Donation Process & FAQsAs a health care professional, you play a vital role in affecting hundreds of lives each year. You have the ability to set in motion the process that allows families the rare opportunity to save and improve many lives through organ, tissue, eye donation. During their time of grief donor families often say they feel that some good came from a sorrowful situation. See below for some important questions you may have about the donation process:
Why do I need to report every death or imminent death to DonorConnect?Federal and local regulations mandate every death and every imminent death be reported to the local organ procurement organization (aka DonorConnect) As a separate consultant, DonorConnect is able to determine the suitability of each patient for organ and/or tissue donation on a case-by-case basis. *See regulations
When do I call DonorConnect?Use of the triggers below will help you comply with the Center of Medicaid and Medicare Services (CMS) regulations, and are the recommended standards of the Joint Commission.
- Call DonorConnect before mentioning donation to the family, so registry status and eligibility can be determined and a coordinated plan for approach can be developed.
- Call DonorConnect before removing a patient from the ventilator (withdrawing support), regardless of diagnosis or age. Call early enough to determine eligibility.
- Call DonorConnect within one hour after an non-ventilated cardiac death.
- Call DonorConnect well before brain death is declared.
- Clinical triggers for referral (call within one hour if patient meet one or more of the following triggers):
- GCS < 4 in a ventilated patient without neuromuscular blockade,
- loss of 3 or more cranial nerve reflexes,
- family asks for donation information, or family decides to withdraw support.
- Call DonorConnect before calling the mortuary.
- Maintain the patient’s hemodynamic stability to evaluate for brain death.
How do I contact DonorConnect?Call the Donor Referral Line at 800-833-6667 (1-800-83-DONOR). We are available 24/7, every day of the year. These calls are answered by our answering service. Shortly after providing the initial referral information, one of our organ coordinators will call you directly.
What information should I have ready?
- Hospital name
- Your first and last name, nursing unit, and unit phone number
- Patient’s age, name, and date of birth
- Ventilated patient: Is brain death anticipated? Has brain death testing been done? Which brainstem reflexes are intact/lost? Is support going to be withdrawn? What has been communicated to family? Is patient on sedatives, paralytics, or hypothermic?
- Unventilated patient: What kinds and amounts of IV fluids and meds have been given? Crystalloids, blood products?
- Chart info: Admission history, diagnosis, height, weight, crucial past medical history, etc.
- Phone number (cell, home, etc.) where family can be reached when they leave the hospital
- Family dynamics if known
What kind of donors are there?
- Brain Death is defined as the irreversible cessation of all brain function including the brain stem.
- The patient is declared legally dead by neurological criteria and clinical testing. The time of the exam becomes the legal time of death. They remain on the ventilator until the recovery is complete. They are eligible to donate heart, lungs, liver, kidneys, pancreas, intestine, eyes, and tissue.
- (DCD) is defined as a procedure in which organs are surgically recovered following the pronouncement of death based on the clinical findings of irreversible cessation of circulation or blood flow.
- These donors typically do not meet brain death criteria, but they have a non-survivable injury. They must remain on the ventilator until family is ready to withdraw support. The attending Physician or designee, according to hospital protocol, withdraws life-sustaining interventions. This takes place at the ICU and the family can be present when the patient cardiac arrests.
- In order to be eligible for donation, they must pass within a certain time frame. If the patient passes within this window, the physician will declare time of death. DonorConnect then waits a full two minutes to take over care to be sure the patient does not auto-resuscitate. DCD donors are eligible to donate liver, kidneys, eyes, and tissue.
- Deceased donation requires lots of planning and family care time.
- Cornea, bone, skin, cardiovascular tissue, etc.
- May be donors up to 24 hours after death, except cornea
- Cornea donation very time-sensitive: needs to be done within 6-8 hours
- Donation discussion with family will normally be done by phone, not face-to-face
Donation after Brain Death
Donation after Circulatory Death (DCD)
What is my role after I call?
Maintain the patient hemodynamically.Organ donation can only occur if the organs are kept viable through mechanical ventilation and vascular support.
Provide grave prognosis to the family.Families need time to accept what has happened to their loved one. Be consistent in your message and work with DonorConnect staff members to determine the best time to tell the family about donation.
Work as a team with DonorConnectIt is important for all multidisciplinary medical staff from the hospital as well as DonnorConnect to work as a team to discuss and communicate declaration, patient management, and the family care plan.
Who talks to the family about donation?DonorConnect has a highly trained staff whose primary role is to ensure families or other authorized personnel carry out the legally binding authorization decisions of their loved ones to be donors. When there is no prior legal documentation of authorization, we seek authorization for donation from the legal next of kin or authorized person (*see resources for a list of authorized person). It is the responsibility of the hospital to provide a grave prognosis and to inform families of the death of their loved ones. However, CMS guidelines require a ‘Designated Requester’ (a DonorConnect team member) to be the one to approach families about donation.
When are families told about donation?Usually families are informed of donation after:
- the patient has been determined to be a suitable candidate and brain death testing has begun; or
- after the hospital has approved withdrawal of life-sustaining interventions
- the physician has been clear about a grave prognosis and the family has had time to process this news.
- after the patient has been determined to be a suitable candidate and brain death testing has begun; or
- after the hospital has approved withdrawal of life-sustaining interventions.
For potential tissue donors only:The family is contacted at home by DonorConnect and told about the following types of donation: corneas, bone with associated tissues of the upper and lower extremities including the hip, skin, saphenous veins and femoral veins, and heart valves. You can help by asking the family for a telephone number where they can be reached. This will enable DonorConnect to act quickly and avoid the removal of the patient’s body by the funeral home or the medical examiner prior to donation.
Where does organ and tissue recovery take place?Organ and tissue recoveries take place in the operating room at the hospital where the patient dies and are treated just like a normal surgery.
- Organ recoveries: These require a scrub nurse/technician, circulating nurse,an anesthesia staff member, and a surgeon.
- Tissue recoveries: These are performed by specially and highly trained DonorConnect technicians and can be done at several locations including the OR, the Medical Examiners’/Coroners’ office, or even at the funeral home.
What if I’m not sure my patient is eligible, or if they might survive?Always call! Our coordinators are specially qualified to screen all donors for eligibility. You never know what the outcome might be! The worst that will happen is DonorConnect will simply stop following your patient.
Why go through this process?Unexpected and often traumatic death can be countered with life-saving donation – a positive and selfless act that offers some comfort to families. When a loved one’s prior decision to be a donor is legally documented, donor families find solace knowing they are complying with their loved one’s decision. When there is no prior legal documentation, next-of-kin often express that they feel a sense of meaning when they decide to donate. They are comforted in their belief that the gift of donation is something their loved one would have wanted because it reflects their lifestyle and values.
Are there physicians on your team?We have an intensivist physicians as well as a procurement and transplantation surgeon on our team that we work with very closely.