Timeframe for Organ Donation for Brain Death

[Nccity2002, MSN, RN]

Hi There,

I am interested in finding out what is the practice of other facilities/states in regard to how much time is given to families to make a decision in regard to organ donation, once a patient is legally declared brain dead. I work in a busy trauma ICU, and in the last three months it seems we are having more situations where brain dead patients (and I mean, legally declared by two MD's, physical exams, and in some case cerebral angiograms), are being kept for long period of times in an ICU bed (twelve days, the longest one, after the patient was declared!!). All those situations involved difficult families dynamics and plain old difficult families; and in many of those situations, they kept changing their minds when they felt that their demands were not being met, such as sponsoring four family members from Mexico...after the hospital already sponsored three other relatives.

My undestanding is that insurance/ medicare stop paying for care once a patient is legally declared, I had worked in community/county hospitals where once declared, family are given 48 hrs to make a decision...but my current facility is a teaching hospital. I think my facility is trying to meet the family emotional needs...but from a practical standpoint, what is the practice in other places??

Thanks!!

[Esme12, ASN, BSN, RN]

The difference here is that you are in a teaching facility and I'll bet they do transplants. They have patients sitting in the building that need organs and they can control the donor's care much more effectively once brain death has been declared. Once brain death has been declared the patient is dead, legally, thoroughly dead.....so you are right insurance companies do not pay. The organ bank and facilities share the cost of the care of the donor. I this case the hospital itself which is partially covered in the transplant itself.....or in grants or the transplant charges/costs itself......or classify the costs as losses, a write off so to speak.

Also, there is no travel time for the organs to arrive at the recipient's location. When the donor is in the community setting the care costs are minimally recovered. The transplant teams have little to NO control over the care of the donor and you have to count in travel time of the removed organ to get to the recipient.....so time limits will be VERY different.

I think you new facility being a teaching facility are not only trying to appease the families but they are trying to save several lives that are physically near by. I will tell you I have dealt with families that definitely vacillate more than others due to cultural beliefs and they can be very trying and time consuming to deal with......but I am sure your facility is just trying to save several lives with one tragic death and have the skill and know how to accomplish this goal.

I know it seems ridiculous to you in the length of time they are allowing these families to vacillate.....but I'll bet they know what they are doing. Peace

[ckh23, BSN, RN]

In my facility, our ethics board will get involved and if no resolution the paitent would be taken off the vent and allowed to have a natural death, regardless of donation status.

[Preeti-ICU-RN]

At my hospital, the decision to donate is reached rather quickly (6-12 hrs). There are exceptions made depending on the case. We have had cases where we've extended this time frame trying to find family members in other countries, trying to ID the "donor" and of course difficult family dynamics. If there are stressful family dynamics, it is just safer to close the case for donation. We have had cases where families were requesting that the hospital and donor network sponsor extended family members from other countries. At times it just feels like they're trying to manipulate the situation to gain entry into the US. The hospital and the donor network does not entertain these ideas for too long. Since your hospital is a teaching hospital, they may be able to take that risk. May be the grants are dependent on the donor patients.

[kingRN2009]

Nebraska allows the patient to remain ventilated for up to 24 hours after declaration unless the family has agreed to donate and an organ recovery system has assumed care. The state requires care be discontinued after 24 hours otherwise.