Susan L. Smith, MN, PhD

Disclosures

March 28, 2003

Identification of the Potential Organ Donor

Organ failure would be a curable problem were it not for the failure of many people worldwide to give the gift of donation. Despite the widespread dissemination of information to the American public regarding organ donation and the adoption of numerous state and national legislative initiatives to facilitate organ donation and transplantation, the gap between the number of donors and those waiting for a donor organ continues to widen. As of March 18, 2003, there were 80,696 UNOS waiting list candidates; in 2002, a total of 24,833 transplants were performed in the United States.[7] Although many kidney transplant and more and more liver transplant programs have appealed to live donors to solve the shortage, cadaveric donors continue to be a major source of organs for transplantation. A major factor in increasing organ donation is the identification of potential cadaveric organ donors in intensive care units (ICUs) and the ability of nurses and physicians working in these units to effectively offer and obtain consent for donation.

The challenge faced by OPO coordinators, physicians, and nurses who care for potential donors is not only to identify in a timely manner physiologic changes that occur as a result of brain death, but also to evaluate the toll these conditions have taken on end-organ function and to clinically manage the cadaver donor so that all suitable organs can be recovered with a likelihood of good posttranstransplant function.

A major factor in increasing organ donation is the identification of potential cadaveric organ donors in emergency rooms and ICUs in community hospitals as well as large urban trauma centers. Although the Hospital Conditions of Participation[4,5] require hospitals to refer all patient deaths to an OPO and/or a tissue or eye bank, the nurses and physicians working in these areas remain a vital link in identifying when a death is imminent and notifying the appropriate organization in a timely manner. Timely notification of imminent death allows the OPO adequate time to interface with nurses and physicians and to gather information needed for a preliminary assessment of the patient's medical suitability as an organ donor before approaching the family to offer the option of donation.

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