Referral
Donor Information Line Referral:
1) Patient is meeting ANY of the following criteria:
- Discussion of terminal extubation
- Persistent GCS 5 or less
- Loss of any TWO brain stem reflexes
- Brain death testing is pending
- Family meetings or Palliative Care consult to discuss end-of-life options
- Code status change to DNR or planned de-escalation/non-escalation of care
- Discussion of removal of life-sustaining therapies (pressors, ECMO)
- Family mentions donation
- To report time of cardiac death (all patient deaths)
2) Within 60 minutes of patient meeting any of the criteria, call donor information line at either:
- National: 800-448-4644
- Local: 303-321-0060
The coordinator at the donor information line will then page the appropriate donor alliance staff member to follow up for additional information.
3) Expect a donor alliance staff member to call back within 15 minutes for further information regarding:
- admission course
- past medical history
- clinical picture
- neuro assessment (GCS & Brainstem reflexes)
- family dynamics / ongoing plan of care
If you have any questions regarding donation, please feel free to ask any responding donor alliance staff member!
4) In case of urgent situations:
- Donor alliance must evaluate patient for organ donation potential prior to withdrawal of life sustaining treatments (including ventilator and/or pharmacological support)
- Donor alliance staff member will call you back with plan as soon as possible
- If family members are requesting withdrawal of support as soon as possible, we encourage hospital staff not to mention donation. Another way to slow this process down is to inform the family: “An end of life coordinator will speak with you soon”. See the section regarding family support service for additional help with bridging statements.
5) After initial information is received, Donor Alliance staff may come round in person with the medical team regarding the referred patient.
6) Donor Alliance staff will follow up daily for updates regarding:
- clinical status
- neurological status
- family dynamics / plan of care
7) In the meantime, please update donor alliance if there are any indications toward comfort measures (i.e. family meetings planned, family gathering to say goodbye, palliative consults), neurological changes, plans for brain death testing, or if family mentions donation. Early notification of patients meeting criteria allows for better communication and collaboration between Donor Alliance and the Hospital. Providing donor alliance as much time as possible is crucial to the assessment for donation and greatly assists in our collaboration with the hospital team and the family! 😊
Remember:
- Notify prior to ALL TERMINAL EXTUBATIONS regardless of diagnosis
- Notify of all deaths within 60 minutes of cardiac death
- Allow Donor Alliance to initiate all conversations about donation
- Donor Alliance will contact you to collaborate on the next steps
E-Referral:
1) Patient is meeting ANY of the following clinical triggers:
- intubated with a GCS 5 or less
- loss of 2 or more brain stem reflexes
- Discussion of poor prognosis in rounds today?
- Discussion of brain death testing?
- Plan for a family meeting or palliative care consult to discuss end-of-life options?
- Code status change to DNR or de-escalation of care?
- Discussion to remove life sustaining therapies, including pressor support, ECMO?
- Has the family mentioned donation?
- TTM – hypothermia protocol initiated?
2) Within 1 hour of patient meeting clinical triggers, submit e-referral.
- The e-referral system will immediately notify a donor alliance staff member.
3) Expect a donor alliance staff member to call you within 20 minutes for further information regarding:
- admission course
- past medical history
- clinical picture
- neuro assessment (GCS & Brainstem reflexes)
- family dynamics / ongoing plan of care
If you have any questions regarding donation, please feel free to ask any responding donor alliance staff member!
An initial phone call with a donor alliance staff member is required for donor alliance to fully capture details regarding plan of care and family dynamics
4) In case of urgent situations:
- Donor alliance must evaluate patient for organ donation potential prior to withdrawal of life sustaining treatments (including ventilator and/or pharmacological support)
- Donor alliance staff member will call you back with plan as soon as possible
- If family members are requesting withdrawal of support as soon as possible, we encourage hospital staff not to mention donation. Another way to slow this process down is to inform the family: “An end of life coordinator will speak with you soon”. See the section regarding family support service for additional help with bridging statements.
5) After initial information is received, Donor Alliance staff may come round in person with the medical team regarding the referred patient.
6) Donor alliance staff will follow up daily for updates regarding:
- clinical status
- neurological status
- family dynamics / plan of care
OF NOTE: Donor alliance will follow up via epic chat as feasible. However, donor alliance staff may call directly if necessary. Epic chat may only be utilized for follow-ups. Initial screenings MUST be done by phone.
7) In the meantime, please update donor alliance if there are any indications toward comfort measures (i.e. family meetings planned, family gathering to say goodbye, palliative consults), neurological changes, plans for brain death testing, or if family mentions donation. Early notification of patients meeting criteria allows for better communication and collaboration between Donor Alliance and the Hospital. Providing donor alliance as much time as possible is crucial to the assessment for donation and greatly assists in our collaboration with the hospital team and the family! 😊
Remember:
- Notify prior to ALL TERMINAL EXTUBATIONS regardless of diagnosis
- Notify of all deaths within 60 minutes of cardiac death
- Allow Donor Alliance to initiate all conversations about donation
- Donor Alliance will contact you to collaborate on the next steps
Special Circumstances
- We absolutely understand there are times when time is not on anyone's side. What we would ask is that you refer the patient as soon as possible, and if able, include the urgency of the situation. A donor alliance staff member will still need to clinically screen with you over the phone, and then create a plan based on clinical potential for organ donation and timeframes.
- Donor alliance will then screen the patient’s clinical picture to their administration and/or medical director. During this time, it is crucial not to terminally extubate prior to hearing back from us, whether that is with a decision to approach the family or to clinically rule out the patient for organ donation.
- Donor alliance always advocates for family approaches to be in person, as these discussions are heavy and sometimes hard for families to hear. However, if time is too restrictive, we can always call the family over the phone if necessary.
- Please refer to the section regarding family support service for additional help with bridging statements, as these techniques have uniquely been helpful to increase time for the family prior to compassionate extubation.
- If the RN is able to inform donor alliance of this transfer, that is very helpful but not required. Donor alliance will find this information and close the referral at the old facility.
- The new RN at the new facility will then have to re-refer this patient at that hospital. We ask that the RN inform the new facility to create a NEW referral # for this patient.
- We would need a new referral # due to data and documentation requirements on donor alliances’ side.
- Donor alliance may stop following a patient for numerous reasons. Some of those (but not all) include:
- patient has a very high neuro status and plan of care will most likely result in trach/peg/LTAC (not going towards comfort measures)
- patient was deemed not a DCD candidate by donor alliance and pt has a high neuro status consistently (no clinical potential for organ donation)
- patient was or is going to be extubated for survival (not for comfort measures)
- patient was a medical rule out based on clinical picture.
- It is important to note that prior to cardiac time of death, only the organ team at donor alliance has stopped following the patient. Within 1 hr, ALL PATIENTS will still need a cardiac time of death reported to donor alliance for tissue team to assess for tissue and eye donation.
Yes. Many times, when donor alliance organ team has stopped following a patient it is based on their clinical picture and plan of care at that time. If there is a neurological change or indications toward comfort measures/withdrawal of treatment (see trigger card), we would still want to know even if we have stopped following a patient. Please let us know as soon as possible, preferably within 1 hr of these changes or indications.
Please re-refer the patient within 1 hour of meeting clinical triggers. When you are re-referring a previously admitted patient, it is OK to use the same referral # as the previous admission if the previous admission had a discharge date of <30 days prior. If it has been longer than 30 days, a new referral # will need to be created.