Hemodynamic Monitoring of Organ Donors: A Novel Use of the Esophageal Echo-Doppler Probe

The esophageal Doppler monitoring (EDM) technology is well described in the literature. As it evolved over the last several years, the use of EDM has found expanded indications in various clinical settings. One of the areas where EDM has not been studied extensively is its use during optimization of organ donors before organ procurement. Close hemodynamic monitoring has become essential in the era of increasing use of extended organ donors. We present six cases of successful EDM use during preorgan procurement resuscitation of organ donors. Despite labile hemodynamics in the majority of these cases, EDM-guided optimization of resuscitative end-points allowed successful organ procurements and transplants, including 12 kidneys, 6 livers, 3 hearts, 2 pancreases, and 2 lungs. The EDM technology is noninvasive, technically easy, and less expensive than the traditional pulmonary artery catheter. Other potential benefits of the EDM include its portability and possibility of deployment in any setting by trained organ procurement personnel or critical care nursing staff. In conclusion, successful organ procurement can be facilitated by the use of EDM technology in hemodynamically labile organ donor patients.

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Chaplain “DOs and DON’Ts” on Organ Donation

Ethics & Medics ◽

10.5840/em201843711 ◽

2018 ◽

Vol 43 (7) ◽

pp. 1-2

Author(s):

Jozef Zalot ◽

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

Family Members ◽

Organ Donor ◽

Organ Donors ◽

Vital Organ ◽

Course Of Action ◽

Donation Process ◽

Organ Procurement Organizations ◽

The Relationship

This guide was developed in collaboration with LifeCenter Organ Donor Network (Cincinnati, OH) to offer chaplains a framework for the best possible course of action when they provide spiritual care to family members of patients who are potential vital organ donors. Some organ procurement organizations (OPOs) may want to control the donation process. They are thus hesitant to invite in—let alone collaborate with—any “outsiders” who they believe might undermine the likelihood of procuring vital organs. So how should a chaplain respond when ministering to potential vital organ donors and their families? Should they speak with family members about donation? What should they say? Do OPOs want chaplains to speak with family members? Should there be limits to these conversations? This can be a touchy area, because vital organ donation necessarily entails the death of the patient. This makes the relationship between chaplains and OPOs sometimes strained.

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How nurses shift from care of a brain-injured patient to maintenance of a brain-dead organ donor

American Journal of Critical Care ◽

10.4037/ajcc2001.10.5.306 ◽

2001 ◽

Vol 10 (5) ◽

pp. 306-312 ◽

Cited By ~ 21

Author(s):

L Day

Keyword(s):

Critical Care ◽

Organ Procurement ◽

Injured Patient ◽

Organ Donor ◽

Critical Care Nurses ◽

Organ Donors ◽

Early Referral ◽

Brain Injured Patient ◽

Brain Injured ◽

Brain Dead

BACKGROUND: The responsibility of obtaining organs for transplantation rests partly on critical care nurses. How nurses balance care of critically ill, brain-injured patients with the professional responsibility to procure organs is a question of ethical and clinical importance. OBJECTIVES: To describe the experiences of critical care nurses in making the shift from caring for a brain-injured patient identified as a potential organ donor to maintaining a brain-dead body. METHODS: An interpretive, phenomenological design was used. In 2 trauma centers, 9 critical care nurses were interviewed, and 2 of the 9 nurses were observed. RESULTS: Identification of potential organ donors is made under conditions of prognostic ambiguity. The transition from brain injury to brain death is a period of instability in which the critical care team must decide quickly whether to resuscitate a patient in order to procure organs. After a patient is brain dead, critical care nurses' relationship with and responsibility toward the patient change. CONCLUSIONS: The process of identifying potential organ donors and holding open the tentative possibility of organ procurement illustrates the practical difficulties of early referral of potential donors to organ procurement organizations. Early referral to an organ procurement organization implies a commitment to organ procurement that some nurses may hesitate to make because such a commitment changes their relationship with a brain-injured patient.

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Cuidados a pacientes em uso de oxigenação por membrana extracorpórea

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963.2019.242035 ◽

2019 ◽

Vol 13 ◽

Author(s):

Daniel Santos ◽

Luana Cardoso ◽

Thalisson Cássia ◽

Michelle Prata ◽

Eduesley Santos

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Latin American ◽

Nursing Care ◽

Hemodynamic Monitoring ◽

Complete Recovery ◽

Critical Care Nursing ◽

Status Monitoring ◽

Membrane Oxygenation ◽

Analysis Technique ◽

Care Nursing

Objetivo: analisar as evidências acerca da assistência de Enfermagem a pacientes em uso de oxigenação por membrana extracorpórea. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa, com busca de artigos publicados em periódicos científicos de 2008 a 2018 e indexados nas bases de dados LILACS, MEDLINE e Scopus e no Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BIREME), analisados pela técnica de Análise de Conteúdo e apresentados em formas de figuras. Resultados: selecionaram-se nove artigos com a análise que agrupou os resultados nas seguintes categorias: Deambulação/Mobilização; Gerenciamento dos circuitos; Cuidados gerais de Enfermagem; Monitorização hemodinâmica, posição prona; Monitorização do estado de sedação; Controle da anticoagulação e monitoração do sangramento. Conclusão: entende-se que a assistência de Enfermagem repercute diretamente na melhora do quadro clínico de pacientes que utilizam este tipo de suporte hemodinâmico, sendo primordial para a sua completa recuperação. Devem-se proporcionar capacitações específicas para que os enfermeiros possuam habilidades e competências suficientes para assistir o paciente de maneira segura e eficaz. Descritores: Cuidados Críticos; Enfermagem; Cardiologia; Oxigenação por Membrana Extracorpórea; Monitorização Hemodinâmica; Cuidados de Enfermagem.AbstractObjective: to analyze the evidence about nursing care for patients using extracorporeal membrane oxygenation. Method: this is an integrative review bibliographic study, searching for articles published in scientific journals from 2008 to 2018 and indexed in the LILACS, MEDLINE and Scopus databases, and the Latin American and Caribbean Center for Science Information. Health (BIREME), analyzed by the Content Analysis technique and presented in figure forms. Results: nine articles were selected with the analysis that grouped the results into the following categories: Ambulation / Mobilization; Circuit management; General nursing care; Hemodynamic monitoring, prone position; Sedation status monitoring; Anticoagulation control and bleeding monitoring. Conclusion: it is understood that nursing care directly affects the improvement of the clinical condition of patients using this type of hemodynamic support, being essential for their complete recovery. Specific training should be provided so that nurses have sufficient skills and competencies to assist the patient safely and effectively. Descriptors: Critical Care; Nursing; Cardiology; Extracorporeal Membrane Oxygenation; Hemodynamic Monitoring; Nursing Care.ResumenObjetivo: analizar las evidencias sobre el cuidado de Enfermería para pacientes que usan oxigenación con membrana extracorpórea. Método: este es un estudio bibliográfico de revisión integradora, que busca artículos publicados en revistas científicas de 2008 a 2018 e indexados en las bases de datos LILACS, MEDLINE y Scopus, y en el Centro Latinoamericano y del Caribe de Información en Ciencia de la Salud (BIREME), analizadas por la técnica de Análisis de Contenido y presentadas en forma de figuras. Resultados: se seleccionaron nueve artículos con el análisis que agruparon los resultados en las siguientes categorías: Ambulación / Movilización; Gestión de circuitos; Cuidados generales de Enfermería; Monitoreo hemodinámico, posición prono; Monitorización del estado de la sedación; Control de anticoagulación y monitoreo de hemorragias. Conclusión: se entiende que la atención de Enfermería impacta directamente en la mejora de la condición clínica de los pacientes que utilizan este tipo de soporte hemodinámico, siendo esencial para su recuperación completa. Se debe proporcionar capacitaciones específicas para que los enfermeros tengan suficientes habilidades y competencias para ayudar al paciente de manera segura y efectiva. Descriptores: Cuidados Críticos; Enfermería; Cardiología; Oxigenación por Membrana Extracorpórea; Monitorización Hemodinámica; Atención de Enfermería.

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Explaining Brain Death: A Critical Feature of the Donation Process

Journal of Transplant Coordination ◽

10.1177/090591999700700104 ◽

1997 ◽

Vol 7 (1) ◽

pp. 14-21 ◽

Cited By ~ 14

Author(s):

Holly G Franz ◽

William DeJong ◽

Susan M Wolfe ◽

Howard Nathan ◽

Denise Payne ◽

...

Keyword(s):

Brain Death ◽

Organ Procurement ◽

Healthcare Providers ◽

Organ Donor ◽

Organ Donors ◽

Visual Aids ◽

Next Of Kin ◽

Critical Feature ◽

Telephone Interviews ◽

Donation Process

To examine how a family's understanding of brain death may affect the decision to donate, an interview study was conducted with the immediate next of kin of 164 medically suitable organ donor candidates. Telephone interviews were conducted with members of both donor and nondonor families 4 to 6 months after the relative's death. Only 61% of the donor and 53% of the nondonor respondents said they had received an explanation of brain death. Few respondents reported that the hospital or organ procurement organization staff used visual aids to clarify or reinforce the information they were given. Next of kin who decided against donation had far less understanding of brain death than did those who decided in favor of it. Before making an organ donation request, healthcare providers must inquire about and address common misunderstandings people have about brain death. Healthcare teams should develop and be trained on a clear protocol for communicating with the families of patients who may be potential organ donors.

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Organų donoro priežiūra intensyviosios terapijos skyriuje

Lietuvos chirurgija ◽

10.15388/lietchirur.2010.1.2122 ◽

2010 ◽

Vol 8 (1) ◽

pp. 0-0

Author(s):

Viktorija Černiauskienė ◽

Monika Čiplytė ◽

Saulius Vosylius

Keyword(s):

Intensive Care ◽

Brain Death ◽

Intensive Care Units ◽

Care Management ◽

Organ Procurement ◽

Organ Donor ◽

Organ Donors ◽

Organ Donations ◽

Vilnius University ◽

Organ Donor Management

Viktorija Černiauskienė, Monika Čiplytė, Saulius VosyliusVilniaus universiteto Anesteziologijos ir reanimatologijos klinika, Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Įvadas / tikslasDonorinių organų poreikis gerokai viršija atliktų organų transplantacijų skaičių. Dažniausios priežastys, dėl kurių potencialūs donorai netampa efektyviais donorais, yra donoro artimųjų prieštaravimas donorystei, medicininės kontraindikacijos, logistikos problemos, neadekvatus potencialių donorų gydymas iki eksplantacijos operacijos. Šio straipsnio tikslas yra apžvelgti naujausius medicinos mokslo laimėjimus atliekant potencialių organų donorų priežiūrą reanimacijos ir intensyviosios terapijos skyriuose. Metodai ir rezultataiIšliekant žymiam atotrūkiui tarp organų pasiūlos ir poreikio, būtina kuo efektyviau panaudoti esamus resursus, daugiau dėmesio skiriant tinkamai potencialaus organų donoro intensyviajai terapijai. Dėl smegenų mirties įvyksta sunkūs daugelio organizmui svarbių funkcijų sutrikimai: kraujotakos ir kvėpavimo sistemų, endokrininiai, elektrolitų balanso sutrikimai, hipotermija, koagulopatija ir intensyvus sisteminis uždegimo atsakas. IšvadosPasirinkta tinkama intensyviosios terapijos taktika galėtų padidinti transplantacijai tinkamų organų skaičių, išlaikyti geresnę jų funkciją po transplantacijos. Reikšminiai žodžiai: smegenų mirtis, intensyviosios terapijos skyriai, audinių ir organų donorystė, gairės Organ donor management in the intensive care unit Viktorija Černiauskienė, Monika Čiplytė, Saulius VosyliusClinic of Anaesthesiology and Intensive Care, Vilnius University,Šiltnamių Str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Background / objectiveThe demand for donor organs greatly exceeds the number of transplantations. Many reasons may determine this inadequacy, such as family refusal, medical contraindications, logistics problems and inadequate management of the organ donor. The aim of the study was to present the recent achievements of medical practice in the management of organ donors in intensive care units. Methods and resultsWhile the discrepancy between the number of organ donations and transplantations persists, it is essential to use available resources more effectively, paying more attention to the intensive care management of the organ donor. Many physiological changes follow after brain death, such as cardiovascular and pulmonary dysfunction, endocrine and homeostasis disturbances, hypothermia, coagulopathy and an enhanced inflammatory response. ConclusionsOptimal intensive care could increase the number of organs available for transplantation and improve their function after it. Keywords: brain death, intensive care units, tissue and organ procurement, guidelines as topic

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Texas Non—Donor-Hospital Project: A Program to Increase Organ Donation in Community and Rural Hospitals

Journal of Transplant Coordination ◽

10.1177/090591999800800304 ◽

1998 ◽

Vol 8 (3) ◽

pp. 146-152 ◽

Cited By ~ 3

Author(s):

Teresa J. Shafer ◽

Roger Durand ◽

Martha J. Hueneke ◽

William S. Wolff ◽

Kimberly D. Davis ◽

...

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

Organ Donor ◽

The United States ◽

Rural Hospitals ◽

Organ Donors ◽

Geographically Dispersed ◽

Johns Hopkins University ◽

Organ Procurement Organizations ◽

Hospital Deaths

Identifying and recovering donors from community and rural hospitals present a challenge to organ procurement organizations. A study of non-donor hospitals in the United States was undertaken at Johns Hopkins University, which identified 31 hospitals (in one service area) with the facilities to accommodate organ donation, though an organ donor had not been produced in 3 years. The purpose of this study was to determine whether donors could be produced from these hospitals. A large, geographically dispersed OPO initiated a program consisting of (1) in-house coordinators, and (2) routine notification of all hospital deaths. Following implementation of this program, organ donation increased 387% among the targeted 25 hospitals. The number of hospitals producing at least 1 organ donor increased 133%. The number of organs recovered in the project increased 449%. In-house coordinators, by identifying potential donors and facilitating an organ donor awareness program, can increase the number of organ donors in hospitals with low, but real, donor potential.

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Organ donation and the rural critical care nurse

American Journal of Critical Care ◽

10.4037/ajcc1994.3.6.473 ◽

1994 ◽

Vol 3 (6) ◽

pp. 473-475 ◽

Cited By ~ 10

Author(s):

LK McCoy ◽

SK Bell

Keyword(s):

Critical Care ◽

Organ Donation ◽

Positive Attitude ◽

Organ Procurement ◽

Medical Center ◽

Organ Donor ◽

Critical Care Nurses ◽

Urban Setting ◽

Organ Donors ◽

Knowledge And Attitudes

BACKGROUND. Less than 20% of people who meet the criteria for organ donors are estimated to donate organs. OBJECTIVE. To examine the knowledge and attitudes of rural critical care nurses regarding organ donation. METHODS. Forty-six critical care nurses from a southwestern medical center provided data for this study. Self-reported knowledge and attitudes were measured using the Organ Donor Attitude Questionnaire and compared with respondents' demographic characteristics. RESULTS. Knowledge scores were found to be average (74% correct). Attitude scores reflected a strongly positive attitude toward organ donation. Increased knowledge of organ donation was not found to be related to a positive attitude. However, both attitude and knowledge were found to be positively correlated with previous experience in caring for either organ donors or recipients. Results were compared with data collected in an urban setting and found to be similar. CONCLUSIONS. Results of this study indicate that exposure to patients affected by organ procurement increased knowledge and improved attitudes of the nurses who provided care. Increased knowledge and positive attitude are important when providing support to families and caring for potential donors. These factors could increase the supply of donors for transplants, which is a goal of the organ procurement process.

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