Final iopo

Question 1

-Nonforprofit health service dedicated to advancing organ tissue and eye donation throughout Indiana
-Each organ has a specific amount to recover organ: gov pays for that
-Link between people waiting for a transplant and potential donors
-Coordinates organ donation with United Network Organ S? Indiana donor families transplant teams, the donor and recipient hospitals and recipient families
-Travel to other states with surgical teams to recover organs for Indiana patients
-Can offer to other states if they don’t except it here
*Cold ischemic time: time that is allowed that needs to be refused and rewarm: 4-5 hours/ abd 6-8 hours
Kidney transplant is highest need

Answer 1

Organ Donation Process IOPO

Question 2

18 ppl die each day waiting for a transplant
Another person is added to the list every 12 minutes
-Look at organ donor look at all 8 organs even though one is not working

Answer 2

Waiting list:

Question 3

COPD, cystic fibrosis, Idiopathic pulmonary fibrosis, pulmonary hypertension

Answer 3

Indications for lung transplant:

Question 4

Ischemic cardiomyopathy, non-ischemic dilated cardiomyopathy, myocarditis, valvular defects, arrhythmia, congenital heart defects (peds pt)

• age much quicker, 4 years for every year you live
• do not feel pain in the chest because the nerve that goes all the way through the body vagus nerve is cut=routine check up and ekg every months then 3 months then 6

Answer 4

Indications for heart transplant:

Question 5

chronic hep for hcv infection, liver cancer, primary sclerosing cholangitis, NASH=big one nonalcoholic sclerotic hepatitis: very sick ascites, alcoholic liver disease, genetic disorders, idiopathic fulminant liver failure
Hep donor gives to hep pt: do not transplant active hep c, can do non active core

Answer 5

Indication for liver transplant:

Question 6

: chron’s disease, trauma, massive resection secondary to tumor, volvulus, sma or smv thrombosis, short bowel syndrome=peds
-28 vessels have to be tied individually

Answer 6

Indication for intestinal transplant

Question 7

: Insulin dependent diabetes who have a hx of frequent acute and severe metabolic complications requiring medical attention=frequent episodes of hypoglycemia or hyperglycemia

Answer 7

Indication for pancreas transplant

Question 8

: chronic hypertension, diabetes, polycystic kidney disease, infection, trauma
-monitor systolic and diastolic, monitor residual pressures/ can last days outside body

Answer 8

Indication for Kidney transplant

Question 9

organs donation process is multidimensional and requires a collaborative effort: transplant center, organ procurement coordinators, hospital staff, both recovering and transplanting surgical teams, donors and recipients, families =take care of families 13 months first everything, counseling group team meeting

Answer 9

Team effort:

Question 10

trauma to head, massive bleeding or swelling of the brain=Hematoma, aneurysm, stroke, hydrocephalus, loss of oxygen to the brain= anoxic event, Ischemia

Answer 10

Cause of brain injury:

Question 11

Any hospital that receives in Medicare or Medicaid they have to establish written protocols for donor identification and referral

• all hospitals must call their local opo with notification of every death and imminent death
• ensures that families of potential donors are made aware of the option to donate or refuse
• The individual who approaches the family must be trained designated requestor
• Hospital referral compliance rate are key in assessing education needs of hospital is audited by cms and jcaho
• Compliance rate is shared with hospital administration quarterly and as needed

Answer 11

CMS Conditions of participation

Question 12

• Vented pt with a gcs of 5 or less
• Before any terminal wean: call at first mention from physicians or gamily/donation after circulatory death
• Cardiac time of death must be called even if you call with the above triggers

Answer 12

Referral triggers/ call criteria

Question 13

Iopo receives the referral form the hospital in order to determine medical suitability

• preliminarily accepted or declined as a potential donor
• if accepted an iopo coordinator may arrive onsite to further evaluate the patient
• HIPPA exempted opo, even though they follow the guidelines, must have the release of medical records

Answer 13

Referral

Question 14

Pt with bacterial meningitis, positive blod cultures, brain tumor, hep b and c, hx of drug and alcohol abuse

Answer 14

Who can donate:

Question 15

occurs when damage to the brain is so bad that it stops working permanently, time of death is when brain died, time of brain death is documented as the time of death on the patient’s death certificate

• cannot be reversed
• can be considered with neuro check and apnea test

Answer 15

Brain death:

Question 16

: known caused of injury to the brain, irreversible condition, all reversible conditions must be excluded, no brain function in all parts of the brain including the brain stem, observation for an adequate period of time/ apnea test 8 mins unstable have to stop

Answer 16

General criteria brain death

Question 17

all 12 cranial nerves absent
1. Pupillary response no light in eyes, pupils neither constrict nor dilate
2. corneal reflex pt will no blink when tissue brushed across eye
3. Dolls eyes: are held open head is turned side to side the eyes should follow the movement of the head
Spinal reflexes start to go away with progression of the case
4. Cold caloric: ice water is injected into the ears while the eyes are held open there should be no eye movement
5. No cough or gag reflex
6. no response to deep pain
7. apnea test

Answer 17

Components of negative exam:

Question 18

: not required to pronounce brain death in state of Indiana but being used with more frequency
-eeg showing no physiologic brain activity
-brain flow study showing no cerebral circulation: gold standard
Cerebral angiogram: 4 vessel study

Answer 18

Confirmatory test

Question 19

• family must understand their loved one is dead prior to any donation discussion
• Indiana donor choice law= verify donor designation status
• offering the option-iopo values a team approach as best possible outcome for family service and donation
• assists the grieving process

Answer 19

Consent

Question 20

-once consent is obtained iopo clinical team is notified and billing is turned over the iopo
-Family services coordinator obtains medical/social history from family
-death documentation and testing is verified
-iopo team assumes medical care of the patient
-begin process of stabilizing patient hemodynamic status and evaluation organ function
- blood draw for serology testing
-lymh node recover for tissue typing
Diganositic tests

Answer 20

icu

Question 21

• Reviewed and entered into iopo electronic charting
• Pt registered with UNOs and chart is uploaded to donor net
• Once hla antgiens and serologies are reported lists of potential recipients are generated for each organ that is transplanted

Answer 21

Registration:

Question 22

14-16 hours after start of donor care, organs placed per unos policy

Answer 22

Organ placement-

Question 23

-begins with first patient and continues until organ is placed for transplant
Organ offers are sent electronilally=can only do 3 centers at a time, unable to skip pts, transplant centers have 1 hour to review information and provisionally accept the organ or decline=all organ declines have to be justified
-once organ are they are back-up offers are sent out

Answer 23

Allocation:

Question 24

• one of the most difficult parts of donation process
• coordination with transplant teams
• coordinator with hospital or
• Delays from transplant centers
• Delay form hospital or
• Weather delays
• Intraoperative delays

Answer 24

Setting OR time

Question 25

Organ recovery is done in a sterile surgical enviro
Midline incision
Organs are freed up and inspects
Aorta is cannulated
Organ are flushed with preservation fluid
Thoracic organs are recovered before abdominal organs

Answer 25

Operating room:

Question 26

iopo coordinator will provide follow up information to the donor family and hospital staff regarding the outcome of the donation

• letter explains which organs were transplanted ans some general info about recipients
• if recipients and donor families wish to contact each other the host opo may help facilitate communication between the two assuming that both parties are comfortable doing so

Answer 26

Bereavement

Question 27

• Get iopo involved asap to begin evaluating the pt as donor
• Help in following the consent protocol=only trained designated requestors can approach families for consent
• Use iopo as your resource and direct questions of your families to organization

Answer 27

Nurses