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The primary purpose of the program is to facilitate the organ and tissue donation process at The Ottawa Hospital and Children’s Hospital of Eastern Ontario (CHEO) in adherence to national safety and practice standards.

Clinical Pathway

The Process

Donor Identification
It is the responsibility of the staff on each unit to identify potential organ and tissue donors. The donor coordinator is available at all times as a resource to assist in this step in the process.

Arrange Transfer of Potential Donor from Referring Facility
It is the responsibility of the donor coordinator to arrange for transfer of a potential donor from a referring facility within the Ottawa Region, if necessary.

Declaration of Brain Death
Brain death declaration, for the purposes of organ donation, is the responsibility of two physicians experienced in the relevant clinical examination. Those individuals who assess patients for brain death should be independent of the transplant team. It is appropriate for the donor coordinator to assist in this step of the process because she/he is part of the critical care team and is not part of the transplant program.

Approaching Family
A decoupled approach is recommended and should be instituted as standard practice at The Ottawa Hospital. Decoupling is defined as introduction of the concept of donation by a donor coordinator not associated with transplantation, only after the family has had time to absorb the reality and finality of brain death. This approach has been recognized internationally and results in the highest rates of consent.

Obtaining Informed Consent
Informed consent is defined as the agreement of a person (or his/her legally authorized representative) to submit to any medical procedure, in full knowledge of all procedures and requirements as well as possible risks and benefits entailed. It is the donor coordinator that has the knowledge and expertise in all aspects of the organ and tissue donation process, therefore is the most appropriate member of the team to participate in obtaining consent.

Donor Assessment/Management
The donor coordinator is responsible for ensuring the completion of the donor assessment, including :

• Arranging for blood samples to be sent to the appropriate laboratories;
• Coordinating diagnostic tests as required;
• Acting as a resource for the donor maintenance protocol;
• Communicate with prospective transplant teams;
• Notifying the Operating Room;
• Obtaining privileges for outside teams.

The coordinator also provides appropriate documentation for retrieval teams. This step also includes a Medical/Social History Questionnaire completed with the family. This comprehensive document is a legal requirement of the donation process and is legislated in the Food and Drug Act, as part of the safety standards. It is the responsibility of the donor coordinator to ensure that the required information on the above mentioned questionnaire is obtained in a compassionate and reliable manner.

Donor Registration and Organ Allocation
Donor registration and organ allocation is the responsibility of the Trillium Gift of Life Network‘s Provincial Resource Centre based in Toronto. The organs would be offered to the transplant centre according to the provincial Trillium Gift of Life Network computer allocation report. Ongoing communication with the retrieval centres would take place until organs are retrieved.

Organ Retrieval
The donor coordinator is part of the retrieval team and will be present in the OR. The responsibilities will include: reviewing donor chart with nursing and medical staff prior to retrieval commencing; supporting the incoming and local teams; assisting with and/or performing perfusion responsibilities; ensuring adherence to retrieval protocols; documentation; packaging; and travel arrangements for organs, tissues and teams.

Family Follow-up
If previously agreed upon by the donor’s family, the coordinator will contact the family members after the retrieval process is completed. With permission from the next-of-kin, a thank-you package(s) will be sent to them. The letter provides the family with information about the transplant and the recipients without revealing the recipient’s identity.

If necessary the donor coordination team will provide follow-up support to family members on issues and concerns about organ donation and transplantation. The program also acts as the liaison for correspondence between donor families and recipients while ensuring confidentiality of those involved. There is an expanded follow-up program within this organ and tissue donation structure.

The above does not reflect the process for the tissue only donor. The responsibilities, complexity, and timelines differ depending on what tissues are being retrieved. Tissue donation falls within the realm of responsibility of the donor coordinator on-call.

Last updated on: December 5th, 2016