• Any ventilated patient with a devastating illness or injury:
• – GCS 5 or less (NOT chemically induced)
• – Loss of any 3 Cranial Nerve Functions
•    – cough, gag, pupil response, pain response, respiratory effort
• – Any discussion of grave prognosis, de-escalation of care OR withdrawal of support
• – Consideration of Brain Death Testing
• – Family asking questions about donation

Any ventilated patient with a devastating illness or injury

• -GCS = 3 and/or loss of spontaneous reflexes
• -Any discussion of grave prognosis, de-escalation of care or withdrawal of support
• -Family asking questions about dontation
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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.

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.

• 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 Is support going to be withdrawn?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

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 DonorConnect

It 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.

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.

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• 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

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 this, it would be appropriate for the physician or nurse to introduce the DonorConnect coordinator to the family. A DonorConnect coordinator will go to the hospital. The family will be told about 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.

DonorConnect works with hospital staff to provide emotional support to the family. In the case of brain death, he/she helps the family understand that their loved one is dead. Collaboration between DonorConnect and hospital staff is imperative to the process to ensure the respect of the potential donor family’s loss while assuring that other lives are saved.

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.

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.