U.S. Department of Health and Human Services
Advisory Committee on Organ Transplantation
Recommendations to the Secretary
CRITICAL PATHWAY FOR THE ORGAN DONOR (APPENDIX
3)
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Critical Pathway for the Organ Donor
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Collaborative
Practice
The following
professionals may be involved to enhance the donation process. Check
all that apply.
Phase I: Referral
Collaborative
Practice
-
Notify physician
regarding OPO referral
-
Contact
OPO ref: Potential donor with severe brain insult
-
OPC on site
and begins evaluation: Time ___Date ___
-
Ht____ Wt
____ as documented
-
ABO as documented
_____
-
Notify house
supervisor/charge nurse of presence on unit
Labs/Diagnostics
none
Respiratory
-
Pt on ventilator
-
Suction
q 2 hr
-
Reposition
q 2 hr
Treatments/Ongoing
Care
none
Medications
none
Optimal
Outcomes
none
Phase II: Declaration
of Brain Death and Consent
Collaborative
Practice
-
Brain death
documented
Time _____ Date _____
-
Pt accepted
as potential donor
-
MD notifies
family of death
-
Plan family
approach with OPC
-
Offer support
services to family (clergy, etc)
-
OPC/Hospital
staff talks to family about donation
-
Family accepts
donation
-
OPC obtains
signed consent & medical/social history
Time _____ Date _____
-
ME/Coroner
notified
-
ME/Coroner
releases body for donation
-
Family/ME/Coroner
denies donation — stop pathway — initiate post-mortem
protocol — support family
Lab/Diagnostics
Respiratory
Treatments/Ongoing
Care
Medications
none
Optimal
Outcomes
The family is
offered the option of donation & their decision is supported.
Phase III: Donor
Evaluation
Collaborative
Practice
-
Obtain pre/post
transfusion blood for serology testing (HIV, Hepatitis, VDRL,
CMV)
-
Obtain lymph
nodes and/or blood for tissue typing
-
Notify OR
& anesthesiology of pending case
-
Notify house
supervisor of pending donation
-
Chest &
abdominal circumference
-
Lung measurements
per CXR by OPC
-
Cardiology
consult as requested by OPC
-
Organ recovery
process discontinued — donor organs unsuitable for transplantation
Labs/Diagnostics
-
Blood chemistry
-
CBC + diff
-
UA o C &
S
-
PT, PTT
-
ABO o A
Subtype
-
Liver function
tests
-
Blood culture
X 2 / 15 minutes to 1 hour apart
-
Sputum Gram
Stain & C & S
-
Type &
Cross Match ____# units PRBCs
-
CXR o ABGs
-
EKG o Echo
-
Consider
cardiac cath
-
Consider
bronchoscopy
Respiratory
Continue Phase
II
-
Maximize
ventilator settings to achieve SaO2 98 — 99%
-
PEEP = 5cm
O2 challenge for lung placement FiO2 @ 100%, PEEP @ 5 X 10 min
-
ABGs as
ordered
-
VS q 1
Treatments/Ongoing
Care
Continue Phase
II
Medications
Optimal
Outcomes
The donor is
evaluated & found to be a suitable candidate for donation.
Phase IV: Donor
Management
Collaborative
Practice
Lab/Diagnostics
-
Determine
need for additional lab testing
-
CXR after
line placement (if done)
-
Serum electrolytes
-
H &
H after PRBC Rx
-
PT, PTT
-
BUN, serum
creatinine after correcting fluid deficit
-
Notify OPC
for
___ PT >14___ PTT < 28
___ Urine output is
< 1 mL/Kg/hr
___ > 3 mL/Kg/hr
___ Hct < 30 / Hgb < 10
___ Na > 150 mEq/L
Respiratory
Continue Phases
II and III
Treatments/Ongoing
Care
Continue Phase
II
Medications
Continue Phase
III
-
Fluid resuscitation
— consider crystolloids, colloids, blood
-
DC meds
except pressors & antibiotics
-
Broad-spectrum
antibiotic if not previously ordered
-
Vasopressor
support to maintain BP > 90 mm Hg systolic
-
Electrolyte
imbalance: consider K, Ca, PO4, Mg replacement
-
Hyperglycemia:
consider Insulin drip
-
Oliguria:
consider diuretics
-
Diabetes
insipidus: consider antidiuretics
-
Paralytic
as indicated for spinal reflexes
Optimal
Outcomes
Optimal organ
function is maintained
Phase
V: Recovery
Collaborative
Practice
-
Checklist
for OR
-
Supplies
given to OR
-
Prepare
patient for transport to OR
-
IVs o Pumps
-
O2 o Ambu
-
Peep valve
-
Transport
to OR
Date ________
Time ________
-
OR nurse
reviews consent & brain death documentation & checks
patient's ID band
Diagnostics
Respiratory
Continue Phases
II and III
Treatments/Ongoing
Care
Continue Phase
II
Medications
Continue Phase
III
Optimal
Outcomes
All potentially
suitable, consented organs are recovered for transplant.
The Critical
Pathway was developed under contract with the U.S. Department of
Health and Human Services, Health Resources and Services Administration,
Division of Transplantation.
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