Nursing Considerations with Organ Procurement

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Who You’ll Hear

Kati Kleber, MSN RN – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center

Melissa Stafford, BSN RN CCRN SCRN – highly experienced and currently practicing nationally certified neurocritical care nurse.

What You’ll Learn

• Organ procurement
• Organ procurement organizations
• What happens after death
• Codes
• Tests for organs
• Prepare the family
• DCD

Nursing Considerations with Organ Procurement

When the patient is donating their organs, there are a lot of things that are now the responsibility of the nurse. In this episode, we discuss what it practically looks like to prepare a patient for organ procurement and some of the variations of the process, as well as our own experiences.

Organ Procurement

What is organ procurement?

• Done in critical care
• It is procuring organs from someone who has passed away and giving them to people who need them.
• Don’t say harvesting – say procuring.

Organ Procurement Organizations

Organ Procurement Organizations are also called OPOs.

• What the OPO’s job includes:
  • After they get a referral about a patient, they will delve into the patient’s chart.
  • They do not talk to the patient’s family
  • They look to see which organs could potentially be donated.
• Remember, organ procurement is an ethically-sensitive situation
  • If you’re not sure if you can say something – exercise caution and don’t say it, chat with your OPO rep who you’ve talked to first
  • In many cases, tissue and eye donation can be done (at the funeral home) if organs cannot be donated. Again, this is out of the nurse’s scope to decide this.
  • Your job is to notify the OPO when triggers are met (which are listed below), and follow their instructions. That’s it. Don’t take it upon yourself to have conversations about donation with the family.
  • Legally you cannot deny a patient or their family the opportunity to donate their organs.
• Know your facility’s policies in regards to how and when to notify OPOs.
• When to call OPOs
  • GCS less than 5
    • Glasgow Coma Scale – the level of unresponsiveness
    • Made up of the eye, verbal and motor response
  • Imminent death
  • The family is wanting to withdraw life support

What Happens After Death is Imminent and OPOs are Notified

What happens after all tests prove the patient is declared brain dead and OPOs have been following?

• First, gain consent.

What Happens If A Patient Codes

We know what happens if a patient is declared brain dead, but what happens if a person codes?

• If the heart stops, do chest compressions on the way to the OR.
• They go to the OR to do the organ procurement immediately.

Kinds of Tests They Do for Various Organs

What are some of the different tests they run for different organs?

• Heart
  • Echo
• Lungs
  • Cath Lab
  • O2 Challenge
  • ABGs
  • Bronchoscopy
• Liver
  • Lab work
  • Ultrasounds of the liver
  • Ultrasound-guided biopsy
• Kidneys
  • Lab Work
  • INO – fluid amount
  • Ultrasounds
• Actual inspection of the organs by the transplant team is incredibly important.
  • Malignancy or other issues can hide and only be seen when the organs are inspected visually.

How to Prepare the Family if You Think the Patient is Brain Dead

If you think the patient is brain dead and there will be tests to verify, the family should be prepared.

• Don’t use the term “brain dead.” Use the phrase “I think the brain is no longer functioning” a lot.
• Brain death is scary.
• Talk to them about the reflexes that aren’t happening.
• Always say, “I’m really concerned about your loved one. I’d really like to see more movement when I’m doing these things.”

DCD – Donation After Cardiac Death

What is it and how is it managed differently?

• Donation After Cardiac Death (DCD):

• Persistent Vegetative State – Patient is not brain dead

More Resources on Organ Procurement:

• Nursing attitudes towards organ donation, procurement, and transplantation from NCBI
• Nursing Considerations with Brain Death
• S1E10 – Dealing with Patient Deaths