criteria for clinical triggers as defined above. | |

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[pic]

IT’S NEVER TOO EARLY TO CALL

CLINICAL TRIGGERS

A mechanically ventilated patient with a severe brain injury-

*For whom a MD is evaluating for brain death OR

*A patient with a GCS of 5 or less OR

*For whom a physician has ordered that life-sustaining therapies be withdrawn

NOTIFY UWHC OPO @ 1-866-894-2676

[pic]

IT’S NEVER TOO EARLY TO CALL

CLINICAL TRIGGERS

A mechanically ventilated patient with a severe brain injury-

*For whom a MD is evaluating for brain death OR

*A patient with a GCS of 5 or less OR

*For whom a physician has ordered that life-sustaining therapies be withdrawn

NOTIFY UWHC OPO @ 1-866-894-2676

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