Donation After Circulatory Death

Step-by-Step Process

Step 1:

CRITICAL CARE UNIT

  • Patient suffers a non-survivable brain injury

  • The Legal Next of Kin (LNOK) and medical staff begin discussions of comfort care and removal of medical support

FAMILY SUPPORT

  • LOPA staff offers LNOK support and the opportunity for organ donation

  • Authorization is obtained and the patient’s neurological functions are assessed

EVALUATION PROCESS

  • LOPA staff performs a neurological assessment to determine if the patient will become pulseless less than 2 hours following the removal of ventilator and IV fluid

  • A formal assessment tool may be used to assist in this determination

FAMILY SUPPORT

  • Results of the neurological assessment are relayed back to the LNOK and medical staff

  • The donation process begins

Step 2:

CRITICAL CARE UNIT

  • The patient remains within the care of the current medical staff throughout the process

  • Lab tests and procedures will be requested (performed?) to evaluate organ function for donation

FAMILY SUPPORT

  • LOPA staff continues to offer support to the family throughout the process

  • Support is also provided to medical staff with ongoing updates and timeframes of the recovery process

Step 3:

RECOVERY PROCESS

  • The normal critical care process of terminal wean is conducted within or near the surgical department

  • Prior to the removal of the ventilator, the patient is prepped for the surgical procedure and a timeout takes place to discuss the process with the hospital staff

  • No LOPA or transplant center team member is involved in the terminal wean process. These team members remain outside of the surgical suite until declaration of death is made.

  • Comfort care medications are given at the discretion of the patient’s physician and must be consistent with hospital guidelines

  • Cessation of circulatory function must occur within a 2-hour time frame for organ donation to proceed. Prior to the surgical procedure, the recovery team must wait an additional 2-5 minutes before entering the room and beginning the procedure

  • Should cessation of circulatory function not occur within this time frame, the patient is transferred back to a non-surgical area to continue the comfort care/terminal wean process

FAMILY SUPPORT

  • LOPA staff continues to offer support to the family throughout the process

  • Support is also provided to medical staff with ongoing updates and timeframes of the recovery process

Step 4:

AFTERCARE

  • Family services contact LNOK within the first few weeks to offer additional support and other valuable resources

  • The designated hospital Donation Services Coordinator provides post-case follow up to medical team members involved in the donation process