Best Practices

Put your knowledge into action with this guide to best practices in organ and tissue donor referral. ​

  • 1 - Collaborative Relationships

Description

Maintain a Collaborative Relationship between hospital staff and CORE.

Consequences

Lack of trust can lead hospital and ICU staff to resist or delay referring imminent death cases to CORE. In some cases, they might undermine or contradict the OPC.

Best Practices

Organ procurement coordinators (OPCs) have an important role in the death and dying process. They have training and experience working with families to discuss donation and with ICU staff on the medical aspects of each case. CORE strives to have all OPCs develop and maintain trusting, open relationships with hospitals. This facilitates working with families during this difficult time period.  

  • 1 - Timely Referral

  • 2 - Refer all Cases

  • 3 - Organ Donation

  • 4 - Tissue Donation

Description

When any of the imminent death trigger conditions are met potential organ donor, a referral to CORE must be made within one hour. 

Consequences

When referrals are made late, CORE staff does not have time to review the case, approach families, or plan effective and appropriate procedures.  Hospitals that neglect to report imminent patient deaths to CORE are in violation of Medicare Conditions of Participation.

Best Practices

There is a trigger card for adult and one for pediatric cases. Keep a copy of the trigger card handy. It can always be found on imminent dealth section of the course. In most cases, the calls will be made by an ICU nurse. You can support that decision by asking if it is appropriate or if it has been done.

Description

All patient deaths must be referred to CORE within one hour. 

Consequences

Patients who do not die in the ICU, or who die suddenly may still be suitable for tissue and cornea donation.  If a death is not reported, then that opportunity can be lost. Hospitals that neglect to report patient deaths to CORE are in violation of Medicare Conditions of Participation.

Best Practices

All patient deaths must be reported to CORE regardless of the mechanism or cause of death, and regardless of the patient’s apparent potential for donation.  This call should be noted in the medical record.

Description

Initial mention of organ donation should be made by an organ procurement coordinator (OPC) from CORE only after the family has been informed about the patient’s prognosis.    

Consequences

If physicians, nurses or other staff mention CORE or organ and tissue donation to patients families before contacting CORE, then people may become confused, upset and resistant. Research has found that families are more likely to refuse to authorize donation in these situations.

Best Practices

Physicians and hospital staff should focus on providing good end of life care. Discussions of brain death, withholding or withdrawl of life sustaining treatment should take place. If the referral to CORE has been made in a timely way, then the topic of organ and tissue donation can be introduced by the OPC after brain death has been discussed.  

Description

Initial mention of tissue donation should be made by an organ procurement coordinator (OPC) or Donor Referral Coordinator (DRC) only after the family has been informed about the patient’s prognosis or actual death.

Consequences

If physicians, nurses or other staff mention CORE or organ and tissue donation to patients families before contacting CORE, then people may become confused, upset and resistant.  Research has found that families are more likely to refuse to authorize donation in these situations.

Best Practices

Physicians and hospital staff should focus on providing good end of life care. Discussions of brain death, withholding or withdrawl of life sustaining treatment should take place. If the referral to CORE has been made in a timely way, then the topic of tissue donation can be introduced by the OPC after prognosis and death have been discussed.

  • 1 - Communication

  • 2 - Management

  • 3 - De-Escalation of Care

  • 4 - Extubation

Description

Proactive Communication - keep CORE informed about patient care decisions in a timely way – before orders are changed, or as soon as possible.

Consequences

If a patient is decompensating, the option for donation may be lost.

Best Practices

Once a patient is identified as a potential donor through imminent death referral and review by CORE, communication about patient care decisions must include the OPC.

Description

Excellent Donor management can affect the viability of organs and tissues for transplant.  

Consequences

If order sets are not followed, then hospital staff may not effectively manage the care of the potential donor. This can result in loss of organs for transplant.

Best Practices

Most hospitals have a standard order set for physiological support for potential donors developed in conjunction with CORE based on current scientific knowledge. The order sets are designed to improve organ function and the best possible outcomes for transplant recipients.

Description

De-escalation of care should only happen after the opportunity for donation has been evaluated by CORE.  

Consequences

If the patient’s physiological status is not maintained, then the opportunity to donate may be lost by the time the Organ Procurement Coordinator is able to evaluate their potential.

Best Practices

Hospital staff should notify CORE before patient care is de-escalated.  Examples include not maintaining hemodynamic stability; withholding or withdrawing medications, fluids or blood tests.  CORE should be notified before patients are made ‘comfort measures only.’

Description

Extubation should only happen after the opportunity for donation has been evaluated by CORE.

Consequences

Once a patient has been extubated, it is too late to consider organ donation. Organs will not be recoverable.  

Best Practices

Hospital staff must notify CORE that a decision has been made to extubate a patient. In cases where there is a potential for donation and the OPC has already spoken with the family, then extubation should not take place without informing CORE. If CORE has determined that there is no option for organ donation, the OPC will inform the hospital that CORE no longer needs to be involved.

  • 1 - Releasing Body to Funeral Home

  • 2 - Proper Eye Care

Description

Releasing a body to the funeral home without informing CORE. 

Consequences

Even when organ donation has been ruled out, there may be the opportunity to recover tissue. Hospital staff may be under pressure from funeral directors, and this may undermine or contradict patient preferences. 

Best Practices

Hospital staff should establish a protocol to confirm with CORE whether a body should be released to a funeral home.  If CORE has been informed in a timely fashion, then the OPC will be able to keep hospital staff informed about the potential to recover tissue. 

Description

Following the eye care protocol is essential for cornea donation.

Consequences

Failure to follow the eye care protocol can result in inability to recover corneas.

Best Practices

CORE has developed a specific protocol for good eye care based on current scientific knowledge.  These protocols are in place at all hospitals in the DSA.