what is the hospital nurses role in organ donation?

  1. I am having a hard time looking for resources that gives a description of what a hospital nurse does in the organ donation process from A to Z.

    For example, the patient is admitted to the ER or whatever floor they may be on, and is in critical condition. they are sent up to ICU for further care and monitoring.

    Once that patient is there, what are the next steps? Assessing, monitoring vitals, labs .. what exactly are the typical policy and procedures when a patient is admitted in critical condition? (I know it varies per facility, but just a general description helps).

    what does the critical care need to assess and monitor for to possibly consider this patient not going to live, brain dead? what exact labs are to be drawn for and monitored? what are the criterias and list that the nurse has to check to see if this patient is a potentially brain dead AND a organ donor? what is the criteria called? I have heard of it but can't remember it. something called "clinical trigger"?

    once the nurse says hey, this patient meets the criteria of brain death and organ donation .. what happens after this? what is the nurse to do? contact their OPO?

    from there, what does the OPO have the hospital nurse do?

    I am having trouble finding sources that list these things, just in chronological order. I found an online powerpoint that lists it but it is from 2009 and I don't know if I can even use that as a reference in my presentation. all of the other sites I've come across, does not have what I need, or they're blogs

    the powerpoint I found, I really liked because it gives me a general description of what exactly is to be done in order and how it needs to be done, etc. it doesn't list references but it does list the presenters' names.

    if any of you can help find something for me, thank you so much! I was told to contact a local OPO and ask these questions but someone else told me that they would only know what THEIR nurse is to do, not a hospital nurse. idk!! Im stressing over this
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  2. 9 Comments

  3. by   PeakRN
    Whenever a health care team member suspects that a patient will be an organ donation candidate they should contact their organ procurement organization immediately. Different organizations will have varying criteria on when they will come out, and some will have nurse ambassadors at hospitals who only talk to families, but they would far prefer an early heads up on a patient who doesn't meet criteria than being notified after a patient dies. You should reach out to your regional OPO for their specific criteria.

    Patients who are brain dead generally will have poor function of their basic life functions and are typically in a Trauma or Neuro ICU. They are often on pressors and intubated. Care would not be any different for these patients before they are declared brain dead. No patient is to be treated differently before declaration of legal brain death. Care is based on their presentation so it isn't really possible to give a routine answer but expect continuous pulse ox, rhythm strips, and other vitals hourly at a bare minimum. Assessments are generally every 4 hours or with condition changes. Hourly UOPs, et cetera. Labs really depend on patient presentation, but generally speaking a CBC and CMP are the absolute bare minimum.

    Once the patient is declared brain dead the OPO will send out a RN who takes over patient care. They have a set of protocols and a Doc on call to determine care. The hospital should not be giving care once the OPO takes custody of the patient. Depending on the OPO they will determine how they want to monitor the patient, but generally the RN will place a central line, arterial line, and use some form of machine or calculation to determine vascular resistance. They try to minimize pressor use to lower vascular resistance and adjust vent settings to optimize lung function. The ultimate goal for the OPO RN at this point to make the organs as viable for transplant as possible.

    Surgery either can occur on site or at another facility, but is performed by a team of specialized procurement surgeons. During this time there are countless personnel working behind the scenes to figure out which organs are viable and who is going to receive them. Surgery has to be set up for the transplant for the receiving patient, who needs to have all of their preoperative testing performed and be prepared for surgery as quickly as possible.

    You should reach out to your OPO. They are always more than happy to give education, and while they cannot tell you what your facility policy will be they absolutely can tell you what their expectations of the primary nurse are. Patients and families who donate their organs are giving an incredible gift, and everyone involved in transplant medicine understands that.
  4. by   xmilkncookiesx
    Quote from PeakRN
    Whenever a health care team member suspects that a patient will be an organ donation candidate they should contact their organ procurement organization immediately. Different organizations will have varying criteria on when they will come out, and some will have nurse ambassadors at hospitals who only talk to families, but they would far prefer an early heads up on a patient who doesn't meet criteria than being notified after a patient dies. You should reach out to your regional OPO for their specific criteria.

    Patients who are brain dead generally will have poor function of their basic life functions and are typically in a Trauma or Neuro ICU. They are often on pressors and intubated. Care would not be any different for these patients before they are declared brain dead. No patient is to be treated differently before declaration of legal brain death. Care is based on their presentation so it isn't really possible to give a routine answer but expect continuous pulse ox, rhythm strips, and other vitals hourly at a bare minimum. Assessments are generally every 4 hours or with condition changes. Hourly UOPs, et cetera. Labs really depend on patient presentation, but generally speaking a CBC and CMP are the absolute bare minimum.

    Once the patient is declared brain dead the OPO will send out a RN who takes over patient care. They have a set of protocols and a Doc on call to determine care. The hospital should not be giving care once the OPO takes custody of the patient. Depending on the OPO they will determine how they want to monitor the patient, but generally the RN will place a central line, arterial line, and use some form of machine or calculation to determine vascular resistance. They try to minimize pressor use to lower vascular resistance and adjust vent settings to optimize lung function. The ultimate goal for the OPO RN at this point to make the organs as viable for transplant as possible.

    Surgery either can occur on site or at another facility, but is performed by a team of specialized procurement surgeons. During this time there are countless personnel working behind the scenes to figure out which organs are viable and who is going to receive them. Surgery has to be set up for the transplant for the receiving patient, who needs to have all of their preoperative testing performed and be prepared for surgery as quickly as possible.

    You should reach out to your OPO. They are always more than happy to give education, and while they cannot tell you what your facility policy will be they absolutely can tell you what their expectations of the primary nurse are. Patients and families who donate their organs are giving an incredible gift, and everyone involved in transplant medicine understands that.
    thank you!!! I have a question. I was told to NEVER ask families about organ donation, that you only talk to the OPO about it. I am assuming the families will get offended if asked or offered? Is it the OPOs role to discuss that with the patients family?
  5. by   LovingLife123
    You are not allowed to ever discuss organ donation with a patient's family. Even if they bring it up they get referred to the organ donation team.
  6. by   LovingLife123
    We call organ donation for any patient that meets certain criteria. Even if the patient is most likely not a candidate or probably won't even die. We use the GCS scale to determine when to call. I think it's 5 or below.

    They follow behind on the patient and if the situation seems dire enough they will send people to the hospital to investigate the situation.

    Once they are determined to be a candidate, lots of labs are drawn as the patient needs to be kept hemodynamically stable.

    Brain death is handled different from cardiac death. With a cardiac death they only have 60 minutes to procure the organs. With brain death, we can keep their heart going to give time to get the body ready for the best procurement possible. It also gives family time to get there and say goodbye.
  7. by   MunoRN
    Quote from PeakRN
    ...Once the patient is declared brain dead the OPO will send out a RN who takes over patient care. They have a set of protocols and a Doc on call to determine care. The hospital should not be giving care once the OPO takes custody of the patient. ..
    This must vary regionally because in multiple facilities I've worked at the hospital staff RNs continue to care for the patient up to the point they are being wheeled into the OR for procurement. The OPO sends out an RN transplant coordinator, but they provide no direct care after the brain death declaration.
  8. by   Charge200J
    Quote from MunoRN
    This must vary regionally because in multiple facilities I've worked at the hospital staff RNs continue to care for the patient up to the point they are being wheeled into the OR for procurement. The OPO sends out an RN transplant coordinator, but they provide no direct care after the brain death declaration.

    Same at my facility. We continue caring for the patient, but we refer to the OPO transplant coordinator for orders. From a billing standpoint I always find it interesting that the patient is actually "discharged" from our team and "re-admitted" in the computer under the OPO. All treatment and procedures from when the OPO takes over is never billed to the family/pt's insurance.

    Caring for these patients is a really unique opportunity.
  9. by   MelEpiRN
    Definitely call your OPO. They're extremely knowledgeable and helpful and the ones I've worked with would be able to help you understand your role. I suppose it could vary state-to state, but your 'role' wouldn't change with regards to much, you may just have to draw some specific labs that they'll tell you to.
    Do not ever bring up organ donation with the families, studies show the OPO is much more successful when somebody from the OPO approaches the family. If the family has questions, just tell them you'll call somebody to come answer them.
  10. by   Julius Seizure
    Quote from xmilkncookiesx
    thank you!!! I have a question. I was told to NEVER ask families about organ donation, that you only talk to the OPO about it. I am assuming the families will get offended if asked or offered? Is it the OPOs role to discuss that with the patients family?
    From the viewpoint of the family, having the primary medical team bring up organ donation can make them feel like you are giving up on saving their family member and now you just want their organs, so you aren't even going to try to help them anymore.

    A distinction between the primary medical team (who are there to do "everything they can" to save the patient) and the organ donation team helps avoid that emotional conflict and avoid damaging the trust between the family and medical team.
    Last edit by Julius Seizure on Nov 21
  11. by   Cat365
    Your responsibility is to make sure OPO is called for brain death, before a terminal wean, or at death.

    You never mention organ donation because you are responsible for the life of their loved one. It can be regarded as a conflict of interest if you bring it up. The OPO staff are trained to discuss this. Also, if you would bring it up and the family was receptive it would be an additional blow to a family that is already grieving if the deceased does not meet the criteria of organ donation.

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