46 - "Offering New Hope and Saving Lives: Donation After Circulatory Death (DCD) Heart Transplantation"

Description:

Clinical Issue: Today worldwide there are over a million people who need an organ transplant. In the United States there are more than 123,000 Americans on the national transplant waiting list. The national transplant organ directory adds one person to the waiting list every ten minutes. Sadly between eighteen to twenty two people die while waiting for an organ donation in the United States every day. The advancement of organ donation has allowed for controlled donation after circulatory death (DCD), where death is determined after cardiac arrest, to offer the greatest increase to individuals waiting for a heart tranplant. Description of the Team: The complexity of this type of surgery involves all standard members of the perioperative team - Surgeon, Anesthesia, Nursing, Perfusion in addition to Cardiology, Organ Procurement and Transplant Network Colleagues, Transplant Coordinators and Organ Transplant Researchers. Preparation and Planning: There is a litany of steps to begin the preparation and planning for an organ donation and it's more complex in terms of a DCD organ transplantation. The basics include the preliminary physical health assessment, transplant screening labs and blood collection and diagnostic exams including a cardiac cath. In addition to the physical assessment a psychological exam and social network support systems of the potential DCD organ recipient are also evaluated.

Assessment: DCD is so precise and requires an extensive review of the potential donor and potential recipient to ensure the best compatibility is evident to increase the likelihood of a successful transplantation. During the procurement phase additional review and comparison of all elements/quantitative data assessment is again reviewed to match the potential DCD donor with the potential DCD recipient. Implementation: Innovative international advances in DCD heart transplantation include direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP). After death is determined, DCD involves removal and reanimation of the arrested heart on an ex situ organ perfusion system. The organ perfusion system perfuses the heart with warm, oxygenated blood, simulating conditions in the body. The “heart in a box” device offers a novel method of preserving hearts for transport that reduces ischemia time when the organ lacks oxygen and blood flow. Outcome: In addition to resuscitating the heart, the device allows the surgeons to assess its functional quality. The ability to ensure the viability of the donor organ and assess any medical matters during the earliest phase of procurement and transplantation leads to better patient outcomes for the DCD organ recipient which is the ultimate goal of organ donation and transplantation. Implications for Perioperative Nursing: Nursing as a profession is always aimed at providing, collaborating and implementing the most current evidence based ground breaking therapies in the advancement of patient care.