Patient (Potential Donor) Assessment
Patient assessment is an integral role of the Specialist Nurse – Organ Donation (SN-OD) and is a vital part of the organ and tissue donation process. It is important that all clinical staff involved in organ donation work collaboratively to ensure that organs offered for transplantation by donors and their families achieve the best possible outcome. The SN-ODs standards of practice and all relevant polices and procedures are based on the principle that respect for the donor and their family and the safety of transplant recipients is paramount.
The purpose of the patient assessment is to determine if a potential donor is suitable to donate organs or tissue and which organs and tissues can be donated. Additionally, it is vital to identify risk factors for the transmission of disease from the potential donor to potential transplant recipients. It is the responsibility of the SN-OD to collect comprehensive information on medical, behavioural and travel history and relay all of the information obtained to the transplant centres. For organs, it is the responsibility of the implanting surgeon to assess the risk of transplant for their individual patients.
Key Components of the Patient Assessment
The key components of patient assessment can be categorised as below:
- Information gathered from speaking to healthcare professionals involved in the potential donors care during this admission and in the past for example GP, Allied Personnel in Health Centre, alternative therapists, etc.
- Information gathered through clinical investigations and procedures.
- Information gathered through discussion with the next of kin.
- A physical examination of the patient.
Obtaining an accurate account and history from the referring clinician and the nursing staff who are providing care for the patient is a critical first step in determining the patient’s current clinical status and determining their past medical history.
After obtaining this information for the clinical staff the SNOD will review the medical and nursing notes of the patient.
Medical and Nursing Notes Review to include:
- Admission history/emergency department documentation, paramedic documentation.
- Detailed past medical history (PMH): previous hospital admissions, previous blood results, scan, X-ray reports, Discharge letters etc.
- Social history, behavioural and sexual history.
- Current and past medications.
- Events since admission.
- Imaging reports (scans, X-rays etc).
- Blood results, including microbiology.
- Current haemodynamic status.
- Brain stem death documentation (if applicable).
- Declaration of futility.
- Documentation of discussions with the family / next of kin.
- Assessment of haemodynamic observation, fluid and drug charts.
- General Practitioner
It is the SN-ODs responsibility to make contact with the General Practitioner (GP). Where possible this should be done on the day of donation to ascertain and verify the past medical history. However, if the GP is not contactable as it is outside office hours, this is carried out as soon as possible on the next working day. Any information obtained from the GP will be communicated to the transplant centres.
Points discussed with the GP:
- Did the patient visit their GP in the last two years?
- Did the patient have diabetes mellitus? If yes were they on insulin?
- Did the patient take regular medication?
- Did the patient ever undergo any investigations for cancer or ever been diagnosed with cancer?
- Did the patient suffer recent significant weight loss?
- Any conditions/illness that they are aware of that may preclude the patient from being an organ donor?
Not only is it vital to liaise with the GP, but also any other health professional who has been involved with the patients care prior to admission to hospital.
Family / Next of Kin Interview
Information gathered from the donor family / next of kin interview is vital and this structured discussion is documented on the Patient Assessment form (PA1). There may be information gathered here that the SN-OD will need to follow-up outside of the family interview e.g. with the GP. It is important that the SN-OD gets an accurate, structured and focused history from the family
A systematic head to toe patient assessment is completed by the Specialist nurse. All findings are documented in a clear and concise manner.
The following is assessed and documented:
General features such as height (measured and checked by two SN-ODs) and weight; signs as pulse and blood pressure
Head, checked for:
- Visible head injury.
- Previous surgery.
- Presence of intracranial bolt or drain.
- ET tube.
- Facial injuries and fractures.
- Ear injuries.
- Eye injuries.
- Nasal injuries.
- Nasogastric / Orogastric tube.
- Face: Checked for skin tone, temperature, swelling and disfigurement.
- Ears: Checked for internal and external injury.
- Neck: Checked for abnormalities, cuts or swelling, signs of trauma and the presence of intravenous.
- Chest: Has the patient had a recent, reported chest X-ray?
The report should comment on:
- Previous scars/operations presence of drains.
- Evidence of consolidation or collapse
- Any abnormalities
- Air entry should be checked and breast examination should be carried out in female potential donors by a member of medical staff to exclude abnormalities.
Abdomen, checked for:
- Previous surgery/scars.
- Signs of pregnancy.
- Signs of trauma.
- Measurement of abdominal girth
- Groin, checked for:
- Blood loss.
- Discharge indicating infection.
- Injection or track marks.
Arms and legs, checked for:
Visible disfigurement. Swelling cuts and bruises. Fractures. Soft tissue damage. Muscle wasting. Signs of DVT. Injection or needle track marks
Digits, checked for:
- Needle marks between fingers and toes in nail beds.
- Respiratory disease (clubbing of fingers).
- Micro emboli.
In addition to the above any other abnormalities (such as tattoos) will be recorded and, if appropriate, discussed with the clinical team caring for the patient; if necessary expert advice will be sought.
To ensure that the donation and subsequent transplantation of organs is as safe as possible is vital that all information gathered in the assessment process thorough and clearly documented.
It is the responsibility of implanting surgeons to make an assessment of the information that they receive to ascertain organ suitability for their patients.
The assessment of the potential donor is one of the most crucial parts of the donation pathway in ensuring safe transplantation. The specialist nurse will always seek expert advice from clinicians should this required in providing a detailed accurate patient assessment to transplant centres.
During the patient assessment process SN-ODs are mindful of ensuring that the patients next of kin are able to spend as much time as they wish at their loved ones bedside, therefore assessment is carried out at a time agreed with the SN-OD, nurse at the bedside and the family.