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Family approach I consent – Danica Avsec

The grief reaction could be? Please mark correct answers

Denial and displacement of the reality, when the family thinks that something was wrong during treatment

Bargaining based on a hope that still better exit is possible

The relatives protect themselves against having to deal with reality

Various display of unexpected emotions and behaviours

Acceptance of death after some time

Family approach I consent – Danica Avsec

When asking for consent for organ donation, we should ask for:

The opinion of the relatives on organ donation

If they know anyone living with a transplanted organ

The opinion of the deceased on organ donation

What kind of person the deceased was

What was the way of life of the deceased related to health, social habits, travelling, etc

Family approach I consent – Danica Avsec

When two parents have different opinions about organ donation of their child:

We explain useful facts why donation is important

We say the decision has to be taken by the head of the family

We try to help the doubtful parent, and ask what we can do for him/her

We suggest speaking with a priest if there is a need

bd

Family approach I consent – Danica Avsec

In a case of disagreement to donation. Please mark correct answers:

It is recommended to ask family for additional explanation for circumstances in which deceased person expressed disagreement

It is recommended to offer consultation with priest or other religious leader when there opposition is based on religion

It is recommended to the family to find somebody from their closest to donate the organs

It is recommended to suggest a break or bedsite visit and then ask again for the donation

a, b, d

SNODs The UK concept to family approach – SusanLee & John Stirling

Which of these are the functions of NHSBT in relation to organ donation?

Maintaining the Organ Donor Register. Matching and allocation of organs. Maintaining a transplant registry. Development of standards, performance indicators and protocols. Auditing and analysing results .

Central point for information and support. Raising public awareness. Development of standards, performance indicators and protocols. Auditing and analysing results. Retrieving organs for research.

Central point for information and support. Raising public awareness. Ensuring organ recipients are correctly consented. Development of standards, performance indicators and protocols. Matching and allocation of organs.

Maintaining the Organ Donor Register. Advise on transplantation techniques. Matching and allocation of organs. Maintaining a transplant registry. Central point for information and support.

SNODs The UK concept to family approach – SusanLee & John Stirling

What is the role of the Specialist Nurse Organ Donation

Supporting clinical staff. Advocate for the potential donor. Support the family. Perform bronchoscopies. Donor characterisation.

Participate in donation from referral to retrieval. Potential donor audit. Hospital engagement. Teaching. Advise on stabilisation and optimisation of the donor.

Hospital engagement. Teaching. Advise on stabilisation and optimisation of the donor. Nurses organ donors on ITU. Potential donor audit.

Consent for donation. Potential donor audit. Advocate for the potential donor. Perform Neurological death tests. Supporting clinical staff.

SNODs The UK concept to family approach – SusanLee & John Stirling

What order is seen as best practice in the UK when contemplating a family approach?

Breaking bad news, confirming understanding and acceptance of loss. Planning. Approaching donation .

Planning. Approaching donation. Breaking bad news, confirming understanding and acceptance of loss .

Planning. Breaking bad news, confirming understanding and acceptance of loss. Approaching donation .

SNODs The UK concept to family approach – SusanLee & John Stirling

In the UK when opt out legislation is in place what is the order in which to approach consent / authorisation

Person in the highest qualifying. First person consent via ODR (Organ Donor Register), written or verbal. Nominated/ appointed representative. Deemed if inclusion criteria met, (need to ascertain last known decision or duty to enquire) relationship.

Person in the highest qualifying. First person consent via ODR, written or verbal. Nominated/ appointed representative. Deemed if inclusion criteria met, (need to ascertain last known decision or duty to enquire).

First person consent via ODR, written or verbal. Nominated/ appointed representative. Deemed if inclusion criteria met, (need to ascertain last known decision or duty to enquire). Person in the highest qualifying.

Deemed if inclusion criteria met, (need to ascertain last known decision or duty to enquire). Person in the highest qualifying. First person consent via ODR, written or verbal. Nominated/ appointed representative.

SNODs The UK concept to family approach – SusanLee & John Stirling

What background is it vital that Specialist Nurses Organ Donation have prior to this role?

Senior / leadership nursing background. Excellent communication skills. Critical Care background (or willingness to undertake education in this). Qualified nurse.

Senior / leadership nursing background. Excellent communication skills. Critical Care background (or willingness to undertake education in this). Student nurse.

Excellent communication skills. Critical Care background (or willingness to undertake education in this). Qualified nurse. Personal experience of donation.

Excellent communication skills. Senior / leadership nursing background. Student nurse. Personal experience of donation.

Management of the potential donor - Rafael Badenes

Which is the most common physiological derangements during the potential donor management:

Disseminated Intravascular Coagulation

Pulmonary Oedema

Metabolic Acidosis

Hemodynamic Instability

Management of the potential donor - Rafael Badenes

During the hemodynamic management of the potential donor after brain death, which of the following is a false:

If Hypovelemia, treatment is fluid loading.

If myocardial dysfunction, treatment is Norepinephrine and fluid loading.

If vasoplegia, treatment is Norepinephrine and fluid loading.

If hypovolemia, consider diabetes insipidus.

Management of the potential donor - Rafael Badenes

During the management of potential donor after brain death, the target range of basic monitoring is:

Invasive Mean Arterial Pressure (20-40 mmHg).

Urine Output (0.2-0.4 ml/kg/h)

Na (135-145 mmol/L)

Platelets > 15 G/L

Management of the potential donor - Rafael Badenes

In the management of polyuria in the potential donor after brain death:

Polyuria is > 2 ml/kg/h

Should not exclude secondary polyuria

In diabetes insipidus, urine specific gravity below 1.005 g/mL

The goal diuresis target using Desmopressin is 0.2-0.4 ml/kg/h

Management of the potential donor - Rafael Badenes

Interventions for a lung protective strategy don´t include:

Avoid any decrease in oxygenation

Closed circuit for tracheal suction

PEEP 0 cm H2O

Bronchoscopy

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

In 2021 in every donor following investigations should be done during evaluation? 

Coronary Angiography 

Collection of 24h Urine for protein diagnostics 

SARS-CoV-2 NAT from nasopharyngeal swab and/or BAL (lung: must) 

Whole body CT-scan.

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

In which donor is a coronary angiography most likely with a pathological result? 

59 yrs, male, ICB, smoker 30 pack years, alcohol 1.5l vine/d, untreated hypertension, ECHO: LVH IVSd 16mm, plaque in aorta ascendens & descendens 

62 yrs, male, SAH Hunt-Hess V, 100 km bicycle/day, ECHO 6 hrs after SAH: LVF good EF 60%, IVSd 10mm, no wall motion irregularities, no plaques, good RVF, non-smoker, no alcohol, no hypertension, CT scan thorax without calcification in coronary artery, neurosurgery hospital without Coro-facilities. 

1 year old baby with multiple heart surgery  

49 years female, head trauma at 50 km bycicle tour, no CVR risks reported

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

A donor with death confirmed by neurologic criteria and legal authorization / written consent to organ donation is reported to you. The ICU physicians tells you: 59 years old, 170 cm, 100 Kg, heavy smoking, heavy drinking, arterial hypertension may not have been treated well; SAH two days ago, on abdominal ultrasound: liver edge blunt, liver parenchyma echo-inhomogenous, pancreas lipomatosis, aorta plaques, both kidney 11cm*6cm (2cm Parenchyma) & otherwise normal morphology; echo-heart two hours after admission two days ago: LVF EF 30%, LVH IVSd 13mm, wall motion abnormality (apical akinesia). 5 years ago he was admitted for pancreatitis (after swollowing a tooth pick with perforation form stomach into pancreas after consumtion of ethanol). Which one of the following is false: 

reject liver regardless of finding during procurement 

consider liver for inspection during procurement after checking all other medical data & perform biopsy to confirm macroscopic assessment –then decide to use graft or not 

pancreas and intestine may not be of perfect quality, confirmation by expert to exclude 

nothing is said about the lung except smoking history. Needs more data. 

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

In the above case regarding the heart following statement is not correct/inappropriate: 

reject the heart because of bad echo findings 

check whether hemodynamics is optimized and then repeat echo 

consider Coro after b) has been checked and resolved 

check valves, and if ok and if heart is not used for transplantation -> consider tissues: heart valves

Donor and Organ evaluation - Carl-Ludwig Fischer-Fröhlich

For donation of an intestinal graft following considerations are an inclusion criteria for donation 

recovery from previous hypotensive periods and/or cardiac arrest events do not preclude donation. 

parenteral nutrition during donor management is desirable 

positive anti-EBV-IgG-VCA. 

a+b+c is correct.  

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

A 4 year old boy was found unresponsive in a private pool and received 30min CPR. 48hours later the child has fixed dilated pupils and diabetes insipidus. Which of the following statements is correct (one applies)

Clinical brain death testing in pre-school children is not sufficient to establish a diagnosis of brain death without imaging

Criteria for brain death testing in this age group are identical to those of adults

A EEG should be performed to establish a diagnosis of brain death

Due to the ischemia of organs during CPR, the child is unlikely to become a suit-able donor

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

A term born girl is resuscitated in delivery room after severe perinatal asphyxia for 25min. On day 3 of life, she is unresponsive. Parents inquire about the option of her to become an organ donor. Which of the following statements is wrong (one applies)

You have to check with the guidelines and legal framework of your jurisdiction as neonatal organ donation may not be allowed

Organs from neonates are too small to be implanted successfully to re-cipients.

In preterm infants, brain death cannot be established using clinical criteria.

Brain ultrasound is not an accepted imaging modality to confirm brain death.

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

A 14 year old child victim of a motor vehicle accident with severe traumatic brain injury develops signs compatible with brain death. Which of the following statements about family care is correct (multiple apply)

Where feasible, a trained organ donation specialist should be present in family meetings.

If brain death testing is performed, the family should be given the op-portunity to be present if they wish.

It is not recommended to explore whether the child had previously expressed views on organ donation in school or at home, as at that age the child would not be able to consent anyway.

If the child does not meet brain death criteria, the same rules for po-tential donation after cardiac death apply as in adults.

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

A 18month old child with severe cerebral palsy has a severe aspiration event which had required 30minutes of CPR. Attempts at extubation failed and the family is inquiring about organ donation. Which of the following statements about organ donation are correct (multiple apply)

Donation after cardiac death should be explored with the family.

Different ischemia times apply for children for DCD compared to adults.

Congenital conditions usually preclude clinical brain death testing.

Deaths in young children <2 years of age represent about half of PICU deaths, but only a small minority of pediatric organ donations.

Infants should not be considered for organ donation as donor-recipient allocation in this age group is extremely hard.

Organ donation in Pediatrics special aspects and considerations - Luregn Schlapbach

You are asked to establish a pediatric organ donation program at your institution. Which of the following statements about pediatric organ donation are correct (multiple apply)

Overall, while there are age-specific criteria, the same principles as in adult donation apply.

Pediatric organ donations are associated with worse transplant outcomes.

Consent rates of parents from potential pediatric donors are much lower com-pared to family members from potential adult donors.

If establishing a pediatric donation after cardiac death program at a pediatric in-stitution is not possible, you will explore partnership with an adjacent adult insti-tution..

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

In which of the following aspects does the Paris classification (2015) of DCDD donors different from the corresponding Maastricht classification (1995)?

It identifies five instead of four categories of DCDD donors

It does not refer to the terms “controlled” and “uncontrolled” DCDD do-nors

It defines a new category III of DCDD donors, as those who have been declared dead following the withdrawal of life-sustaining therapies

It subclassifies category II DCD donors in categories IIa and IIb, de-pending on whether the cardiac arrest preceding death occurs outside or inside the hospital, respectively

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

The functional warm ischemia time in controlled DCDD is defined as:

The time extending from admission to the ICU until the decision to withdraw life-sustaining therapies

The time extending from the moment of terminal extubation until signif-icant hypoperfusion of organs

The time extending from significant hypoperfusion of organs until cold preservation or in situ regional perfusion

The time extending from significant hypoperfusion of organs until the determination of death

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

The determination of death by circulatory criteria following the withdrawal of life- sustaining therapies is based on:

The irreversible (“cannot return”) cessation of systemic circulation

The permanent (“will not return”) cessation of systemic circulation

The permanent (“will not return”) cessation of circulation to the brain

The irreversible (“cannot return”) loss of neurologic functions

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

Outcomes of organs obtained from donors declared dead by circulatory criteria are more likely to:

Develop delayed graft function in kidney transplantation

Develop ischemic-type biliary lesions after liver transplantation

a and b are correct

Display better graft survival at one year after transplantation

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

An early conversion of possible donors after brain death into donors declared dead by circulatory criteria in controlled circumstances:

Must be avoided as much as possible

Requires the consideration of whether brain death is a likely outcome should the withdrawal of life-sustaining therapies be delayed

The possibility of delaying decisions to withdraw of life-sustaining thera-pies must be considered following an informative process with relatives and the treating team

All of the above

Brain death – Julien Charpentier

The diagnosis of brain death should be made first with regard to:

National recommendation

Your own experience

Legal recommendation

Medical knowledge

Brain death – Julien Charpentier

In the concept of whole brain death, choose the correct answer:

It concerns the brain stem and the cerebral hemispheres

The brain stem is not involved

The apnea test is not important in this context

The brainstem reflex does not need to be tested

Brain death – Julien Charpentier

Which of the following conditions is not required before a diagnosis of brain death can be made?

Body temperature > 35°C

A known cause of death

Family consent

A mean blood pressure > 60 mmHg

Brain death – Julien Charpentier

Which of the following symptoms is not consistent with a diagnosis of brain death?

arm movement after upper lip stimulation

High blood pressure

Polyuria

Leg movement after hand stimulation

Brain death – Julien Charpentier

Regarding the apnea test, what is the correct answer if the test is positive?

PaCO2 is the only criteria.

Hypoxemia is the strongest stimulation of the respiratory centers.

It is a safe procedure because it is performed after a clinical exception.

The respiratory centers are located in the brainstem.

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

The 5 minutes observation (“No touch”) period before confirming death starts

From the onset of apnoea

From the time the carotid pulse becomes impalpable

From the time of loss of consciousness

From the simultaneous loss of the circulation, breathing and con-sciousness

From the time heart sounds and breath sounds are no longer au-dible

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

When confirming death using circulatory criteria in someone receiving mechanical ven tilation:

The five minutes observation time in an asystolic patient should start only after the patient is disconnected from the ventilator

The application of PEEP should be continued during the observation pe-riod to maintain lung expansion if lung donation is being planned

Mechanical ventilation can be continued while observing for 5 minutes loss of the circulation and unresponsiveness.

Mechanical ventilation can continue if the “apnoea ventilation” mode on the ventilator is switched off

The patient should be extubated first

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

After 5 minutes of cardiorespiratory arrest, it is safe to diagnose death because

It will no longer be possible to restart the heart

The period of time after which spontaneous resuscitation will oc-cur has passed

The brain will have suffered irreversible necrosis

To wait any longer would compromise donated organ function

No one has ever had a good neurological outcome after such a long period of asystole

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

The absence of mechanical cardiac function is normally confirmed using a combination of the following:

The absence of a central pulse on palpation or arterial line and the absence of heart sounds on auscultation.

The absence of a central pulse on palpation or arterial line and a prolonged central capillary refill time.

The absence of heart sounds on auscultation and a prolonged central capillary refill time.

The absence of palpable heart contractions on the chest and the absence of heart sounds on auscultation.

The absence of a radial pulse on palpation and the absence of heart sounds on auscultation.

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

With regards to organ retrieval following diagnosis of death using circulatory criteria

Death must occur within 1 hour to allow donation to proceed

It is ethically acceptable to change usual practices around end of like care to facilitate donation

If no ICU staff are available, a member of the transplant team may di-agnose death

Retrieval must always take place in daytime hours

It is impossible to retrieve the heart in a DCD donation

Multi-organ retrieval – Gabriel C. Oniscu

During DCD multi-organ procurement, the preferred portal vein perfusion is best undertaken via:

Superior mesenteric vein

Portal vein

Inferior mesenteric vein

No portal perfusion should be undertaken

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