Critical Care Medicine — Core of Discipline

C9 Identifying, assessing, and managing potential organ donors

Key Features:
- This EPA includes the identification of potential organ donors (by both neurological and circulatory criteria), referral to the local organ donation organization or program, and communicating with families about the opportunity for donation, but does not include obtaining consent for donation.
- This EPA also includes the assessment of death by neurological criteria, the physiological management of the potential organ donor, and collaboration with the donation physician, donation coordinator and other members of the donation team.

Assessment Plan:
Direct observation and/or case review by supervisor
Use Form 1. Form collects information on:
- Etiology: Death by circulatory criteria (DCC); death by neurological criteria (DNC)
Collect 3 observations of achievement
- At least 1 of each etiology
- At least 2 DNC declaration

Form

F1: Observation

Milestones

• ME 2.2. Recognize and respond to clinical features that identify opportunities for organ donation

• COM 3.1. Convey the option of organ and tissue donation as part of end-of-life discussions with family members

• COM 4.1. Communicate with patients and families in a manner that is respectful, non-judgmental, and culturally aware

• HA 1.1. Facilitate access to bereavement support for a patient’s family, as appropriate

• COM 5.1. Document the organ donation assessment and discussion, completing all required documentation

• ME 2.4. Develop and implement management plans to maintain organ donor homeostasis with appropriate hemodynamic, respiratory, temperature, urine output, fluid, electrolyte, and glucose targets

• COL 1.2. Work effectively with organ procurement organization personnel, transplant surgeons, and in-hospital diagnostic services to ensure complete evaluation of individual organ/tissue suitability for transplant

• ME 4.1. Establish plans for ongoing care of potential organ donors, incorporating considerations of patient comfort and family concerns

• P 1.3. Manage ethical issues encountered in the clinical setting

• ME 2.2. Exclude reversible causes of coma

• ME 2.2. Assess brainstem reflexes and response to pain

• ME 2.2. Perform an apnea test

• ME 2.2. Use ancillary testing when appropriate

• ME 1.3. Apply guidelines for the determination of death by neurological criteria (DNC) and death by circulatory criteria (DCC)

• P 3.1. Adhere to regulations regarding DNC and DCC declaration

Context Variables

• Etiology (single-choice)
  • Death by circulatory criteria (DCC)
  • death by neurological criteria (DNC)

Requirements

• Collect 3 observations of achievement (minimum 3)
• At least 1 of each etiology (minimum 2)
  • Counted once per distinct Etiology
• At least 2 DNC declaration (minimum 2)
  • Only counts when Etiology is death by neurological criteria (DNC)