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.