Myths surrounding organ and tissue donation were discussed in part 1 of this donation education series and were hopefully dispelled. If you missed part 1, you can read it at https://allnurses.com/general-nursing-discussion/8-organ-and-1098026.html. In part 2 of this series, clarification as to what organs and tissues can be donated and when a person may begin to be considered a potential organ donor will be discussed.
Identifying Organs and Tissues that can be Donated for Transplantation
Lungs (either as a pair or individually)
Liver (can be split for two recipients)
Tissues including bone, tendons, ligaments, and cartilage
In simple terms, a single organ donor can potentially save the life of eight...yes, eight...individuals.
An additional two individuals can benefit from the gift of sight.
Tissue donation can potentially benefit hundreds of people when used in orthopedic surgeries such as spine fusions, joint replacements, and hip and knee reconstruction to name just a few.
Choosing to be an organ and tissue donor isn't just a small gift but rather a gift that can reach hundreds of people and thousands of miles to recipients in many locations.
Recognizing Clinical Conditions that Can Lead to Brain Death
Anyone who has sustained a severe neurologic injury can potentially progress toward brain death and make them a potential organ donor. This includes:
Severe traumatic brain injury from blunt head injury, gunshot wound etc.
Anoxic brain injury due to prolonged cardiac arrest with a long downtime, drowning, or an intentional or accidental overdose
Referring a Potential Donor: The Criteria
Criteria for referring a person to the local Organ Procurement Organization (OPO) differs by region and OPO. However, generally speaking, here are some baseline criteria you should know:
A possible organ and/or tissue donor is a person who is on a ventilator who has experienced a significant neurological insult with a Glasgow Coma Scale of less than 5.
A possible tissue donor is any person who has suffered a cardiac death.
Calling the OPO Before Brain Death
The patient isn't brain dead. Why would I notify the OPO? What is critical to understand is that notifying the OPO of a potential donor does not mean the person will become a donor or that every possible measure to save the person's life will not be taken. The early call to the OPO allows for an awareness of the patient presence within the critical care area and provides an opportunity to be available in the event the conversation of organ donation arises. Additionally, the hospital is legally required to make the referral call as part of the Centers for Medicare and Medicaid Services participation.
The OPO should be notified of the following:
All potential donors or deaths
If the family begins asking questions about organ donation
If a discussion arises regarding withdrawing support
Indicating a Desire to Donate: When the Family Brings Up Donation
Sometimes as the family is beginning to see the grave prognosis of their loved one, a conversation regarding the possibility of donation may arise. When this occurs, it's recommended the clinical staff do the following:
Acknowledge what a wonderful gift the family is considering
Let the family know you will contact your local organization who can answer questions about donation
Contact the local OPO as soon as possible
Individuals specifically trained to discuss organ donation should be the ones to approach the family about the possibility of donation when the right time arises. This is not to say that the critical care nurses and physicians are not key players in the donation process. They most certainly are and no donation would be possible without their knowledge, dedication, and tireless efforts to maintain organ function.
Understanding Brain Death
Brain death is sometimes used as a loose term in the acute care setting. What is important to note is that brain death is death and is irreversible. Although a person with brain death may appear like they are sleeping, they are not. Brain death is the cessation of all brain activity including brainstem function that inhibits the ability to breathe spontaneously. In part 3 of this series, we will discuss in more detail how brain death is determined prior to an organ donation case proceeding.
Failing to Meet Brain Death Criteria: Donation after Cardiac Death
Not all patients who meet clinical triggers for a donor referral will become brain dead. Some will improve which of course is always the desired outcome. Others may have a significant neurological injury but do not meet strict brain death criteria. If the prognosis is so grave that the patient will likely die within a short period of time once artificial life support is withdrawn, donation after cardiac death or DCD, may be an option. The recovery of organs takes place only after the patient has been pronounced legally dead. Nationwide approximately 20% of donations now occur following cardiac death. DCD is an added option for families who wish to donate life when brain death criteria have not been met.
To all of you who are registered donors or who have considered the national donor registry, thank you. For those of you interested in investigating further how you can let your wishes surrounding donation known, log onto www.RegisterMe.org
Additionally, more information about organ and tissue donation can be found at the United Network for Organ Sharing (UNOS) website located at www.unos.org
Until next time...Embrace the Journey...wherever your journey may take you.