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  • 1. The Impact Of An Effective OPO DCD Practice On Donation and Transplantation RatesJM Edwards, G O’Shaughnessy, S Demczyszyn, R Hasz, HM Nathan Presented by: Gweneth O’Shaughnessy, BS Gift of Life Donor Program Philadelphia, Pennsylvania, USA
  • 2. Gift of Life Donor ProgramPhiladelphia, Pennsylvania USA • Non-Profit Organization • Established in 1974 • Federally designated OPO (by Medicare) for eastern PA, Southern NJ & Delaware - 134 Acute Care Hospitals - 15 Transplant Centers, 43 Programs - 10.3 Million Population Gift of Life Donor Program Office (Philadelphia, PA) • 2011* Projected Data: - 440 Organ Donors / 42.7 Donors/MM - 1,236 Bone Donors and 2,551 Cornea Donors • Over 31,000 organs for transplantation and over 375,000 tissue allografts • Accredited by: the Association of Organ Procurement Organizations (AOPO); American Assoc. of Tissue Banks (AATB) & Eye Bank Team Philadelphia Transplant Recipient Athletes Competing Assoc. of America (EBAA); UNOS/OPTN at the 2010 U.S. Transplant Games in Madison, WI member OPO
  • 3. Background:DCD is the foundation of modern clinical transplant.The IOM and SCCM have affirmed that it is amedically effective, ethically appropriate method ofprocuring organs. DCD provides an additional organdonation option if a patient is medically suitable butdoes not fulfill strict brain death criteria.Aim:To demonstrate how this OPO implemented aneffective DCD program and to illustrate the impacton donation and transplantation.
  • 4. Materials and Methods: Considerations For OPO Personnel Educating Hospital Personnel • Utilize a broad referral trigger; Education evaluate all donation pathways ‒ Routine Referral ‒ Clinical Triggers DCD • DCD Policy (development and implementation)Policy Case • Comprehensive education (physicians, nurses, ER, ICU, OR, etc.)Orientation & Training Clinical Practice• Didactic & Simulated Learning • OPO on-site response• Weekly Clinical Case Reviews • Administrator On Call oversight• Skills Workshops • Donation and Communication• All Teach All Learn Pathways
  • 5. Legislative& Regulatory Framework 1986: Omnibus Budget Reconciliation Act 1994: Pennsylvania Act 102 1995: New Jersey Donor Enhancement Act 1998: Delaware Gift of Life Initiative Medicare Conditions For Participation 2008: Joint Commission
  • 6. Consult Gift of Life on all Vent-Dependent Patients w/a Non-Recoverable Neurologic Injury/Illness To preserve the organ donation option for patients/families, call 1-800-KIDNEY-1 according to the following criteria:(regardless of age, medical history, current hospital course, hemodynamic status) 1. At the first indication the patient has suffered a non-recoverable neuro injury/illness (pt. begins to lose some neuro reflexes) 2. Prior to the first formal brain death examination 3. Prior to family discussion of DNR or withdrawal of support 4. Patient has suffered: Head Trauma, Anoxia, CVA Call Gift of Life – 1-800-KIDNEY-1 (1-800-543-6391)In collaboration with the care team, Gift of Life will initiate the first mention of organ donation (after it has been determined that the patient is a medically suitable candidate for donation).
  • 7. Patient Referrals & Donation Outcomes, 1995 – 2010 Organ Donor Not Brain Dead DCD Donors Organ Donors Referrals Referrals (% of total donors) 1995 823 194 222 2 (1%) 1996 950 224 262 12 (4.6%) 1997 1,104 312 292 14 (4.8%) 1998 1,164 341 298 25 (8.4%) 1999 1,280 455 331 24 (7.3%) 2000 1,366 506 298 23 (8%) 2001 1,359 439 315 32 (10%) 2002 1,507 454 354 36 (10%) 2003 1,540 537 344 51 (15%) 2004 1,733 613 387 47 (12%) 2005 2,233 762 382 57 (15%) 2006 2,466 821 401 67 (17%) 2007 2,941 841 389 47 (12%) 2008 3,475 1,107 428 70 (16%) 2009 3,815 1,219 439 65 (15%) 2010 3,767 1,627 392 85 (22%)Totals 31,523 10,452 5,534 657 (12%)
  • 8. Materials and Methods Considerations For Hospital Personnel • No different referral trigger for DCD. A broad trigger is utilized to Education capture all ‘not brain dead’ referrals. • Brain dead donation pathway is priority DCD • Understand and support timing of donation discussionsPolicy Case • Separation of care team from transplant personnel • Withdrawal phase / contingency planning • Gift of Life – Care Team debriefings
  • 9. Pathways For Organ Donation Vent Dependent Patient With Non-Recoverable Neurologic Injury/IllnessDonation After Donation After Brain Death Neuro Cardiac Death Exam • Exam Not c/w Brain Death• Exams c/w Brain Death • Care Team/Family Discuss Grave Prognosis and W/D of Medical• Pt Declared Dead in ICU Treatment/Support• Donation Discussion • Donation Discussion (OPO / Member of Care Team) (OPO / Member of Care Team)• Maintain Hemodynamics • Maintain Hemodynamics • Optimize End Organ Function• Optimize End Organ Function • Move To OR for W/D Phase• Operative Phase • W/D Care/Comfort c/w Hospital Practice • Pt Declared Dead in OR• Surgical Recovery of Organs • Surgical Recovery of Organs
  • 10. Five Scenarios That Trigger A Donation Discussion Family Mentions Donation. Donation Mentioned Brain Death Pronounced. Independent of Explained to the family. Gift of Life . Family understands. Patient and Family Decision To Pulmonary or Limit, Decelerate or W/D hemodynamic instability. Therapies.
  • 11. Results Organ Donor Experience, 1994 – 2010 Total Donors = 5,742 BD (n=5,085) DCDs (n=657) 85 (392) 2010 307 2009 374 65 (439) 2008 358 70 (428) 2007 342 47 (389) 2006 334 67 (401) 2005 325 57 (382) 2004 340 47 (387) 2003 293 51 (344) YEAR 2002 318 36 (354) 2001 283 32 (315) 2000 275 23 (298) 1999 307 24 (331) 1998 273 25 (298) 1997 278 14 (292) 1996 250 12 (262) 1995 220 2 (222) 1994 208 (208) 0 50 100 150 200 250 300 350 400 450 500 NUMBER OF ORGAN DONORS*Source: Based on GLDP data through December 31, 2010.
  • 12. Results: DCD Organs Transplanted 1995 – 2010 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ’10 TOTAL DCDDONORS 2 12 14 25 24 23 32 36 51 47 57 67 47 70 65 85 657Kidneys 4 17 21 37 43 42 50 65 77 72 88 122 83 100 89 142 1,056 Livers 1 2 3 9 9 9 13 12 12 9 22 16 11 14 8 8 158 Lung 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 0 6Pancreata 0 0 0 0 0 0 2 0 1 4 4 2 0 0 0 0 13 Total Organs Transplanted 1,233* Source: Based on GLDP data through December 31, 2010.
  • 13. Results: DCD Experience By Hospital Type 1995 – 2010 657 DCD Cases in 88 Hospitals • 14 Transplant Centers (362 cases – 54%) • 15 Trauma Centers** (138 cases – 21%) • 59 Community Hospitals (164 cases – 25%)* Source: Based upon GLDP data through December 31, 2010.** Trauma centers only-does not include transplant centers that are also trauma centers.
  • 14. ConclusionThis OPO has demonstrated that aneffective DCD program increases the supply of transplantable organs.