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Transcript of DMP presentation
Donor Management Practitioner (MSc/PGDip)
BACKGROUND2 years PG dip/MSc: DMP at University of B’ham
4 DMPs each with previous extensive cardiac experience at senior staff level
BSE TTE/TOE echocardiography
Clinical skills: Invasive line insertion/Bronchoscopy/Independent protocol driven management of donor
Consultant led teaching
SCOUT TRIAL
Active nationally since April 2013 - active at QEHB since June 2013
Current Scout team consists of Retrieval surgeon and DMP
DMP works independently from retrieval team
Rest of team joins the DMP once the organs have been accepted
AIMS OF TRIAL
Increase the number of donor hearts/lungs retrieved and transplanted
Rectify the national supply and demand issue
Improving the quality of all retrieved organs
Successful pilot will lead to rolling out scout scheme to all DBD donors in UK
INITIAL ACTIONSDevelop an audit/database to run parallel to national audit
Held educational awareness and introductory meetings with local and national ITU departments
Continuing clinical skill competencies
Contact with CTAG and DOH/NHSBT
Provide a 24/7 Donor management service here at QEHB
OUR AIMSProve that our intervention improves the function of the small pool of cardio thoracic donors
Derive a successful transplant from the said optimised organs
Forge a relationship with local and national ITUs and integrate into the Heart and Lung service QEHB
Compile a database of our outcomes and research which can be monitored by clinical leads
HOW WE DO IT
Informed at point of consent for ‘Optimisation before retrieval’
Travel to donor hospital ahead of the retrieval team
Broadly divided into two main roles
Assessment and Optimisation
ASSESSMENT
Utilising several modalities to carry out a full assessment of both heart and lungs
Trans-oesophageal echocardiography
Right heart catheterisation (PAFC)
Bronchoscopy
PiCCO (EVLW)
Blood gas analysis/biomarkers and microbiology (sputum/lavage samples)
OPTIMISATION
On basis of previous findings, employ a comprehensive donor management protocol
Algorithmic
Based on extensive research carried out by Professor RSB and Venkat
Written by RSB and most importantly demonstrated by over course of our training - first hand experience
Donor UKT NumberRetrieval UnitDate and time of DMP arrival
Time (T)
Heart Rate
MAP
Mean PAP
PCWP
CVP
CO
CI
SVR
EVLW
Fi 02/ Peep
pO2
pCO2
ph
BE
HCO3
Drug Concentration Rate of infusion ml/hr
Noradrenaline
Vasopressin
Insulin
T3
Adrenaline
Dopamine
Dobutamine
Metraminol
Fluid Name Volume administered
Colloid
Crystalloid
Blood
Respiratory Manouvers
Chest physio
Suction
Alveoli recruitment procedures
Heart beating donor managementDonor detailsDonor age: Sex: Blood group: Height: Weight:Cause of death: 1st BSD tests: 2nd BSD tests:Medical History:Medication on admission:
Bronchoscopy findings
(MA
P –
RaP
mm
Hg)
Cardiac output (l/Min)
Time (T)
Symbol A B C D E F G H I J K L
ECHO Findings
Time
LVEF RV
AV
MV
TV
REPORTING FINDINGS
In recent NHSBT UK strategy ‘Taking transplant to 2020’, it was stated in one of many outcomes that ‘Transplant surgeons are to be supplied with more information and guidance to help decide which organs can be safely and effectively transplanted into which recipients’
Our diagnostic findings can be used as specific markers for function and suitability for retrieval
ACCEPTANCE OF OPTIMISED ORGANS
The optimised organs are offered nationally and it is of main priority to maintain the function until time of retrieval
This is achieved by careful titration of inotropes/fluids/hormone replacement therapy and continual haemodynamic monitoring
Detailed handover to SNOD and local anaesthetist involved in care of patient during retrieval process
SUMMARY
The success of a transplanted organ is multi-factorial but optimisation before retrieval plays a huge part
To quote again from NHSBT 2020 strategy ‘The care a person receives at end of life can have a significant impact on the functioning of their organs and without the right support, otherwise transplantable organs may become unusable’
ANY QUESTIONS