Introduced by Adam J. Teller, CPTC Procurement Transplant Coordinator .

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Ms. Anne Gulatto. Review. OneLegacyUNOS ( United Network for Organ Sharing)Collaborative Practice Donor administration Success stories. OneLegacy. Established in 1977Not for profitFederally subsidized and assigned by CMS as an OPOLicensed by California as a tissue bankServing 220 clinics, 14 transplant focuses
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Benefactor Management of the Consented Donor Presented by Adam J. Teller, CPTC Procurement Transplant Coordinator

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Ms. Anne Gulatto

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Overview OneLegacy UNOS ( United Network for Organ Sharing) Collaborative Practice Donor administration Success stories

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OneLegacy Founded in 1977 Not revenue driven Federally subsidized and assigned by CMS as an OPO Licensed by California as a tissue bank Serving 220 healing centers, 14 transplant focuses & 18.1 million occupants Serve seven areas in Southern California

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Umbrella Organizations United Network for Organ Sharing Maintains the National Organ Transplant Waiting List under contract with the U.S. Branch of Health and Human Services American Association of Tissue Banks Provides tissue saving money measures to advance quality and wellbeing in tissue transplantation Association of Organ Procurement Organizations Recognized as the national illustrative of organ obtainment associations (OPOs) The EBAA is the broadly perceived authorizing body for eye banks

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United Network for Organ Sharing (UNOS) Maintains U.S. organ transplant holding up rundown Determines national organ gift strategy Private, non-benefit association that works the Organ Procurement & Transplantation Network & U.S. Logical Registry of Transplant Recipients Under contract with Center for Medicare & Medicaid Services (CMS) of the U.S. Dept. of Health & Human Services

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Collaborative Practice OPO and clinic will recognize the Best Practices and actualize them cooperatively Best Practices incorporate Early Referral Effective Request Process Donor gatherings Education Tracking of doctor\'s facility execution Consistency of contributor administration

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Patients on the UNOS Waiting List Source: UNOS April 9 th 2010

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UNOS Organ Allocation Policy Potential beneficiaries are positioned by these criteria: Urgency of Need For heart & liver patients, the most ailing at the highest priority on the rundown Blood Type ABO must be perfect Size Height and weight must be good Tissue Typing For kidneys & pancreas

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OneLegacy Donor Service Area Local Seven-region territory Regional We are in Region 5 National A sum of 11 UNOS Regions in the U.S.

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Organs & Tissues That May Be Transplanted ◄ ORGANS TISSUES ◄ ● ◄ ● Kidneys ● Liver ● Heart ● Lungs ● Pancreas ● Sm. Digestive tract Cornea/Eyes Heart Valves Skin Bone Tendons Cartilage Veins ◄ ● ◄ ● ◄ ● ◄

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Donor Management Procurement Transplant Coordinator (PTC) ceases every single past request and composes new requests The PTC is in charge of the administration of the different organ giver from the assent through the working room recuperation handle. This first arrangement of requests will be maybe a couple full pages, (institutionalized requests) and yes, everything is STAT… .have I said the amount we value your diligent work?

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Donor Management Central line and A-lines are embedded if not officially done Central lines: IJ or SC for exact readings of CVP estimation.

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Donor Management - General Goals SBP 90-110 mmHg U/O 1-3 cc/kg HR 60-140 PAWP 7-12 Serum electrolytes WNL-Checked q 6 hours and prn CBC and coags WNL-Hct no less than 30 SPO2 >95% PaO2 90-110 torr pH 7.35-7.45 PCO2 35-45 torr

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General Goals Frequent ABG\'s (q 2-4 hours) PIP <32 mm Hg Lowest conceivable Fio2 Turn, pack and suction q 2 hours Antibiotic scope Zosyn 3.375 grams, Levaquin 750 mg, Vanco1 gram Control of DI

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Donor Management PCXR after line arrangement If lungs are being secured, a PCXR is required no less than like clockwork Fluid shortage redress Evaluation of pressors and conceivable expansion of T-4 (levothyroxine) trickle First dosage of 1 gram Solumedrol IVP Electrolyte, base shortfall rectification Addition of wide range anti-infection agents

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Vasopressin Aka: Pitressin Used as hormone substitution of ADH from back pituitary organ in mind dead patient Very compelling in treating DI related hypotension May or may not give 1-2 units IV bolus of Vasopressin before beginning dribble Drip rate is 0.5-2 units/hour Closely watch Urine Output—don\'t make the contributor anuric

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DI Treatment Look at aggregate I/O –since admission Output bungle with expanded Na and diminished K+ recommends DI Treat with Vasopressin/DDAVP Calculate add up to volume deficiency and supplant with 0.9% or 0.45NS FORMULA: 0.6 x body weight in kg = 1X Serum Na x 1X isolated by ordinary Na = X2 – X1 = add up to volume shortfall in liters Note this might be 10 or 12 liters so give substitution more than 12 to 24 hours

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Electrolyte Imbalances ~40% of cerebrum dead patients encounter hypokalemia of under 2.5 mEq/liter Hypocalcemia, Hypophostemia may likewise follow and may prompt to myocardial gloom Hypernatremia and hypomagnesemia may happen, particularly with DI

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Coagulopathy Frequently found in head injury patients GSW, SAH, Blunt injury Probably because of a lot of tissue fibrinolytic operator (local tPa) from the necrotic cerebrum into systemic flow Treat with proper blood products Platelets, FFP, Cryoprecipitate, PRBC\'s (leukocyte lessened) Hct ought to be no less than 30 for numerous organ recuperation

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Donor Management Heart 12 Lead EKG (serial) Echocardiogram (serial) Cardiac Enzymes CPK/MB, Troponin levels Hormone substitution (T-4,Vasopressin, Steroids) Cardiac Cath Usually done on heart givers > 45 years of age May be vital if pt is < 45 years of age and has noteworthy hazard elements

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Echocardiogram Effective in screening for anatomic variations from the norm Determine the physiological and hemodynamic solidness/work Tool to gauge viability of administration Hormone substitution Fluid administration

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Donor Management Lung Changes after cerebrum demise occurs Absence of bronchospasm because of death of cerebrum stem and medulla oblongata Declining capacity of bronchial submucosal organs Decreased or truant capacity of cilia These progressions result in gathering of bodily fluid in the needy projections of the lungs Potential for neurogenic pneumonic edema Thought to happen subsequently of brokenness of neuroepithelial bodies found in the epithelium of the alveoli and distal bronchioles

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Donor Management Lung Maintain pCo2 35-45, pH 7.35-7.45 Keep understanding warm Maximize tidal volume; 12-15cc/kg Aggressive trunk PT Maintain CVP 6-10 Use colloid versus crystalloid for liquid substitution Humidify at 100% relative moistness Over blow up ETT sleeve

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Donor Management Lung Initiate weight control ventilation and 1:1 I:E proportion PEEP of no less than 5 Keep PIP < 32 Lowest conceivable FiO2 Goal is PO2 of >125 on 40% and additionally PF proportion >300 Bag and Suction q2 hours Chest PT, postural seepage, ABG\'s q 2 hours and prn

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Donor Management Lung Possible utilization of Narcan 8-10 mg IVP Alveolar Recruitment Maneuvers CPAP of 30 for at least 1 minutes Gradual increment of PEEP to 15-20 more than 1-2 minutes Pressure Control ventilation Antibiotic scope: Levaquin 500mg q 24h and Zosyn 3.375 grams q 8 hour, Vancomycin 1 gram q 24 hours

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Donor Management Lung Chest X-Ray (serial) Bronchoscopy (serial) Sputum gram recolor and C&S ABG on 40% and 100% Possible Chest CT Usually for Trauma Patients and patients with noteworthy history

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Donor Management Liver Maintain Na < 150 Correct Electrolyte Imbalances Serial Liver Enzymes Tap water NG Lavage Possible Abdominal Ultrasound/CT

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Donor Management Kidney Avoid DI Serial UA with small scale Renal measurements dopamine 2-5 mcg/kg/min Serial BUN/Creatinine

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Donor Management Pancreas Serial Amylase, Lipase Blood glucose ( < 150 mg/dl ) Minimize use of IV dextrose Tight glucose control

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Donor Management Continued " 92% of organs that neglect to meet transplantation criteria on starting assessment can be practically revived." Zaroff, JZ. Et al. Agreement Conference Report: Maximizing utilization of organs recouped from the corpse benefactor: Cardiac suggestions". Flow 2002;106:836.

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The Gift of Life For some families: The endowment of organ and tissue gift is the main positive involvement in the terrible chain of occasions encompassing the loss of their adored one. It can help offer intending to a generally silly occasion that has happened.

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Donor Management Remember! The survival of transplanted organs depends intensely on pre contributor and benefactor administration executions

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Lily 2008 1984 Liver tumor, anticipating transplant Matthew Bemis, Lily\'s giver 1985

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Tong Hao (Recipient) "She runs, hops and plays ordinary as opposed to sitting in the stroller." – Yehong & Frost, Tong\'s folks

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Ms. Anne Gulatto

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Additional Resources UNOS Critical Pathway for the Organ Donor: Zaroff, JZ. Et al. Accord Conference Report: Maximizing utilization of organs recouped from the dead body contributor: Cardiac suggestions". Flow 2002;106:836. • Zaroff, JZ. Echocardiographic assessment of the potential heart giver. J Heart Lung Transplant 2004 ; 23(95):S250. The Role of Thyroid Hormone in Donation, Transplantation and Cardiovascular Disease (Medical Management to Optimize Donor Organ Potential February 23-25, 2004 California Health and Safety Code, segments 7150-7156.5, 7180-7184.5 and 7188-7195.

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