Mario C., Son of Maria, HEART TRANSPLANT RECIPIENT
The Clinical Services Operations subdivision, comprised of a dedicated group of health care professionals is available 24 hours a day, 7 days a week to serve six South Florida counties and the Commonwealth of the Bahamas. This team of highly skilled, specially trained professionals dedicate themselves to the support of grief-stricken families while conducting the clinical management and surgical recovery of vital organs for transplantation on behalf of critically ill potential recipients. Clinical staff members respond to all Donation Service Area (DSA) hospitals in South Florida for potential donor referrals as designated by CMS to perform functions such as: Medical and Physical assessments, providing organ donation related information/education to medical professionals, requesting organ donation authorization, performing clinical organ donor management, and coordinating the surgical recovery and transportation of vital organs for transplantation and research.
As part of its general operational structure, LAORA Clinical Team staff members are dispatched at separate intervals in the donation/evaluation process to increase the likelihood of a favorable organ donation related experience for the donor family, hospital staff, and the potential recipients.
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:
- Clinical evaluation to confirm the total absence of brainstem reflexes and an absence of respiratory drive.
- 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 have 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 has been performed at donors’ bedsides throughout the country. In the last 10-15 years, many Organ Procurement Organizations (OPOs) have organized allocation centers where allocation may be done in a centralized area. However, most OPOs kept allocating thoracic organs at bedside. In 2015, LAORA’s leadership decided to create an Organ Allocation Center to perform both abdominal and thoracic allocation. This change allowed the Donor Management Coordinators to focus solely on managing donors and improving communication between the OPO and transplant centers. Performing allocation from a centralized location has improved organ placement times and increased the number of organs placed. Due to improved donor management, the OPO has been able to place 16.7 percent more transplanted organs.
Beginning in February 2015, LAORA staffed its new OAC with five new hires with clinical backgrounds. Their extensive six-week training included shadowing Surgical Recovery Coordinators (SRCs) and Donor Management Coordinators (DMCs), and lectures in both thoracic and abdominal anatomy and physiology. Training also included determining the quality of hearts and lungs via Echocardiogram, ABG results, EKG reading Chest X-Rays/CT scans, and bronchoscopies. The team also learned the regulations and standards set for OPOs by their regulatory bodies. They were considered fully trained after an additional month of extensively supervised allocation. The department launched in April 2015.