ED Accreditation Update
Tips on meeting standard for organ donation policy
Hospitals are scrambling to develop a policy regarding organ donation after cardiac death (DCD) in order to be in compliance with a revised standard from the Joint Commission on Accreditation of Healthcare Organizations that goes into effect Jan. 1, 2007.
One of the most critical aspects of such a policy is clinical triggers for organ donation, according to Denise Mogg, RN, MSN, director of emergency services at St. Luke's Hospital in Kansas City, MO. While the overall policy is important, it's critical to give nurses a list of situations that might meet criteria for organ donation, "getting those triggers so imbedded in practice that it triggers the contact of our organ bank so they can come in and say 'yes' or 'no,'" she says. At St. Luke's, the criteria for DCD include:
- The patient has suffered a nonrecoverable neurological illness or injury requiring dependence on mechanical ventilation.
- The family, with the medical staff, has decided to withdraw life support.
- Based on the evaluation of the transplant network staff, with the hospital health care team, the determination is made that cardiopulmonary death likely will occur within 60 minutes following withdrawal of life support.
- The transplant network staff will determine if the patient is a suitable candidate for DCD. That staff will utilize the most current criteria in determining the patient's suitability for organ transplantation.
Give nurses a card to carry
Because nurses are so busy, it's important to give them that information in an abbreviated format for everyday practice, Mogg says.
St. Luke's has compiled a condensed list of clinical triggers for all potential organ, tissue, and eye donors. That list includes the triggers above, plus the absence of two or more of the following brain stem reflexes: cough, gag, pupillary response, respiratory effort, or response to pain. According to the policy, determination must be made with the exclusion of: drug intoxication, hypothermia, severe hypotension, neuromuscular blockade, central nervous system depressants, and metabolic disturbances. [The complete organ donation policy is available with the on-line version of ED Management. Section XIII covers DCD. If you're accessing your on-line account for the first time, go to www.reliasmedia.com. Click on the "Activate Your Subscription" tab in the left-hand column. Then follow the easy steps under "Account Activation." If you already have an on-line subscription, go to www.reliasmedia.com. Select the tab labeled "Subscriber Direct Connect to Online Newsletters. Please select an archive." Choose "ED Management," and then click "Sign on" from the left-hand column to log in. Once you're signed in, select "2006" and then select the November 2006 issue. For assistance, call Customer Service at (800) 688-2421.]
These clinical triggers have been put on a reference card that nurses carry behind their name badge and have been put in a book at the nurse's station, Mogg says. "That jogs their memory," she says. "Those clinical triggers are what they work with every day."
Nurses normally are assessing those triggers anyway, Mogg says. "We're just asking them to take it a step further and say, 'Hey, this is a good time to call the organ bank or the organ procedure agency, and this patient may be a potential donor," she says. "They're not making any donor decisions; they're just saying this is a potential one."
You should define cardiac death
In addition to clinical triggers, policies for DCD should include a definition of cardiac death, based on circulatory and respiratory criteria, says Susie McBeth, associate director of standards interpretation at the Joint Commission.
"Once they determine that there's no life, no possibility of life, then they determine how they will contact the OPO [organ procurement organization]," she says.
Hospitals are scrambling to develop a policy regarding organ donation after cardiac death (DCD) in order to be in compliance with a revised standard from the Joint Commission on Accreditation of Healthcare Organizations that goes into effect Jan. 1, 2007.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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