First Trauma Code

[usafmedic45]

You know that they can still recover kidneys, heart valves, tendon, ligaments, bone, skin, corneas even after cardiac death right?. The criteria are nationally standardized for the most part.

 

[usafmedic45]

This patient was not a donor possibility.

What makes you say that?

 

[Dwindlin]

You know that they can still recover kidneys, heart valves, tendon, ligaments, bone, skin, corneas even after cardiac death right?. The criteria are nationally standardized for the most part.

We don't code people in this region just because they are donors, is this a common practice else where?

 

[usafmedic45]

Nope....it's not a standard protocol. It's just something of a joke around here that if you work a trauma and they arrest at any point, you're effectively transporting and treating a donor. However, that said, it was a valid defense if our medical director asked why you worked someone: "His license says he's an organ and tissue donor". It may not be in the protocols but it was done at least by myself and several others that I have worked with.

 

[RocketMedic]

What makes you say that?

Diabetic, cardiac history, and lack of nearby/reasonable harvest team ability.

 

[usafmedic45]

Diabetic, cardiac history, and lack of nearby/reasonable harvest team ability.

Ah.....good point. They could have still harvested tissues probably.

By the way, you do realize that most organ transplant procurements aren't done at places with a dedicated team right?

 

[Brandon O]

You know that they can still recover kidneys, heart valves, tendon, ligaments, bone, skin, corneas even after cardiac death right?. The criteria are nationally standardized for the most part.

This is not my field, but as I understand it most tissues (which are non-living items) are not super time-sensitive as far as viability, and can be recovered within a day or two of death. And I believe even kidneys can only be taken if bypass is underway.

I used to have this same understanding (CPR to help maintain organ viability) but recently sat through a very good talk at the Western Mass EMS Conference and was disabused of this. Good stuff like hearts come from those on life support or neurologically dead, not someone who dies in the field with no ROSC.

Interesting topic. Folks who work in procurement are very passionate and understandably so; they help an amazing number of people.

 

[usafmedic45]

And I believe even kidneys can only be taken if bypass is underway

You can procure cadaveric kidneys within a couple hours of cardiac death as I understand it. It's preferable to get them from a "living donor" but you can (and they used to do it heavily in the past) recover them from the "freshly dead" so to speak.

Why would they bypass a patient to recover organs? Do you mean they have to still have perfusion? What about donation after cardiac death (where they withdraw support from someone in the OR and allow them to progress to clinical death prior to recovery of the organs, such as is done if someone is not technically brain dead but the otherwise non-recoverable clinically)?

Good stuff like hearts come from those on life support or neurologically dead, not someone who dies in the field with no ROSC.

Right...but my point being if we can get ROSC from these folks- and we do in a significant number of cases who are later realized to be nothing more than ventilated corpses- why not give them the chance to be donors? Also, you can still get a lot of stuff out of a person who is clinically dead and its much easier to convince most coroners and ME (speaking as a former deputy coroner and my experiences with a lot of my colleagues) to allow procurement if the patient is in the hospital than sitting in the morgue.

 

[Sasha]

You can procure cadaveric kidneys within a couple hours of cardiac death as I understand it. It's preferable to get them from a "living donor" but you can (and they used to do it heavily in the past) recover them from the "freshly dead" so to speak.

You can procure one of my kidneys right now for the right price.



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[usafmedic45]

You can procure one of my kidneys right now for the right price.



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No comment.....just, no comment. LOL

 

[medic417]

You can procure one of my kidneys right now for the right price.



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No comment.....just, no comment. LOL

Isn't there a word for someone that sells herself for money?h34r::unsure:

 

[Brandon O]

Why would they bypass a patient to recover organs? Do you mean they have to still have perfusion? What about donation after cardiac death (where they withdraw support from someone in the OR and allow them to progress to clinical death prior to recovery of the organs, such as is done if someone is not technically brain dead but the otherwise non-recoverable clinically)?

Okay, ya made me dig up my notes.

Here's what I have: ideally we have a brain-dead patient who is on life support. We have lots of time to bring in the transplant guys, set everything up, then pull organs and rush them over to the recipients.

Alternately, there's the possibility of donation after cardiac death by planned extubation. You have a patient who is NOT brain-dead, but surely will not survive without our ongoing life support (the classic DNR pull-the-plug scenario), and the family or proxies support withdrawing care. You extubate; if the heart stops within 50 minutes (why 50? I may have this down wrong), you can go ahead and take live organs. Ideally, if you're in a major tertiary center (we have a couple in Boston that'll do this), you park them on cardiac bypass, keeping the patient perfused, and we can have it all -- otherwise, we get a "just died, hurry and grab some stuff" situation, and all you get is the relatively robust kidneys and liver.

You can also have an unplanned arrest, but usually you won't get much but tissue from that.

I am far from an expert here and there may be regional variation, so find a real expert if you want good advice; YMMV.

Right...but my point being if we can get ROSC from these folks- and we do in a significant number of cases who are later realized to be nothing more than ventilated corpses- why not give them the chance to be donors? Also, you can still get a lot of stuff out of a person who is clinically dead and its much easier to convince most coroners and ME (speaking as a former deputy coroner and my experiences with a lot of my colleagues) to allow procurement if the patient is in the hospital than sitting in the morgue.

Fair enough. I gather than any ROSC, even for a moment, will be used as the last time known alive, which can affect donation significantly. So you may be onto something.

 

[usafmedic45]

Fair enough. I gather than any ROSC, even for a moment, will be used as the last time known alive, which can affect donation significantly. So you may be onto something.

That was my point all along. You get practice out of them even if they can't be procured from.

BTW, as someone who has benefited from tissue donation, I would argue that getting those items out of a body is quite a big deal. It's not as glamorous as a heart or set of lungs, but it's still just as useful only in different scenarios.

 

[usafmedic45]

Ideally, if you're in a major tertiary center (we have a couple in Boston that'll do this), you park them on cardiac bypass, keeping the patient perfused, and we can have it all -- otherwise, we get a "just died, hurry and grab some stuff" situation, and all you get is the relatively robust kidneys and liver.

Usually, the way DCD is done with the procurement teams already present. I mean, you said it yourself: it's a planned extubation. That negates the "need" for bypass. I've worked quite a few hospitals (including a major transplant center) and been in on more procurements than I can count and I have never seen anyone put on bypass for it. Maybe Boston's OPO is in bed with the local perfusionists and does it differently, but I've not seen that done anywhere I have worked.

 

[Brandon O]

Maybe Boston's OPO is in bed with the local perfusionists

:lol:

 

[medicdan]

Maybe Boston's OPO is in bed with the local perfusionists and does it differently, but I've not seen that done anywhere I have worked.

You said it, not me. I have seen the same thing as Brandon-- an obsession with bypass post extubation while procurement teams get in place. I'll ask a friend at NEOB and see what their policy is.

 

[usafmedic45]

That's just :censored::censored::censored::censored:ing stupid. Why not just hold off on a planned extubation for DCD until after the teams arrive?