Anencephalic Donation Possibilities

Breakout Session B

Presenters:Leandra McHargue, RN, BSN, Loma Linda University Medical Center

Becky Hill, CPTC, OneLegacySarah Grays, RNC-NIC, CPTC, OneLegacy

Moderator:Lynn Willis, MHA, UC Irvine Health

• Understand the possible donation opportunities for anencephalic babies• Learn the practical steps that can be taken to

help families of neonatal/anencephalic infants

Objectives:

What can I do at my hospital to begin helping parents of

anencephalic infants incorporate donation into end of life care?

Questions to Run On:

Turning a “No” Into a “Maybe”Anencephalic & Neonatal Donation Possibilities

Leandra McHargue, RN, BSNBecky Hill, CPTC

Sarah Grays, RNC-NIC, CPTC

• The past: brief donation history• The present

Why re-examine now? Colin’s Story What we learned Arriana’s Story

• Looking to the future

Agenda

• 1980s: LLUMC formed an aggressive anencephalic donation program

Baby Gabriel Focus was thoracic organs

• Debates on consciousness and brain death• 1994: AMA recommended use of anencephalic

infants as donors pre-death• 1995: AMA suspended that policy

Past: Brief History

• Current possibilities and basic criteria Liver for hepatocyte cell infusion: Cytonet• Birth weight greater than 2kg • Recovery within three hours of cardiac standstill

En-bloc kidneys: UC Davis• Birth weight approximately 2kg• Intubated at birth, done as DCD recovery

Heart Valves: tissue transplantation• Weight greater than 3.6kg

Present: Why Re-Examine Now?

Crossroads of medicine andthe desire of these families to donate.

Present: Why Re-Examine Now?

Leandra McHargue, RN BSNNICU Bereavement Coordinator

Loma Linda University Medical Center

Colin’s Story

The Perry Family

Colin’s Story

Colin’s Story

Colin’s Story

What We Learned

• Education & collaboration Hospital staff, L&D, NICU,

OR Surgeons and recovering

team• Challenges of assessing a donor

that has not yet been born• Preparation for possible

intubation/kidney recovery scenario

Opportunities for liver donation

Cardiac Standstill

O2 Sat < 80%

3 consecutive hours

of O2 Sats < 80%

Occurs within 3 hours

of last O2 Sat < 80%

Liver must be flushed (in OR)

within 3 hours of last O2 Sat < 80%

Does not occur within 3 hours of last O2 Sat <

80%

Liver is a medical rule-out due to poor perfusion

Cytonet Liver Perfusion Criteria

Sarah Grays, OneLegacyMegan Aberl, Arriana’s Mom

Arriana’s Story

Megan’s Family

Arriana’s Story

Arriana was born on December 11 at 2252

to proud parents Megan & Ignacio

Arriana’s Story

Arriana’s Story

Arriana’s Gift

Arriana became the 20th anencephalic infant to

donate in the US in 2012

• Families have the desire to donate• Five potential donors in one year

Each baby and hospital team inspired & educated

• Future potential: Pediatric DCD heart: Loma Linda University Medical

Center Organs for research: International Institute of

Medicine

Looking to the Future

Thank You

Loma Linda University

Medical Center

Kaiser Permanente Riverside Medical

Center

Riverside County Regional Medical

Center

Providence Saint Joseph Medical

Center

Riverside Community

Hospital

What can I do at my hospital to begin helping parents of

anencephalic infants incorporate donation into end of life care?

Questions to Run On: