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END OF PAGE What are the Roles for hospital staff prior to extubating a DCD donor - ANSWERS-1. Administering heparin/comfort care medications
- Extubating
- Declaring the donor dead ABO O is the universal - ANSWERS-Donor ABO AB is the universal - ANSWERS-Recipient Reactive serology results for HBsAG means what? - ANSWERS- Exposure likely and actively infected Reactive serology results for HBcAb means what? - ANSWERS- Exposure but not necessarily infection Reactive serology results for HBsAb means what? - ANSWERS- Exposure likely through vaccination; likely immune but not infectious Ultimate goal of donor management - ANSWERS-1. Optimize organ function
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- Postpone the inevitable cardiopulmonary collapse of the brain dead donor until OR
- Transplant the most organs per donor what is Cushing Triad? - ANSWERS-1. Increasing systolic blood pressure
- Bradycardia
- Widening pulse pressure System responsible for the body's inability to secrete adrenocorticotropic hormone (ACTH) and maintain blood pressure after brain death - ANSWERS-Hypothalamic-pituitary-adrenal axis The massive catecholamine storm and loss of ADH and ACTH after brain death leads to? - ANSWERS-1. Vasodilation
- systemic inflammation
- Neurogenic pulmonary edema
- A switch from aerobic to anaerobic metabolism
- Acute left ventricular failure
END OF PAGE Direct effect of drugs on Alpha- 1 receptors effects what part of the body? - ANSWERS-Arteries Effect of nitroprusside - ANSWERS-Decreases blood pressure and increases heart rate Main cause of coagulopathies after brain death - ANSWERS- Thromboplastin release Spinal reflexes occur in 40 - 50% of brain dead donors T/F - ANSWERS- True What lab is required within 24 hours of crossclamp by UNOS? - ANSWERS-Urinalysis What lab has a false increase caused by facial fractures - ANSWERS- Amylase what ECHO results to pay particular attention to - ANSWERS-1. Left ventricle and septal wall measurements
- Segmental or global akinesis
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- Valvular dysfunction what is a Wall motion abnormality related to brain death - ANSWERS- Global akinesis What are the UNOS age requirements for cardiac catheterization - ANSWERS-Male donors 40 years and older and female donors 45 years and older what are the UNOS required procedures/tests for lung transplantation - ANSWERS-1. Bronchoscopy and sputum gram stain
- FiO2 challenge within 2 hours of allocation
- Chest X-Ray within 3 hours of allocation PEEP maneuvers should not be started before the bronchoscopy to begin lung recruitment as soon as possible T/F - ANSWERS-False Consolidation on chest X-Ray is indicative of what? - ANSWERS- Severe pneumonia
END OF PAGE Key hospital contacts passionate about and support organ donation - ANSWERS-Donor champions Referral/clinical trigger for organ transplantation - ANSWERS-1. Family decision to withdraw care
- Absence of 2 or more brainstem reflexes
- GCS 5T or less
- Neurological injury Percentage of brain dead patients experiencing cardiac arrest within 24 hours - ANSWERS-62% Percentage of brain dead patients experiencing cardiac arrest within 72 hours - ANSWERS-87% Percentage of families making the final decision to withdraw life- support within 24 hours after discussing it with hospital staff - ANSWERS-66% Name of Federal regulation requiring hospitals to have written protocols to notify the OPO of imminent death and support the option of donation
END OF PAGE until a formal request may be made - ANSWERS-CMS Conditions of Participation for Hospitals First step in evaluating hospital performance or donor issues - ANSWERS-Perform a medical record review Donor Management Goals (DMGs) strive for what? - ANSWERS-More organs transplanted per donor Information to gather on a new referral - ANSWERS-1. Brief hospital course
- Neurological assessment including GCS
- Past medical history
- Current labs UNOS exclusionary criteria - ANSWERS-1. Multi-system organ failure with overwhelming sepsis
- History of melanoma
- HIV infection
- Gangrenous bowel
END OF PAGE Amount of organs transplanted per single donor is called? - ANSWERS- Organs transplanted per donor Percentage of families who choose to donate divided by amount who decline is called? - ANSWERS-Consent rate Percentage of eligible donors who survive to OR and are cross clamped is called? - ANSWERS-Conversion rate Percentage of referrals made within mandated timeframe is called? - ANSWERS-Timely referral Goal of community education - ANSWERS-1. Register all of those interested in donation
- Promote family conversations about donation
- Have a presence to promote donation awareness Who is Legal next-of-kin for an adult with adult children, a spouse, a mother, and an ex-spouse at the bedside? - ANSWERS-Spouse
END OF PAGE Who is Legal next-of-kin for an adult with a durable power of attorney (DPOA), adult children, a spouse, and a brother at bedside? - ANSWERS-DPOA Who is Legal next-of-kin for an adult with an estranged spouse, adult children, parents, and grandparents at bedside? - ANSWERS-Estranged Spouse Who is Legal next-of-kin to obtain consent from for an unidentified male with no family/friends? - ANSWERS-Medical Examiner/Hospital administration When organs are matched to the same ethnic background, transplantation success rates increase. T/F - ANSWERS-True What is One identified reason for a family's decline of donation - ANSWERS-Misunderstanding of brain death What document States that the family has a right to receive information suited to the family's needs and capacities about the need for organ and tissue donation - ANSWERS-The Donor Bill of Rights
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- Timeline
- Disfigurement
- Ensuring an understanding that donation is an anatomical gift, no money is exchanged What do these share in common?
- 19 - month old who was breastfed by HIV+ mother
- Male-to-male intercourse within the last 5 years
- Hemophiliac who received human-derived growth hormone - ANSWERS-Factors that may classify the donor as a CDC-high risk Synthetic growth hormone does not carry the risk factor for prion disease T/F - ANSWERS-False Isuprel a drug used for brain dead donors with bradycardia is what kind of drug? - ANSWERS-Beta-agonist Observation period recommended by the 1987 Pediatric Brain Death Guidelines for infants 7 days to 2 months of age - ANSWERS- 48 hours
END OF PAGE Observation period recommended by the 2011 Pediatric Brain Death guidelines for newborn infants (37 weeks gestational age) to 30 days old
