Purpose: The purpose of this study is to highlight the benefits of cultivating a collaborative relationship between a Long-Term Acute Care (LTAC) hospital system and the designated Organ Procurement Organization (OPO) to standardize a novel donation process.
Methods: The methodology began in collaboration with a LTAC hospital system, and their 66-bed facility. The monthly death record review indicated donation opportunities were missed. This triggered hospital wide education to reinforce referral triggers.
A recent case highlighted the referral and donation potential and collaboration between the LTAC and OPO. A mechanically vented IMC patient with a chronic tracheostomy was referred prior to compassionate extubation allowing OPO evaluation. Once donation criteria was met for Donation after Circulatory Death (DCD) potential, the patient’s family was approached and they authorized for DCD and approved transfer to an acute care facility. Prior to beginning the case the OPO was met with obstacles. The LTAC was not registered in the United Network for Organ Sharing system as an organ donation facility, as it does not have an operating room. A transfer to an acute care hospital was necessary to initiate the case start. The OPO identified a Level II Trauma acute care hospital as the transfer location, which had limited ICU beds available due to high patient census. Once a bed was identified, the OPO worked with hospital leadership at the accepting hospital to identify an admitting physician. Once transferred, the routine DCD process was followed through the DCD attempt.
Results: As a result of this donation process, a patient who previously would not have been evaluated and determined to be a candidate was able to proceed through the DCD pathway and attempt. Following compassionate extubation, the patient did not expire in the timeframe for organ donation and has been honored as a donor in spirit. Both hospitals received case debriefs to support their efforts of making the donation attempt happen.
Conclusion: In conclusion, the OPO identified that LTAC hospitals have donation referral potential, and the OPO worked with the hospital and system to support mechanically vented referrals. The above LTAC referred twice as many mechanically vented patients in 2022 than in the previous two years combined. The established relationships of all parties culminated in a learning opportunity for the LTAC hospital, acute care hospital, and OPO alike.