The Role of Palliative Medicine in Organ Donation: From Bedside to Operating Room (752)

Abstract

1.Identify key communication issues associated with the process of organ donation.2.Improve skills in brain death determination.3.Learn how to enhance patient and family comfort in the operating room. Background. With the increasing recognition of the value of palliative care consultation, palliative care specialists have become involved in areas where their skills in communication, empathy and expert symptom management are called upon to provide comfort for patients and families. In the process of donation after cardiac death (DCD), palliative care teams have been increasingly used to provide expert symptom management, communication around sensitive issues, and family support. The role of palliative care mitigates perceived conflict of interests between organ donation networks and ICU teams. Case description. A 49-year-old male presented to the emergency room with sudden loss of consciousness. Upon arrival, the patient was found to be unresponsive. The patient was intubated. A noncontrast CT scan was performed and showed an unusual density seen in the basilar artery. A CT angiogram of the brain and neck was performed which demonstrated a basilar artery thrombus on the right with congenitally diminutive artery noted on the left. Patient was administered tPA in the Emergency Department with no improvement in his neurologic exam. Interval CT scan showed progressive hematoma effacing the pons. In subsequent hours, no neurological improvement was manifest. The family was informed of the prognosis. The family elected to withdraw support. The patient's family members initiated the conversation regarding organ donation. The palliative care team was called to participate in the organ donation process. Conclusion. Palliative care team can play an important role in the organ donation process. They facilitate communication between donor networks, ICU team, and families; they coordinate a multidisciplinary approach in preparation for the withdrawal process and provide expert symptom management at the time of withdrawal of therapy.