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ORGAN DONATION AND TRAUMA
By Tristan Saggese
SOME IMPORTANT INFORMATION
•Donation restrictions / contradictions • 30% of organ donations are from trauma patients • Before donation: • Identify and evaluate donors,
Obtain consent, Brain Death, Preservation etc.
BRAIN DEATH
• Brain death confirmation •No overwhelming consensus…• Less time after brain death = More successful transplants• Criteria for Brain Death?
CARDIAC DEATH
•When Brain Death hasn’t been confirmed…•United States uses Cardiac Death indicator
POLICY
• Geisinger Medical Center, Pennsylvania• Published 1992• Efficiency of
donation Process
METHODS
• Observed108 patients admitted for trauma-related injury over 36 month period. • Characterized patients
based on many characteristics • Questionnaire
RESULTS
RESULTS CONT.
CONCLUSIONS // TAKEAWAYS
• Increasing professional education•64% consent refusal• Public education! •Arbitrary age boundaries
PEOPLE
• Department of Surgery at the University of Missouri• Published 2001
METHODS
• 18 question survey• 96 active trauma
surgeons71 trauma surgeons replied• Purpose: donation
and OPOs
RESULTS
• Broad range of results and opinions
RESULTS CONT.
RESULTS CONT.
RESULTS CONT.
CONCLUSION
•Hospital-wide donation education programs • How to “approach”?• The how and when may of the “approach” may be important• Example: Decoupling • Pediatric brain death
PRACTICE
• University of Southern California Keck School of Medicine• Published 2007 • In-house
coordinator program (IHC)
BACKGROUND
•Organ Donating Breakthrough Collaborative (Collaborative)• Aggressive management protocol • In-house coordinator program with help of OPOs
METHODS
•Two full time in-house coordinators• IHCs provided extensive “Family support” • Timely discussion of organ donation • Time with families•Pre and Post IHC periods compared
RESULTS
RESULTS CONT.
CONCLUSION
• OPOs significantly effect trauma and other patient donations • More time spent with families • Transplant coordination programs • Time of interaction? • 33% of IHC hospitals achieved 75% conversion rate
goal • Consent is still an issue
CONCLUDING THOUGHTS
•High demand for organs; we still need strategies to increase donations • Age-related factors? • IHC programs?
REFERENCES
• Finger, Erik B. "Organ Procurement Considerations in Trauma." : Overview, Organ Distribution, Criteria for Organ Donors. N.p., 2016. Web. 18 Aug. 2016.
• Johnson, Colleen M., Lee S. Miller, and Stanley J. Kurek. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, Mar. 2001. Web. 19 Aug. 2016.
• Kennedy, Alfred P., John C. West, and Stephan E. Kelley. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, Oct. 1992. Web. 19 Aug. 2016.
• Salim, Ali, Carlos Brown, Kenji Inaba, Angela Mascarenhas, Pantelis Hadjizacharia, Peter Rhee, Howard Belzberg, and Demetrios Demetriades. "Improving Consent Rates for Organ Donation: The Effect of an Inhouse Coordinator Program." The Journal of Trauma: Injury, Infection, and Critical Care 62.6 (2007): 1411-415. Web.
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