Abstract Details

Title Survey of Nationwide Organ Procurement Organization (OPO) Practices in Verification of Death by Neurologic Criteria (DNC)

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-001

Objective To explore Organ Procurement Organization (OPO) practices regarding verification of Death by Neurologic Criteria (DNC).

Background OPOs play a vital role in ensuring a sound practice of DNC determination. While national guidelines and hospital policies delineate how to determine DNC, OPO practices regarding DNC verification are not standardized and little is known about the verification process or prevalence of practice deviations determined by OPOs.

Design/Methods Electronic, mixed-methods survey administered to OPO representatives (directors, administrative leads) nationwide.

Results Twelve different OPO representatives (including medical directors, advisors, and administrators) responded across 6 geographical regions, with 8 reporting covering >50 referral hospitals. Most (92%, 11/12) reported checking DNC verification policies via ��ɫ�� Practice Parameter (AANPP, 92%) and/or Society of Critical Care Medicine/Child Neurology Society/American Academy of Pediatrics (33%) guidelines. Also, most (83%, 10/12) reported independently reviewing and verifying each DNC determination, with 33% (4/12) listing their medical director as the reviewer. Only 25% (3/12) thought all referring hospitals followed AANPP guidelines in practice, and 42% (5/12) reported concerns about guideline-discordant hospital policies. Moreover, 75% (9/12) reported concerns about hospital clinician knowledge surrounding DNC determination, and 83% (10/12) reported receiving referrals for DNC determinations that were ultimately reversed. All respondents reported experiences with cases in which their organization requested additional information or testing (92% further clinical evaluation, 75% repeat apnea testing, 83% additional ancillary testing) due to concerns about DNC determination validity. The most common concerns were regarding possible confounding due to sedating medications (58%), metabolic abnormalities (50%), hypothermia (42%), or inappropriate conduct of apnea testing (42%).

Conclusions Nearly all surveyed OPOs reported a guideline-directed DNC verification process. Many reported concerns about clinician knowledge surrounding DNC determination and guideline-discordant practices and hospital policies. Research is needed to identify barriers and facilitators to systematic implementation of guideline-concordant practices across the country.

Authors/Disclosures
Kasra Sarhadi, MD PRESENTER	Dr. Sarhadi has nothing to disclose.
Kris Hendershot	No disclosure on file
Natalie Smith, MD	Ms. Smith has nothing to disclose.
Michael Souter, MD (Harborview Medical Center, University of Washington)	Dr. Souter has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teleflex. Dr. Souter has a non-compensated relationship as a Medical Director with LifeCenter Northwest that is relevant to AAN interests or activities.
Claire Creutzfeldt, MD	The institution of Dr. Creutzfeldt has received research support from NINR. The institution of Dr. Creutzfeldt has received research support from NIA.
Abhijit Lele	Abhijit Lele has received personal compensation for serving as an employee of LifeCenter Northwest .
Carolina B. Maciel, MD, MSCR, FAAN	Dr. Maciel has received research support from American Heart Association. Dr. Maciel has received research support from National Institute of Health.
Julius Balogh (St Vincent Infirmary)	No disclosure on file
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. An immediate family member of Dr. Greer has or had stock in Vertex Pharmaceuticals. The institution of Dr. Greer has received research support from NINDS. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Katharina M. Busl, MD, MS, FAAN (University of Florida)	Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Huffman Powell Baley. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University Science. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SCCM. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Assistant Editor with Neurocritical Care that is relevant to AAN interests or activities.
Ariane Lewis, MD, FAAN (NYU Langone Medical Center)	Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience.
Sarah Wahlster, MD	Dr. Wahlster has nothing to disclose.

��ɫ����

��ɫ����

��ɫ��

��ɫ��