5 Things Physicians Should Know About Organ & Tissue Donation

5 Things Physicians Should Know About Organ & Tissue Donation
1. When should patients be referred to NJ Sharing Network?
Tissue Referral: Every death should be referred for potential tissue donation. One tissue donor can restore health through bone, skin, corneas and heart valves to over 50 people.
Organ Referral: Any vented patient with a non-survivable neurological injury or prior to palliative extubation should be referred for organ donation. One organ donor can save the lives of up to 8 others.
2. Why is it important that only NJ Sharing Network staff initiate the donation discussion?

• NJ Sharing Network’s specially trained staff will determine medical suitability prior to donation discussion. • Perceived conflict of interest: It is important that there is a separation between the healthcare team caring

for the patient and NJ Sharing Network who is there to offer donation options.
• NJ Sharing Network will notify the family if the patient has already designated their legally binding wishes

through the state registry.

3. What is my role as a physician in the donation process?

• Communicate frequently with NJ Sharing Network staff onsite.
  
• Ensure that declaration of neurological death is done in accordance with NJ State law and hospital policy.
  
• Maintain organ viability to optimize the number of life-saving gifts.
  
• Allow for a separation between grave prognosis and NJ Sharing Network’s initiation of the donation conversation.
  4. How are organs recovered?
  Donation after Neurological Death: After pronouncement of neurological death (please reference hospital policy) patients are maintained on a ventilator while potential recipients are identified.
  Donation after Cardiac Death (DCD): After a family has chosen palliative extubation and consent has been obtained, withdrawal typically occurs in the operating room. If the patient passes within 90 minutes, vital organs can be recovered for transplant.
  5. What are the benefits for families that donate?
  Comfort in knowing their loved one lives on • Opportunity to meet the recipients • Grief Counseling • Memorial Flag Raising Ceremonies • Participation in NJ Sharing Network’s Annual 5K Celebration of Life
  www.NJSharingNetwork.org • 1-800-541-0075 Information provided reflects federal and state regulations
  

Facilitating the Gift of Life
Saving lives through donation and transplantation

Optimizing Organ Function Brain Death Determination (per NJ State Law)

MAP
CVP
EF
PH
P/F Ration Sodium
Glucose
Urine Output
# of Vasopressors

> 65 mm Hg Prerequisites:
5-10 mmHg • Coma, irreversible and cause unknown > 55 % • Neuroimaging explains coma
7.35 - 7.45 • CNS depressant drug effect absent
> 300 (if barbiturates given, serum level <10 mg="" ml="" span="">135-145 mEq/L • No evidence of residual paralytics
80-150 mg/dL • Absence of severe acid base, electrolyte, endocrine 0.5-3cc/kg/hr abnormality
1 pressor or less • Normothermia (core temperature >36 ° C) • Systolic blood pressure > 100 mm Hg

Examination:
• Pupils nonreactive to light
• Corneal reflex absent
• Oculocephalic reflex absent (doll’s eyes)
• Oculovestibular reflex absent (cold calorics)
• No spontaneous respirations
• Gag reflex absent
• Cough reflex absent to tracheal suctioning
• Absence of motor response to supraorbital pressure
(spinal reflexes may be present)
• One exam with an apnea test can be completed in conjunction
with a confirmatory test, blood flow study preferred.
• The apnea test must start with a normalized PCO2. The terminal PCO2
must be >60 and/or a rise in 20 over the initial PCO2.

source http://www.njsharingnetwork.org/file/Physicians-Should-Know_Facilitating-The-Gift.pdf