Clinical Services

The American Academy of Neurology brain death evaluation protocol, followed by Florida Statute, is intended as a useful tool for clinicians. This guidance is opinion-based. Alternative protocols may be equally informative.

The determination of brain death varies somewhat from hospital to hospital, but generally includes:

1. Clinical evaluation to confirm the total absence of brainstem reflexes and an absence of respiratory drive.
2. Ancillary tests performed including EEG, cerebral angiography, nuclear scan, Transcranial Doppler (TCD), CTA and MRI/MRA.

Prior to the acceptance of the concept of brain death under the Uniform Determination of Death Act in 1980, all organ donors fell under the protocol now called Donation after Circulatory Death. In the 2000s, the organ procurement and transplantation community returned to accepting organ donation after circulatory death as an acceptable, approved method.

This allows non-brain dead patients with specific clinical profiles who have suffered non-survivable brain injuries through either traumatic or clinical brain injuries to donate their organs and help save the lives of patients awaiting transplant.

LAORA is always grateful for the outstanding performance of all hospital staff members helping to facilitate organ donation. Throughout the hospitals we serve, we are humbled by the collaboration we receive every time we arrive to evaluate potential donors.

For organ donation to exist, a tight link must unify an Organ Procurement Organization (OPO) with its DSA hospitals. This union is supported by nurses, respiratory therapists, echo technicians, surgical technicians, physicians, PA’s, NPs and all members of the health care team in general. Thanks to this help, we’ve had great success throughout the years, but we cannot stop here; as days go by we are constantly reminded that more sick patients are added to the organ waiting list than the number of organs available.

We share an imperative to continue to work as a team and strive for the same results. This imperative includes implementing best practices and a pro-donation atmosphere to achieve an increase in the numbers of organ donors.

To achieve our mutual goals your hospital must be proactive and medically maintain patients that may be or are in the process of being pronounced brain dead, giving all families the equal opportunity to have their loved ones become organ donors.

The number of potential recipients awaiting their life-saving organ in the United States grows daily. The number waiting is over 100,000 and there are not enough organ donors to help all of them to receive the organ transplants they need.

Traditionally, HIV positive potential donors were excluded from donation. Then, on November 21, 2013, the HOPE Act (HIV Organ Policy Equity Act) was signed into law. This law makes it possible for us to transplant organs from HIV positive donors into HIV positive recipients who may be willing to accept an organ from an HIV positive donor. We can also use research to better understand how HIV positive organs can help those in need to receive life-saving transplants.

By offering HIV positive donor organs to HIV positive recipients waiting for a transplant, we can reduce the number of people waiting for transplants, saving the lives of both HIV positive and HIV negative people.

Historically, Organ Allocation was performed at the bedside throughout the country. Within the last 10-15 years, we have had a change in practice to improve the outcomes for our communities. Now, many Organ Procurement Organizations (OPOs) have allocation centers located in a centralized area. However, most OPOs still continue to allocate thoracic organs (Heart/Lungs) at bedside. Life Alliance decided to create an innovative Organ Allocation Center which has the capacity to perform both abdominal and thoracic organ allocation.

This change allowed the Donor Management Coordinators to focus solely on managing the donor hero care. This also enabled us to improve the communication between us and transplant centers. Performing allocation from a centralized location has improved organ placement times and increased the number of organs placed.

The Organ Allocation Coordinator department was staffed with five new hires with clinical backgrounds when it began in February 2015. This includes our staff of Surgical Recovery Coordinators (SRC) and Donor Management Coordinators (DMC). They went through extensive training.

Our training process includes shadowing, thoracic and abdominal Anatomy and Physiology lectures, determination of quality of the heart/lungs via Echocardiogram, ABG results, EKG, CXR/CT, Bronchoscopy, overview of UNOS, OPTN, CMS and OPO Policies and Procedures and one month of extensive supervised allocation in practice.

Once proven to be fully trained, the department launched in April of 2015. We are very proud of this feat and continue to equip our staff with the latest offerings in training and in practice to keep up with the standards of our stakeholders, and most importantly to serve our community most efficiently by saving lives through organ donation and transplantation.