Before hospital staff can refer patients to the OPO, all patients who are at risk of imminent death must be identified.
The responsibility for determining whether a patient meets the clinical criteria for referral to the OPO generally falls on the bedside nurse. Anyone can make the referral, but the patient must be identified by a medical professional, either a nurse or physician, managing that patient.
The Advisory Committee on Organ Transplantation recommends the guidelines in the blue box for identifying patients at risk for imminent death.17
The Trigger Card
In CORE’s service area, these guidelines are outlined on trigger cards that are distributed by CORE staff. You can download a copy below. A different version is available for pediatric cases. The clinical triggers apply to patients on ventilator support.
A patient that meets any of the criteria on the card should be referred to CORE. It is important that contact with CORE be initiated before extubating any patient to enable CORE to assess donor potential.
- Refer all patients regardless of age or medical history
- Call CORE prior to deceleration of life sustaining treatment
- Mention donation or CORE to the family before contacting CORE
- Begin extubation before contacting CORE
All deaths that occur in the hospital must be reported to CORE within one hour. That means that patients who were not on the ventilator, or who died suddenly must be referred immediately. This is very important to preserve the option of tissue donation.
Imminent Death Criteria used by CORE
- Death expected within 24 to 48 hours.
- Patient has suffered severe, irreversible brain injury.
- A Glasgow Coma Scale score of 5 or less.
- Anoxia secondary to cardiac arrest.
- Change in medical care protocol from active treatment to "Do Note Resuscitate" or "Comfort Only" or "De-escalation of Care" being considered.
- Terminal wean or a planned withdrawal of support being considered allowing natural death to occur.
CORE Trigger Card