To accomplish preservation, abdominal cooling lines will be inserted and femoral artery and vein catheters inserted within the 60 minute time allowance. The kidneys will be flushed with a perfusion solution designed to limit the amount of further ischemic damage. Once cooled, the donor can be maintained up to four hours until an operating room is available and a standard organ recovery can be performed.
The second method for recovering organs from non-heart-beating donors is applicable to patients in MedSTAR or the emergency department who suffer uncontrolled cardiac arrest. In this situation it is imperative that the respective unit physicians pronounce death prior to any intervention from the Transplantation Services Department and that there be a clear delineation of the time of death versus the initiation of organ preservation protocols. Based on recommendations made by the attendees of the Consensus Conference on Trauma Victims and Organ Donation (WHC, MRI, WRTC, 1993), numerous steps have been taken to educate the community about this program.
Since appropriate steps have been taken, and with concurrence from the Community Oversight Committee, it has been determined that line placement for the purpose of preserving the option of donation for the next-of-kin is both legal (Anatomical Gift Amendment Act of 1996) and appropriate in the event that the family is not present. If the family is present, the Family Advocate must obtain consent prior to the placement of the cold preservation lines.
When a potential donor is identified, the Trauma Fellow, Trauma team leader (R4), trauma nurse, or designee in MedSTAR shall page the in-house Family Advocate through the in-house MedSTAR emergency page system. MedSTAR staff may participate in the ROR Protocol only in a support role to the line placement team. This type of support may include locating supplies and movement of the decedent to a more suitable location for line placement. They may not participate in direct hands-on donor preservation line placement.
Potential ROR donors shall be cared for in MedSTAR or an ICU or the PACU until organ recovery occurs. Under no circumstance should these patients be transferred to a floor to await ROR unless specific arrangements are made between the ICU medical staff and the nursing supervisor covering the ICU.