The majority of deaths in MedSTAR or an ICU may fall under the jurisdiction of the Medical Examiner for the District of Columbia. The Family Advocate shall assist with notification and must obtain consent from the Medical Examiner’s office prior to initiation of any procedure, should this death fall under their jurisdiction. Regardless of the next-of-kin’s wishes, the Medical Examiner has the right to object to donation of any organs or tissues, if such removal would potentially impact the determination of cause and manner of death. Under no circumstances will any procedure be initiated without the Medical Examiner’s approval. Once the Medical Examiner has agreed to allow intervention, the Family Advocate will immediately notify the Line Placement Team.
The Family Advocate shall respond to the MedSTAR unit immediately (they carry a code pager) and determine whether a decedent is a potential rapid organ recovery candidate. This determination will be made in consultation with the attending physician/intensivist. The Family Advocate will then immediately notify the Line Placement Team. A search for the next of kin in conjunction with local authorities will be instituted if a family member cannot be located. The Family Advocate is responsible for offering the option of organ/tissue donation to the decedent’s next-of-kin. The consent will be obtained utilizing the standard Uniform Donor Form according to WHC Standard Practice #583.20 and ODA SP#C.300. Additionally, the decedent’s medical/social history must be obtained from the legal next-of-kin and documented utilizing the standard OPO Medical History Form.
A Line Placement Team will be available in-house 24 hours a day to respond to a preservation call. If deemed necessary, the team member will draw 10 ccs of blood and run a STAT HIV screening. Should the potential donor test positive, organ preservation will be discontinued. Two 10cc red top tubes and one lavender top tube of blood will be drawn and labeled. One red top tube will be held for the project coordinator to be sent for virology testing and the second sent to the stat lab for ABO determination, BUN, creatinine and electrolyte levels. The lavender top will also be sent for CBC evaluation. Aerobic and anaerobic blood cultures will also be drawn and sent. The bladder will then be catheterized and a specimen sent for stat urinalysis and urine culture. An additional 3 red top tubes of blood must also be drawn for the Medical Examiners Office along with as many PVC test tubes of urine as possible. All tubes must be labeled with the donor’s name, social security number (if available), medical record number, and the date and time of death. A visual image will be recorded at the medical examiner’s request. The OPO will be advised as soon as possible about the potential donor and the whereabouts of the blood samples. The OPO Coordinator will notify the central donor lab so that arrangements can be made