Non-Heart-Beating Organ Transplantation Practice and Protocols (2000) / Chapter Skim
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1 Non-Heart-Beating Organ Transplantation: Background and Current Practices
1 Non-Heart-Beating Organ Transplantation: Background and Current Practices
Pages 6-15
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From page 6... ...
A protocol must be in place in order for nonheart-beating donation to proceed. Protocols to cover non-heartbeating donation are needed in order to: · make this option available to all patients and families who wish to donate organs and tissues, · respond to increased donation referrals generated by HCFA regulations, and · contribute to the supply of organs for transplantation.
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From page 7... ...
The development of non-heart-beating donor protocols is a cooperative effort among OPOs, hospitals, health care professionals, and communities. OPOs act as leaders, intermediaries and facilitators, assisting hospitals with development of protocols or providing OPO protocols to smaller hospitals with limited numbers of referrals and limited resources for protocol and staff development.
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From page 8... ...
Because of improved transplant outcomes, organ procurement after death by neurological criteria has virtually replaced organ procurement after death by cardiopulmonary criteria. During the past decade, renewed interest in organ donation following death by cardiopulmonary criteria has developed for two main reasons.
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From page 9... ...
As far as this study was able to determine, only one center in the United States preserves organs in situ in this situation, although it is more common in Europe (Alvarez et al., 1997, 1999, Ward et al., 1997~. Under a program based on extensive community outreach and local legislation, this medical center takes measures to preserve organs in situ pending family contact and consent (Washington Hospital Center, Appendix F)
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From page 10... ...
47-50~. NON-HEART-BEATING DONOR PROTOCOLS: 1997-1999 The 1997 IOM study on non-heart-beating organ transplantation found considerable variation in the recovery of organs from non-heart-beating donors by different OPOs and medical centers.
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From page 11... ...
The remaining OPOs reported using their non-heart-beating donor protocols seldom or not at all during 1998. The possibility of an association between non-heart-beating organ procurement activity and protocol revision was considered but not found.
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From page 12... ...
The protocols varied on criteria for declaring death, the administration and timing of medications and medical procedures, and management of the withdrawal of life support (p.44~. Following the publication of the IOM report in 1997, a limited number of OPOs revised their non-heart-beating organ procurement protocols or developed new draft protocols.
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From page 14... ...
However, there is room for twoway accommodation: accommodation by the family to the needs of organ procurement and accommodation of the organ procurement process to the needs of families. Factors that influence family options for visiting, leave-taking, and attendance during death include hospital policies and procedures, family and staff preferences, and the demands of the organ procurement process, including the transfer of the patient from a patient care unit to the operating room and the pressure for rapid organ recovery.
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From page 15... ...
Each of these factors must be identified and addressed in order for change to take place, each of them was considered in the design of this study and in the conclusions and recommendations of this report. In this report, the message to be disseminated includes the need for nonheart-beating donor protocols, the emphasis on patient and family choices and concerns, and specific recommendations for protocol content.
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