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All abstracts are organized by track and listed in alphabetical order by title.

Brain Death

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Author: 

Christy Meda Prakash, Respiratory Care Practitioner/Medical ICU Clinical Specialist, St. Joseph Mercy Health System Ann Arbor

Co-Authors:

St. Joseph Mercy Ann Arbor Brain Death Committee, 2019 aka A Guide To Understanding Brain Death

Purpose: To assist the support members of a patient that either is possibly brain dead or has been declared brain dead understand the process

Methods: Committee and research

Results: In general many people do not understand the finality of brain death, the difference between brain death and coma and the process to declare brain death or to rule it out.

Conclusion: 1. Educational handout was created 2. Revision of Brain Death policy

Defining Donation: Ethical Perspectives with Neurologically Intact DCD

UTOP DonorConnect

Author: 

Megan McClenny, ODC/RN/CPTC, DonorConnect

Co-Author: 

Sara Bowman, ODC/RN/CPTC, DonorConnect

Kate Elorreaga, FSC, DonorConnect

Purpose: A neurologically intact patient with a history of muscular atrophy, respiratory failure, and tracheostomy made the decision to withdraw care on himself. He had previously made himself a registered donor and given his mother power of attorney to make medical decisions if he was unable to for himself. Once the family decided to withdraw care patient was referred and OPO approached the family for donation. They agreed donation was something their son would want. During discussions with the family, they made it known that they did not want donation discussed with their son as they felt it would cause him more undo stress to have those conversations prior to withdrawing care. He was initially too sedated to make medical decisions upon OPO arrival to the hospital but became more lucid as time went on and after authorization. He eventually was awake enough to participate in his plan of care the day the withdraw was scheduled for and he verbalized that he did not want to have care withdrawn at that time. Family was still adamant the OPO not speak to him about donation. The case was placed on hold until the patient and his mother picked a time for withdraw of care the next day.

Methods: OPO worked with the hospital ethics team and ICU MDs. OPO stance was that if the hospital would align with them, then they would feel okay to move forward with DCD without speaking directly to the patient. All parties from the hospital were comfortable with the family’s decision to not speak directly to the patient because he was on the registry and the mother had legal POA for medical decisions.

Results: When recovery surgeons became aware of the patient’s neurological status and that family was refusing to let OPO speak directly to the donor, they were not comfortable participating and refused to come recover.

Conclusion: OPO medical director stated she thought that the OPO needed to provide more education for local surgeons regarding neurologically intact cases as this was not something they frequently encounter. OPO decided they cannot force a surgeon to recover if they are uncomfortable and ultimately had to walk away from this donor after authorization and lists had been ran due to not having any surgeons willing to recover. Family was upset that surgeons would not support patient’s registry status and their feelings that they knew what was in the best interest of their son.

Implementation of a “Hard Stop” Process to Prevent Potential Recipient Harm

SCOP

Author: 

Michael Lotts, RN, Clinical Donation Coordinator II/Admin. on Call, We Are Sharing Hope SC

Co-Authors: 

Julia Mekarski, Manager of Clinical Services, We Are Sharing Hope SC

Matthew Pipitone, Manager of Clinical Donation Specialists, We Are Sharing Hope SC

Purpose: To determine if implementation of a "Hard Stop" process will prevent potential recipient harm by ensuring all donor information has been reviewed by the Administrator on Call (AOC)/Medical Director prior to recovery.

Methods: The OPO developed a “Hard Stop” process to ensure review of all available donor medical information prior to recovery—potentially affecting patient safety. The “Hard Stop” process is implemented at AOC and/or Medical Director discretion but may be requested by any OPO staff member. It is initiated when there is an ABO discrepancy/indeterminate result, massive transfusion protocol (MTP), questionable brain death declaration, unresolved suspicion of malignancy and/or infectious disease process but should be utilized in any situation in which there is information that may affect recipient safety. This medical information may include, but not be limited to, previous medical records, pathology reports, consultations and/or additional information from family members The “Hard Stop” is documented by the onsite coordinator and the AOC in the OPO EMR and will prohibit the setting of a recovery time until final donor suitability is determined. The “Hard Stop” may only be released by AOC and/or Medical Director after all donor information has been reviewed.

Results: A 34-year-old Caucasian male donor case was initiated by the OPO. Serology, ABO, and HLA testing specimens were sent to their respective laboratories. All specimens were post transfusion, and no pre-transfusion specimen could be located. The blood type results from two outside laboratories were concordant (blood group B). Despite this, multiple blood samples were evaluated at a third laboratory and those results, although discordant with the other 2 labs, were consistent and resulted as indeterminant. The Medical Director on call had multiple conversations with different blood bank managers and medical directors. Given the unresolved indeterminant results from the third lab, the medical director and AOC discussed the risks and benefits of listing this donor as a blood group B donor despite these findings. As the OPO could not fully explain the indeterminate, the team did not feel comfortable ignoring this lab result. Therefore, the OPO decided listing the donor as blood group AB was the only way to ensure the safety of potential recipients. After the release of the “Hard Stop,” the donor was listed as blood group AB, resulting in the safe recovery and transplantation of lungs and kidneys.

Conclusion: The “Hard Stop” process effectively ensures all donor patient information is reviewed prior to recovery and effectively prevents potential recipient harm.

Implementation of Medical Record Review Coordinators Leads to an Average Increase in Donation

MIOP

Author: 

Kristie Carnevale, Medical Record Review Coordinator - Gift of Life Michigan

Co-Authors: 

Sheri Frank, BSN, RN, CCRN-K, SCRN, Medical Record Review Coordinator - Gift of Life Michigan

Tonia Porterfield, Medical Record Review Coordinator - Gift of Life Michigan

Purpose: An Organ Procurement Organization (OPO) launched a Medical Record Review Coordinator (MRRC) position intended to relieve Hospital Services Associates (HSA) from the monthly death record review requirement. This gave the OPO its most accurate data, while allowing the HSAs more time on-site at respective hospitals. HSAs are available sooner for potential donation possibilities, among other efforts to increase donation, thus leading to more organ and tissue donors, on average, over the last three years.

Methods: Empirical data for three years prior to and three years post-implementation of the MRRC position were collected and analyzed. The data sources utilized were our OPO’s staff dispatching and tracking report, the donor event log, and the death record review summary report.

Results: The MRRC team was launched in 2017 as a branch of the Hospital Services Department. Over the next three years, the MRRCs grew from reviewing 10 hospitals monthly to accomplishing 55 hospitals each month (Chart 1). The following increases were evident in the data for the periods before and after MRRCs: • HS on-site responses for potential organ donors (Chart 2) - The prior average was 250 responses per year, afterwards, responses grew to an average of 711, or a 184% growth. • Vented organ potential referrals (Chart 3) - Increasing the HSAs on-site frequency led to an 8.5% increase in referrals from an average of 6,983 to 7,576 post-MRRC implementation. • Total organ donors (Chart 4) - Organ donation increased by 16.4% from 280 to 326. • Number of organs transplanted (Chart 5) - The average number of organs transplanted increased from years prior by 16.1% from an average of 851 to an average of 988. • Approaches for organ donation (Chart 6) - There also was an 18.3% increase in the number of approaches from 624 to 738 for organ donation. • Total tissue donors (Chart 7) - There was a 25.2% increase (1,060 to 1,327) in the average number of tissue donors.

Conclusion: The study provided clear evidence that the implementation of the MRRC positions enabled the HSAs more on-site presence and visibility aiding in the increase in both organ and tissue donation over a three-year period, saving more lives and reinforcing the decision to add the MRRC positions at our OPO.

Implementation of the APOLLO Research Project Within An OPO; Structured Training and Planning Lead to Successful Implementation and Processes

Gift of Life Donor Program Feat Img

Author: 

Gena Mayer, Manager, Transplant Coordinator Services, Gift of Life Donor Program

Co-Authors: 

Richard Hasz, MFS, CPTC, Vice President of Clinical Services, Gift of Life Donor Program

Howard Nathan, BS, CPTC President / CEO, Gift of Life Donor Program

Purpose: This abstract demonstrates the effectiveness of having a structured training, implementation and a standardized process for successful participation in a national research project requesting research authorization from African-American donor families.

Methods: The OPO was invited to participate in the National Institute of Health’s (NIH) APOLLO study evaluating the long term outcomes of donated African-American kidneys. In order to participate in the study the OPO needed to train several departments within the OPO as well as work with their contracted HLA lab. Procurement coordinators were trained in the approach of African-American families for the APOLLO project by providing the background of the project as well as being given scripted family approach language. Once authorization for the project is obtained there is a standard process that occurs on every case where the APOLLO samples are collected in the OR, sent to the contracted lab and the contracted lab contacts the OPO’s designee to confirm the sample should be run. This process occurs on each case ensuring that there is consistency each time there is an APOLLO donor. There are also redundancies built into this process which includes multiple OPO staff members in each part of the process starting from authorization, to specimen collection through specimen drop off which has helped minimized any errors in sample collection. It is important for the study that recipients of APOLLO donor kidneys are also enrolled in the study. The OPO encourages transplant centers to enroll their recipients. The OPO ensures the centers are aware of the APOLLO donors by indicating the donor is an APOLLO donor in DonorNet, indicating it in allocation calls and sending a weekly report of APOLLO donors to the transplant centers. The APOLLO Study itself only requires a flyer to be included in the box with the donated kidney.

Results: Data results since July 22, 2019 when the OPO began participation in the study: 42 African American donor families were approached for research, 34 authorized research, 31 of these families were approached for the APOLLO study and 29 of the families authorized the study, two families declined and three families were not approached due to rule out criteria for the study. 21 successful APOLLO samples collected. Full data can be seen in the uploaded file.

Conclusion: The success of implementing a research project within an OPO requiring specialized authorization as well as additional steps to the donation process is reliant upon training and clear processes. It is also vital for the OPO to support all aspects of the research study from beginning to end in order to help make the biggest impact on donation and transplantation.

Increase OPO and Transplant Center Engagement Through Collaborative Organ Case Review

MIOP

Author: 

William Thompson, Clinical Manager - Organs, Gift of Life Michigan

Co-Authors: 

Jennifer Henderson, Transplant Center Liaison, Gift of Life Michigan

Bruce Nicely Chief Clinical Officer, Gift of Life Michigan

Purpose: Build a more collaborative partnership with local transplant centers to save more lives. An Organ Procurement Organization (OPO) created a more interactive weekly event where organ cases are discussed with transplant centers, including the case challenges which provide opportunities for better outcomes. Better collaboration, in-person visits and weekly conference calls with the local transplant programs have improved both communication and relationships. Interaction among numerous stakeholders allows for discussion of every aspect of donation and transplantation, allowing for increased utilization of transplantable organs and changes to acceptance criteria by the centers involved. Equally important, transplant center programs were given a voice in the cases being reviewed.

Methods: All transplant programs in the DSA were invited to participate in weekly retrospective review of the previous week’s organ donation cases and outcomes. OPO staff conducted the reviews from various transplant centers during the year, with all other centers joining remotely. Case summaries were provided to potential participants a few days prior to the call.

Results: Participation has grown as evidenced by the tracking and monitoring participation in weekly case reviews. Eight of nine transplant centers have hosted case reviews at least once during 2019, with numerous employees attending and engaging in the reviews. The third and fourth quarters of 2018 demonstrated that fewer than 10 individuals from the OPO and transplant centers attended the weekly discussion. In 2019, attendance rose to 30 participants - a 200% increase. The change has strengthened the relationships between the OPO and transplant centers. Frequent suggestions to improve organ use outcomes have been offered, and some centers have changed their acceptance criteria.

Conclusion: Including transplant centers in the OPO’s case reviews has bolstered relationships between the OPO and local centers. All parties routinely join the reviews, allowing them a voice. Tracking weekly call attendance allows the OPO to continue to evolve case reviews and grow the relationship between transplant centers and OPO staff. The local acceptance of more organs has been the highlight of this change, saving more lives with a higher level of collaboration.

Massive Transfusion Protocols: The Unintended Impact on Organ Donation

TXGC

Author: 

Javier Nieto, MD, CPTC, Manager of Organ Clinical Operations, Southeast Region, LifeGift

Co-Authors: 

Kaitlyn Fitzgerald BSN, RN, CPTC, LifeGift

R. Patrick Wood, MD, FACS, LifeGift

Purpose: Massive transfusion protocols have become more common in the past several years and most OPO’s have had experience with organ donors whose blood type determination has been difficult due to the massive transfusion of blood type O negative packed red blood cells into the trauma patient. In the massive transfusion protocols, packed red blood cells, fresh frozen plasma and platelets are combined in fixed amounts to be rapidly transfused into the trauma patients.

Methods: If the donor’s blood type cannot be confirmed because there is no pre-transfusion sample, the donor’s organs must be allocated as if they were AB blood type and allocated to AB blood type recipients since AB blood type recipients can receive organs from a donor of any blood type. AB recipients are therefore the universal recipients and can be safely transplanted with organ from donors whose blood type cannot be determined.

Results: Our OPO had two donors, in a 5-day period, who suffered extensive traumatic injuries and both received large volumes of whole blood. The question came up that because the donors received whole blood and since whole blood contains all of the blood elements including lymphocytes, that there was the potential that the tissue typing results, which are usually obtained using the donor’s blood (lymphocytes), could be erroneous due to the presence of transfused lymphocytes. We sent the donor’s blood to the HLA lab and lymph nodes to a different HLA lab in the donor hospital. HLA results were the same for the blood and the lymph node. The heart, liver and left kidney from the first donor were successfully recovered and allocated to AB blood type recipients (the right kidney was not transplantable due to a traumatic injury). No organs were recovered from the second case and the case was shut down.

Conclusion: With the addition of whole blood to the arsenal of the helicopter and ambulance EMTs, massive transfusion protocols are now being started in the field. The likelihood of the EMT’s being willing and able to obtain pre-transfusion blood samples for blood type determination seems unlikely in view of the urgency of taking care of the trauma victim. The question of whether the transfusion of large volumes of whole blood will affect the tissue typing of the donor remains open.

OPO and Transplant Center Partnership Expand the Donor Pool

carolina-donor-svs-feat-img

Author: 

Nissa Casey, Manager of Preservation, Carolina Donor Services

Purpose: There are currently over 3,000 people waiting for a life-saving heart transplant. While the first heart transplant was from a donation after circulatory death (DCD) donor, hearts from this donor pool are no longer considered a viable option in the adult population. Research to utilize the DCD donor pool was being performed at the transplant center. In order to successfully perform heart recoveries on DCD donors with minimal disruption the hospital DCD process, a partnership between the transplant center and organ procurement organization (OPO) was forged.

Methods: The transplant center contacted the OPO’s Research Coordinator early in the process of protocol development. Information about the project was presented to the OPO’s Research Review Committee (RRC). Along with the Research Coordinator, the RRC, a multi-disciplinary group consisting of representatives from the Executive and Leadership teams, reviews and approves all OPO research related activities. With RRC approval, the Research Coordinator began developing education strategies for hospital staff, and OPO teams in the Family Services, Hospital Development, Organ Services, and Preservation departments. The transplant center performed education for each OPO department while the Research Coordinator collaborated with a Hospital Development Specialist to develop standardized tools and education templates for project introduction to our hospital partners. Hospital education efforts were focused on operating rooms in all A hospitals, and post-donation surveys were used to identify opportunities for more targeted education.

Results: Since the project’s go live date in November, the OPO has had four DCD heart donors resulting in one transplant. Because the initial two donors were required per the clinical study protocol, fifty percent of the OPO’s DCD hearts have been transplanted. The OPO has also accompanied the transplant team to provide preservation services on three flyouts, all of which have resulted in transplants for a one hundred percent utilization rate. Survey results from one local donor highlighted the need for more targeted education.

Conclusion: Early collaboration between the two organizations allowed the OPO to adequately prepare its staff and hospital partners for significant changes to the DCD process. Managing this change resulted in minimal impact to the hospitals while increasing the heart utilization rate and expanding the donor pool.

OPO Creates Transplant Center Symposium

PATF

Author: 

Jessica Yokubeak, Manager, Organ Donor Referral Services, Center for Organ Recovery and Education

Purpose: In order to further successfully collaborate with one of the OPO's key customers, transplant centers, the OPO decided in 2018 to hold a Transplant Center Summit. The OPO was committed to sharing best practices and learning more about the transplant center processes with candidates and recipients.

Methods: The OPO began planning an annual Transplant Center Symposium in 2018. The front line team members were involved in the planning and deployment of the agenda as well as the symposium. The 2018 agenda centered around OPO processes and procedures. The 2019 agenda requested more involvement in the Transplant Center with presentations and panel discussions.

Results: A survey was performed and concluded that the attendees, being transplant center staff, wanted more collaboration with the OPO. Additionally, it was determined to continue with this Symposium on an annual basis.

Conclusion: A survey was performed and concluded that the attendees, being transplant center staff, wanted more collaboration with the OPO. Additionally, it was determined to continue with this Symposium on an annual basis.

Post-Procurement Donors with Multi-Drug Resistant Organisms

TXGC

Author: 

Javier Nieto, MD, CPTC, Manager of Organ Clinical Operations, Southeast Region, LifeGift

Co-Authors: 

Rodney Cruz, RRT, CPTC, LifeGift

R. Patrick Wood, MD, FACS, LifeGift

Purpose: It is a requirement and standard practice to obtain blood and urine cultures on every deceased organ donor in addition to sputum cultures on every deceased lung organ donor. The positive results of these cultures are communicated to the receiving transplant program’s patient safety contact within 24 hours of the communication of the results to the host organ procurement organization (OPO). No reporting is required to the donor hospital at this time.

Methods: In our OPO, The Patient Safety Coordinator (PSC) or QS Specialist, or other designate will monitor UNET for the addition of a new donor. The laboratory receiving the culture samples will be contracted, via phone or through the online portal, to ensure sample arrival. Based on the arrival time the PSC/QS Specialist will begin the tracking for the culture results. The testing lab will be contacted on the 3rd day following receipt of the sample to obtain the final urine and sputum cultures and preliminary blood cultures and again on the 6th day following receipt to obtain the final blood cultures. Direct contact with the testing lab is required if the 3rd and 6th day results are not received.

Results: Our OPO PSC obtaining retrospective culture results on organ donors will notify the appropriate transplant center patient safety contact, or designee, as determined by the transplant center, with any donor cultures that are reported as positive (within 24 hours of receipt), this includes both preliminary results as well as final results that may include sensitivities.

Conclusion: The reporting of positive cultures is of importance to the organ recipients from deceased organ donors due to the immunosuppression therapy required to decrease the potential for organ rejection. This has been properly identified by the OPOs and transplant programs and has resulted in policies that reflect the effective communication of positive results to the receiving transplant programs. We have observed an increase in our culture sensitivity results that includes multi-drug resistant organisms. The lack of communication to the donor hospital represents a potential missed opportunity to alert the hospital where the donor spent the days prior to organ procurement for them to proceed with the proper terminal cleaning of the donor hospital unit to avoid the spreading of such organisms among their current in hospital patients. A revision of the reporting process is recommended to prevent the spreading of this organisms in the donor hospitals.

Unlearning Cultural Competence “A Modern Approach to Cultural Competence Training”

Donor Network West Featured Image

Author: 

Sharon Shamoon, CPC, Donor Network West

Co-Authors: 

Ashley Garcia, CPC, Donor Network West

Purpose: If a patient with Anaplastic ependymoma of posterior fossa brain, WHO grade 111 cancer is diagnosed and the blood-brain barrier is breached, then there is still a chance for successful organ transplant

Methods: Full workup began with disclosure of patient's diagnosis. Ended with a post mortem brain biopsy

Results: Patient was diagnosed with in-vitro brain tumor at age of 5 months and then became brain dead Successful heart transplant

Conclusion: You can successfully transplant organs from patients that are considered high risk with rare CA