Organ Procurement Coordinators Research Articles

Technical Aspects of Intravascular Pressure Monitoring during Donor Care

Many biological signals must be measured and interpreted accurately to titrate therapy properly during donor care. Although the technological aspects of intravascular pressure monitoring are usually delegated to bedside nursing colleagues, organ procurement coordinators should be familiar with those devices and methods. The equipment, supplies, and procedures used for arterial and central venous pressure monitoring are reviewed. Transducer leveling and zeroing plus maintenance of the hydraulic tubing system between the transducer and bedside monitor are especially important. These variables may greatly influence the accuracy of the displayed pressures and, therefore, must be considered during donor assessment as treatment is considered.

Technical aspects of intravascular pressure monitoring during donor care

Many biological signals must be measured and interpreted accurately to titrate therapy properly during donor care. Although the technological aspects of intravascular pressure monitoring are usually delegated to bedside nursing colleagues, organ procurement coordinators should be familiar with those devices and methods. The equipment, supplies, and procedures used for arterial and central venous pressure monitoring are reviewed. Transducer leveling and zeroing plus maintenance of the hydraulic tubing system between the transducer and bedside monitor are especially important. These variables may greatly influence the accuracy of the displayed pressures and, therefore, must be considered during donor assessment as treatment is considered.

Improving the Recruitment and Retention of Organ Procurement Coordinators: A Survey Study

Organ procurement coordinators (coordinators) employed by organ procurement organizations (OPOs) are critical to the success of organ donation. However, their high turnover rates may threaten the success of organ donation. This cross-sectional study examined employment satisfaction and factors contributing to job turnover among 326 coordinators representing 52 of 58 OPOs (90%) who completed an online survey. Most (93%) respondents reported high levels of job satisfaction, although 26% reported considering leaving their OPO, and 61% perceived a high turnover rate at their OPO. Considerations of leaving the OPO were most likely to emerge at 2 years of employment. To secure coordinator job satisfaction, it is essential that prospective coordinators be adequately prepared and informed about negative as well as positive aspects of this line of work. In hiring, OPOs should recruit more proactively, using their staff as contacts, and seek experience in critical care, intensive care, or other on-call work. To retain satisfied employees, OPOs should offer more education and advancement opportunities and focus on such issues as call and hours, rather than salary per se. OPOs should consider a variety of alternative pay structures, particularly separate on-call pay, whether or not coordinators are actually called into service.

Human Pancreatic Islets and Diabetes Research

Human islet research is crucial to understanding the cellular biology of the pancreas in developing therapeutic options for diabetes patients and in attempting to prevent the development of this disease. The national Islet Cell Resource Center Consortium provides human pancreatic islets for diabetes research while simultaneously addressing the need to improve islet isolation and transplantation technologies. Since its inception in 2001, the consortium has supplied 297.6 million islet equivalents to 151 national and international scientists for use in clinical and laboratory projects. Data on the volume, quality, and frequency of shipments substantiate the importance of human islets for diabetes research, as do the number of funded grants for beta-cell projects and publications produced as a direct result of islets supplied by this resource. Limitations in using human islets are discussed, along with the future of islet distribution centers. The information presented here is instructive to clinicians, basic science investigators, and policy makers who determine the availability of funding for such work. Organ procurement coordinators also may find the information useful in explaining to donor families why research consent is so valuable.

An Introduction to the Electrocardiogram during Adult Donor Care

Organ procurement coordinators use continuous monitoring of the electrocardiographic rhythm from the donor's heart during bedside care. Similarly, organ procurement coordinators are often asked to report interpretations of 12-lead electrocardiograms provided by hospital cardiologists. To aid in these important functions, this article describes the biochemical bases of electrocardiograms and alterations in electrocardiograms caused by common electrolyte disorders, hypothermia, and myocardial ischemia that may occur during donor care.

An introduction to the electrocardiogram during adult donor care

Organ procurement coordinators use continuous monitoring of the electrocardiographic rhythm from the donor's heart during bedside care. Similarly, organ procurement coordinators are often asked to report interpretations of 12-lead electrocardiograms provided by hospital cardiologists. To aid in these important functions, this article describes the biochemical bases of electrocardiograms and alterations in electrocardiograms caused by common electrolyte disorders, hypothermia, and myocardial ischemia that may occur during donor care.

Communicating Effectively about Donation: An Educational Intervention to Increase Consent to Donation

Families' refusal to consent to solid organ donation is a major contributor to the organ deficit in the United States. Previous research has identified organ procurement coordinators as best able to obtain consent from families; however, few studies have examined the effects of coordinator training programs on consent rates. To test the effects of the Communicating Effectively About Donation intervention on the rate of family consent to solid organ donation. A nonrandomized repeated measures design. Participants included 17 hospitals, 502 donor-eligible patients and their families, and 22 coordinators from an organ procurement organization in Ohio. Coordinators were given in-service training on the use of effective relational and affective communication techniques through a day-long interactive workshop and simulated donation scenarios. Families' final donation decision and coordinators' donation-related behaviors. Training of coordinators was associated with increases in coordinators' comfort speaking with patients' families about donation and answering donation-related questions, in the amount of time coordinators spent discussing donation with family members, and in the number of donation-related topics discussed with families. Consent rates increased from 46.3% to 55.5% after the intervention. The results suggest that improving coordinators' communication skills may be a fruitful avenue for increasing the rate of family consent to donation; however, a more definitive test of the training is needed to confirm the intervention's effectiveness.

Advanced practice organ procurement techniques: placement of pulmonary artery catheters

Insertion of pulmonary artery catheters by organ procurement coordinators may be incorporated into donor management to optimize organ perfusion. As invasive procedures are added to coordinator roles, the organ procurement organization must include didactic instruction and supervised clinical experience as part of any training program. Policies and procedures guiding the use of the pulmonary artery catheter and the measurements obtained must be provided by the organization to guide practitioners. This article focuses on methods for insertion and basic troubleshooting of a pulmonary artery catheter.

Advanced Practice Organ Procurement Techniques: Placement of Pulmonary Artery Catheters

Insertion of pulmonary artery catheters by organ procurement coordinators may be incorporated into donor management to optimize organ perfusion. As invasive procedures are added to coordinator roles, the organ procurement organization must include didactic instruction and supervised clinical experience as part of any training program. Policies and procedures guiding the use of the pulmonary artery catheter and the measurements obtained must be provided by the organization to guide practitioners. This article focuses on methods for insertion and basic troubleshooting of a pulmonary artery catheter.

Advanced Practice Organ Procurement Techniques: Insertion of Arterial Catheters

Placement of arterial catheters by organ procurement coordinators is becoming more common. Classroom and clinical training in this technique and provision of appropriate quality assurance and supportive policies/procedures by organ procurement programs will ensure the coordinators' success. This discussion reviews technical aspects of insertion of catheters into the radial, femoral, and axillary arteries, potential complications, and alternative noninvasive methods of measuring blood pressure.

Advanced practice organ procurement techniques: insertion of arterial catheters

Placement of arterial catheters by organ procurement coordinators is becoming more common. Classroom and clinical training in this technique and provision of appropriate quality assurance and supportive policies/procedures by organ procurement programs will ensure the coordinators' success. This discussion reviews technical aspects of insertion of catheters into the radial, femoral, and axillary arteries, potential complications, and alternative noninvasive methods of measuring blood pressure.

Advanced practice organ procurement techniques: insertion of central venous catheters

Placement of central venous catheters by organ procurement coordinators to assist in obtaining blood samples or for measuring intravascular pressure is appropriate. Preparation for this role should include appropriate didactic instruction and supervised clinical experience. The organ procurement organization must ensure that such training occurs and must support a continuing quality assurance program for such providers. Policies and procedures must be provided to guide practitioners in site selection, timing of implementation, and titration of measurements obtained. Also, resources must be readily available to treat any complications. This discussion reviews methods for insertion of venous catheters placed in the femoral, internal jugular, or subclavian veins.

Advanced Practice Organ Procurement Techniques: Insertion of Central Venous Catheters

Placement of central venous catheters by organ procurement coordinators to assist in obtaining blood samples or for measuring intravascular pressure is appropriate. Preparation for this role should include appropriate didactic instruction and supervised clinical experience. The organ procurement organization must ensure that such training occurs and must support a continuing quality assurance program for such providers. Policies and procedures must be provided to guide practitioners in site selection, timing of implementation, and titration of measurements obtained. Also, resources must be readily available to treat any complications. This discussion reviews methods for insertion of venous catheters placed in the femoral, internal jugular, or subclavian veins.

Cardiac Dysrhythmias during Donor Care

Organ procurement coordinators must treat various cardiac dysrhythmias (arrhythmias), including rhythm disturbances that may cause or follow a cardiac arrest, in about 15% to 50% of donors. Treatment decisions should be based on the particular dysrhythmia and its effect on donor blood pressure. Medications selected should be effective but short acting. In this article, data available in publications located through a PubMed search are reviewed and specific dysrhythmias that are likely to occur during donor care are described. Treatment recommendations are based on guidelines from the American Heart Association.

Cardiac dysrhythmias during donor care

Organ procurement coordinators must treat various cardiac dysrhythmias (arrhythmias), including rhythm disturbances that may cause or follow a cardiac arrest, in about 15% to 50% of donors. Treatment decisions should be based on the particular dysrhythmia and its effect on donor blood pressure. Medications selected should be effective but short acting. In this article, data available in publications located through a PubMed search are reviewed and specific dysrhythmias that are likely to occur during donor care are described. Treatment recommendations are based on guidelines from the American Heart Association.

Introduction to the Interpretation of Chest Radiographs during Donor Care

Organ procurement coordinators often provide independent interpretations of chest radiographs during donor care. Catheter or tube position, lobar atelectasis, extra-alveolar air, air bronchograms, pleural fluid, and other findings are important throughout donor care and when deciding if a lung is acceptable for transplantation. Technical factors, features of a normal chest radiograph, and abnormal radiographic findings are reviewed and examples are presented.

Introduction to the interpretation of chest radiographs during donor care

Organ procurement coordinators often provide independent interpretations of chest radiographs during donor care. Catheter or tube position, lobar atelectasis, extra-alveolar air, air bronchograms, pleural fluid, and other findings are important throughout donor care and when deciding if a lung is acceptable for transplantation. Technical factors, features of a normal chest radiograph, and abnormal radiographic findings are reviewed and examples are presented.

Comparison of Consent Rates between Hospital-Based Designated Requestors and Organ Procurement Coordinators

Recent legislation in our service area has put restrictions on who is allowed to approach families about donation. Many hospitals have therefore requested training for designated requestors to speak with families. The organ procurement organization followed the consent rate of 2 hospitals to evaluate the effectiveness of the designated requestors in the consent process. This article compares the success of the hospital-based designated requestor program in obtaining consent with that of another hospital, which relies solely on the organ procurement coordinator to approach families. Thirteen staff members in hospital A received the 8-hour designated requestor training. A decrease in the consent rate at hospital A prompted the organ procurement organization to interview the 13 requestors. Possible reasons for the decline ranged from lack of experience to the lack of identification as donor family advocate. Both hospitals were encouraged to consider a multidisciplinary approach, which includes the organ procurement coordinator in the request process.

The coordinator attrition problem in the United States: myth or reality?

Excessive attrition among organ procurement coordinators has been suspected problem for many years. In 1994 the United Network for Organ Sharing undertook a procurement coordinator attrition study. Initially, focus groups were conducted in conjunction with the 1994 North American Transplant Coordinators Organization's annual meeting. In 1996, 69 executive directors from organ procurement organizations were surveyed on the subject of procurement coordinator attrition. Thirty-five executive directors responded, resulting in a 51% response rate. The UNOS procurement coordinator attrition study explored actual attrition rates, relationships of certain demographic factors to attrition rates, economic impact of attrition on the organizations, and various job tenure issues. The period under study was January 1, 1990 through December 31, 1993. Results did not demonstrate an industry-wide attrition problem. Additionally, the study revealed no enduring attrition problem in any single organization, and some organizations were found to have no attrition during the entire study period.

The Coordinator Attrition Problem in the United States: Myth or Reality?

Excessive attrition among organ procurement coordinators has been a suspected problem for many years. In 1994 the United Network for Organ Sharing undertook a procurement coordinator attrition study. Initially, focus groups were conducted in conjunction with the 1994 North American Transplant Coordinators Organization's annual meeting. In 1996, 69 executive directors from organ procurement organizations were surveyed on the subject of procurement coordinator attrition. Thirty-five executive directors responded, resulting in a 51% response rate. The UNOS procurement coordinator attrition study explored actual attrition rates, relationships of certain demographic factors to attrition rates, economic impact of attrition on the organizations, and various job tenure issues. The period under study was January 1, 1990 through December 31, 1993. Results did not demonstrate an industry-wide attrition problem. Additionally, the study revealed no enduring attrition problem in any single organization, and some organizations were found to have no attrition during the entire study period.