Download IOPO Education Module 10-07

IOPO
Indiana Organ Procurement Organization
Organ and Tissue Donation
Review
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Objectives
At the end of this module the learner will be
able to:
• Acknowledge that all imminent and actual
deaths must be reported to IOPO
• List the potential types of donation
• Utilize the resources for any questions
regarding tissue/organ protocols
• Identify the clinical triggers for a referral
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Facts
• There are over 90,000 people waiting for an
organ transplant.
• 17 people die each day waiting for an organ
transplant.
• It is estimated that 1 in 25 people will need a
tissue transplant at some point in their life.
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Organ Donation
Can Be a Life-Saving Gift
•
•
•
•
•
•
Heart
Lungs (can be 1 or 2 recipients)
Kidney’s (usually 2 recipients)
Liver
Pancreas
Small Intestine
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Tissue Donation
Skin:
Temporary covering for burn victims to prevent fluid loss and infection and it is
used in surgical applications, such as abdominal wall and breast reconstruction and
deep tissue burn repair.
Bone and Tendons:
Bones are made into putty, powder or other consistencies for
procedures such as hip/knee replacements, spinal fusions and dental implants.
Larger bone used for cancer and trauma victims to avoid amputation.
Tendons used for ACL repairs.
Heart for Valves: Replace defective valves (Aortic, Pulmonary).
Many are
transplanted into children with congenital heart defects.
Vein/Artery:
Coronary Artery Bypass and Peripheral Vascular Reconstruction.
Corneas, sclera, whole eye: Gift of sight to 2 people with corneal blindness or
can repair the eye from injury or trauma.
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Organ Donors
• Organs can be recovered from a patient that
has been declared brain dead or through
donation after cardiac death (DCD).
• Brain death is defined as total & irreversible
destruction of the brain & brainstem. Brain
death is declared by patient’s MD
• Donation after cardiac death is best
described as a terminal wean from a
ventilator in the operating room.
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Tissue Donors
For tissue to be donated, the donor must
sustain a cardiac death or brain death.
All deaths should be evaluated for tissue
donation. That is why it is mandatory that
each and every death be called to IOPO!
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Donation After Cardiac Death
(DCD)
DCD is when a patient will not deteriorate to
brain death (the irreversible cessation of
blood flow to the brain.) Therefore, organ
donation may become a possibility for
families when they decide to terminally wean
the patient.
However, the family’s decision to do a
terminal wean must come prior to
evaluation for DCD.
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More on Donation After Cardiac Death
• With these patients, they are declared dead after
cessation of cardiac and respiratory function when
withdrawn from the ventilator in the operating room.
• Families are permitted into the operating room to
be by their loved one’s side during the terminal
wean.
• Per the Clarian policy, there is a 90 minute time
frame set for terminal wean process to time of
pronouncement of cardiac arrest.
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Therefore…
If the patient does not cardiac arrest within the
90 minute time frame the patient is then
returned to either the ICU or designated floor
for completion of end of life care.
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Your Responsibilities…
The Center for Medicaid and Medicare Services
(CMS) and JCAHO has specific hospital conditions
for participation. They require all hospital staff to
call on every death and every imminent death.
This is supported by Clarian Health Policies.
“Imminent death is when a patient is not expected to survive
their injury.”
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Indiana’s Donor Choice Law
• Effective July 1, 2001, the Indiana Donor Choice
Law states that anyone 18 years of age or older
can declare their decision to donate organs and
tissues when obtaining/renewing a drivers license.
• The law was designed to uphold the individual’s
right and decision to donate, and prevents anyone
from modifying or preventing the anatomical gift
from being carried out.
• IOPO (Indiana Organ Procurement Organization)
will access the BMV and see if a patient has
declared himself or herself a donor.
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Clinical Triggers for When to Call IOPO
1-800-356-7757
• Call on any patient with a Glasgow
Coma Scale (GCS) of 5 or less
• Call at first mention of terminal wean
from family or physician
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Making the Referral to IOPO
1-800-356-7757
Per IOPO, ANYONE can call, secretaries,
physicians, chaplains, social workers,
nursing, and make the referral to IOPO. It is
best to have the patient’s chart in front of you
for the information that will be requested.
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Questions You May Be Asked
 Area code and phone of referring facility. Name of unit
or floor the patient is located.
 Name and title of person making phone call to IOPO
 Does the patient have a heart beat?
 Is patient currently on a ventilator (currently, previously,
or never)?
 Patient name, date of birth/age, race, sex, weight
 Social security number (if available)
 Date and time of death (if applicable)
 Is this a Medical Examiner or coroner case
 Documented medical history?
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The Referral to IOPO
1-800-356-7757
Donation should not be discussed with the family by the
hospital staff or physicians without the assistance of an
IOPO trained requestor. CMS requires that only a
trained requestor speak to the family about the option
of donation.
Remember….Call on all deaths within one hour.
Sharing information with the IOPO team about a patient is
not a HIPPA violation.
Medical suitability must be determined prior to anyone
approaching any family about donation.
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Support for the Potential Organ Donor in
the Ventilated Units
• For those patients on ventilators, IOPO needs your
help in order to better preserve organs for donation.
• Remember the simple “Rules of 100”!!
The goals for keeping patients vital signs:
SBP >/= 100
U/O >/= 100 – 300 cc/hr
pO2 >/= 100
Temperature WNL
Electrolytes WNL
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Now for donation myths…
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Myth #1
MYTH:“Carrying a driver’s license with a red
heart will affect the medical care I receive.”
FACT: Your donation decision does not affect
the quality of your medical care.
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Myth #2
MYTH: “Donation will change my appearance
and affect my funeral plans.”
FACT: An open casket and normal viewing are
still possible.
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Myth #3
MYTH:“Donor families will be charged for donation.”
FACT: The donor family will not incur any charges for
donation expenses. When the patient becomes an
organ donor their account number is changed so
that IOPO incurs all costs from that point.
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Myth #4
MYTH: “Rich or famous people receive donated
organs and tissues more quickly than others.”
FACT: Placement of organs is determined by a
combination of medical factors such as degree of
illness, blood type, the size of the organ needed
and the length of time the patient has been waiting;
not social status.
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What is Your Responsibility?
Call!
You must call IOPO for any
imminent or actual death
1-800-356-7757
Call!
Call!
Call!
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You are finished with the WBT
Now you will need to take the assessment in
order to complete your training.
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Question 1
After a cardiac death there is no possibility for
any donation?
A. True
B. False
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Answer 1
A. Incorrect
B. correct, there is a possibility of donation
after cardiac death because the patient can
be a organ donor through the DCD process
or a tissue donor.
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Question 2
Brain death is defined as irreversible?
A. True
B. False
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Answer 2
A. correct, brain death is defined as the
irreversible cessation of blood flow to the
brain. Brain Death is Death.
B. Incorrect
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Question 3
The Indiana Donor Choice Law states that
even though your driver’s license indicates
your decision to be a donor, anyone can still
prevent your decision to donate.
A. True
B. False
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Answer 3
A.incorrect
B. correct, The Indiana Donor Choice
Law was designed to uphold the
individual’s choice to be a donor.
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Question 4
According to Center for Medicaid and Medicare
Services (CMS) Hospital Conditions of
Participation, all deaths must be called into
IOPO:
A.
B.
C.
D.
Prior to the removal of ventilators
When brain death is imminent
With cardiac time of death
All of the above
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Answer 4
A. Wrong answer, there is a better choice.
B. Wrong answer, there is a better choice
C. Wrong answer, there is a better choice
D.Correct, all of the answers are correct. To be
compliant with CMS regulations, terminal wean,
brain death, and cardiac death must be referred.
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Question 5
Discussing a patient with IOPO is a HIPPA
violation.
A. True
B. False
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Answer 5
A. incorrect
B. Correct, IOPO is exempt from HIPPA. It is
OK for IOPO to inquire about a patient.
IOPO maintains strict confidentiality with all
information that is obtained about donors
and potential donors.
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Question 6
There is not a possibility of an open casket
funeral with organ or tissue donation.
A. True
B. False
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Answer 6
A. incorrect
B. Correct, any patient who is a donor can
certainly have an open casket funeral. IOPO
will not procure tissues in areas that are
visible.
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Question 7
“Donation after cardiac death” is a terminal
wean that occurs in the operating room.
A. True
B. False
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Answer 7
A.Correct, DCD is a terminal wean
that is done in the operating room
if patient expires in less then 90
minutes
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Question 8
A potential tissue donor is any:
A. Patient off the ventilator and has
sustained cardiac death
B. Patient on the ventilator facing imminent
death or brain death
C. A and B
D. None of the above
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Answer 8
A. Wrong, there is a better answer.
B. Wrong, there is a better answer.
C. Correct, a potential tissue donor is
anyone who is either on the vent with a
heart beat or has suffered cardiac death.
Someone on the ventilator does not
become a tissue donor until cardiac time of
death.
D. incorrect
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Question 9
Medical suitability for donation must be
determined by IOPO prior to discussing
donation with a family and only an IOPO
representative should discuss donation with
the family.
A. True
B. False
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Answer 9
A. Correct, IOPO does not wish to offer the
option of donation to a family and then turn
around and find out they may not be
suitable. IOPO determines suitability first
before giving the family the option.
B. incorrect
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Question 10
According to IOPO, eligible people to refer a
patient to IOPO are:
A.
B.
C.
D.
Secretary
Nurse, Physician
Chaplain, Social Worker
All of the above
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Answer 10
A.
B.
C.
D.
Wrong, there is a better answer
Wrong, there is a better answer
Wrong, there is a better answer
Correct, an employee does not have to
have a specific title to refer a patient to
IOPO. It can be any hospital employee.
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Question 11
Clinical triggers to make a referral consist of:
A. GCS of 5 or less
B. Prior to withdrawing any support
C. At the first mention of terminal wean
D. All of the above
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Answer 11
A.Wrong, there is a better answer
B. Wrong, there is a better answer
c. Wrong, there is a better answer
D. Correct, all these triggers are
correct. By using these clinical
triggers the hospital will remain
compliant with CMS regulations.
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THANK YOU
Thank you for taking the time to review and
understand the organ and tissue donation
process. You can contact the referral line at
any time should you have questions.
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