UHW EM ORGAN DONATION PATHWAY. WHY? UHW: very busy ED, 140,000 attendances per annum Neurosurgical...
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Transcript of UHW EM ORGAN DONATION PATHWAY. WHY? UHW: very busy ED, 140,000 attendances per annum Neurosurgical...
WHY?
• UHW: • very busy ED, 140,000 attendances per annum• Neurosurgical tertiary referral, trauma centre• Potential donors - 1 per fortnight
• ED pathway normalises and standardises referral• Gives a structure to something that remains stressful and
usual for ED staff
• Encourages and supports good practice• End of life care• Collaborative approach
IDENTIFICATION AND FIRST STEPS
Intubated and ventilated potential donor identified.Consensus agreed by at least two consultants of appropriate specialty on plan to withdraw treat in patients best interests in view of terminal and irreversible prognosis. Discussion with consultant on call for intensive care to agree that plan to consider organ donation is appropriate.Determine critical care capacity if donation is considered appropriate.Contact the Specialist Nurse for Organ Donation and check Organ Donation Register. Commence checklist re: documentation
The story begins one Monday evening…
22 year old motorcyclist
• pupils “fixed and dilated at the scene”
• GCS 4 with decerebrate posturing in ED
• Discussion with neurosurgery
• “further treatment futile”
The story continues…
• Difficult family dynamics• Father refuses to proceed with OD conversation before
patient’s grandmother can attend the next day.• The patient is “optimised” overnight in the EU.• At some point the pupils are noted to be slightly
unequal and sluggishly reacting.• The next morning the EU consultant is uncomfortable
with the decision to withdraw and insists on further assessment.
• Patient transferred to ITU for active medical treatment.• Patient since transferred to neuro ward for
rehabilitation.
Less than one week later; same department, same EM consultant……..
44 year old motorcylist
• ‘pupils fixed and dilated’• GCS 5 at scene• GCS 4 on arrival in EU• Neurosurgeons • “treatment is futile”• Plan to withdraw
treatment
• ITU review
• Non-collaborative approach• Family consent to
donation• Transfer to ITU
• Donation of kidney and pancreas
ITU review:
“hopeless prognosis”
Plan to extubate, keep comfortable allow the family to sit with him and let him pass away peacefully.
Learning Points
• Open dialogue between ITU and EU is essential• Don’t take information for granted• Review everything and assume nothing• Document all decisions and their timings
accurately and as contemporaneously as possible
• Further introductory information to emphasis process of decision making about withdrawal• Addition of a checklist