THE UNIFORM ANATOMICAL GIFT ACT governs organ and tissue donation in the United States, and most states have additional legislation. Some states require medical staff to ask about organ donation upon every death. Others require staff to notify an organ procurement organization, which sends a representative to approach the family.
When the decision is made to donate a patient's organs and tissues, extensive documentation is required regarding family discussions, protocols, and authorization permits. Review your facility's policies as well as those of the organ procurement organization to ensure that all required documentation is completed.
If a patient's driver's license or other documents indicate a wish to donate organs, place copies in the medical record and document that you've done so. Whoever contacts the organ procurement organization must document the conversation, including the date and time, the name of the person spoken with, and instructions given. If you were part of the discussion of organ donation with the family, document who was present, what the family was told and by whom, and their response.
Patients who are candidates for donation have highly specialized needs. Maintain hemodynamic and electrolyte values within tight ranges to maintain organ or tissue viability. Assess and document urine output hourly and closely monitor and document lab results.
Most organs used in transplants come from people who have suffered brain death. Specific brain death criteria are used to determine death. The apnea test is accepted as a standard in determining brain death. If this test is performed, document the person or persons present and conducting the test, ventilator settings before starting the test, and test results.
Document the date and time the patient is pronounced brain dead. Many state laws require hospitals to send an end-of-life summary to their organ procurement organization describing the patient's condition at admission and the circumstances surrounding the death. Record your nursing care of the patient until the time of organ procurement. Document any teaching, explanations, and emotional support given to the family.