Unit 2: Summary and Quiz
The Centers for Medicare & Medicaid Services (CMS) Conditions of Participation require hospitals to refer all imminent and actual deaths to their regional OPO. Referrals must be made within one hour of determination of death or risk for imminent death. It is generally the responsibility of the bedside nurse to initiate referral to the OPO donor referral center.
All hospital staff should have a CORE trigger card, which states objective criteria for determining whether a patient is at risk for imminent death. There is no penalty for referring a patient who does not die or does not have the potential to become a donor.
Upon referral to CORE, the donor referral coordinator queries the state donor registry to determine if the patient is registered as a donor. At the same time, the patient undergoes screening for donor suitability. The donor referral coordinator, working from the donor referral center, work closely with organ procurement coordinators, surgical teams, transplant teams, and other OPOs to recover and arrange transportation of organs. The donor referral center handles the complex logistics of finding a suitable match for donated organs.
Organ procurement coordinators work with the transplant surgeons to make decisions about donor suitability on a case-by-case basis in accordance with exclusionary criteria set for by the Centers for Medicare & Medicaid Services and the FDA (for tissue).
A nationally recognized best practice is for the OPC to develop good relationships with the end-of-life care team at the hospital. They should be considered part of the care team with a specific role and primary responsibility for communicating with families about donation.
Evidence indicates that neglecting best practices in the referral process—including untimely referral to CORE, no call to CORE prior to extubation, or mistimed or inappropriate family approach or release of the body—results in the loss of donation opportunities.