ORGAN DONOR MANAGEMENT – HOSPITAL CHECKLIST (NDD)

ORGAN DONOR MANAGEMENT – HOSPITAL
CHECKLIST (NDD)
3. Consent for Organ Donation
Consent form signed and witnessed
Family Contact information for ODHD for Medical/Social Questionnaire__________________________
Pastoral care or Social worker referral for donor family, if appropriate
Coroner notified, record name and number for ODHD________________________________________
4. Donor Screening, Maintenance and Organ Evaluation (Review requirements with ODHD)
Organ Donor Management (recommended guidelines reviewed)
Initial blood work drawn
Cultures / Sputum for Gram Stain
Urinalysis including ACR
O 2 Challenge
12 Lead ECG
CXR
Echo
Eye Care for Cornea donors (Consult with Eye Bank of BC phone # 1-800-667-2060)
Results ODHD Coordinator Will Require:
Lab work (including cultures of gram stains if available)
Chest X-ray
12 Lead ECG
Echo
O 2
Challenge
5. OR Checklist
OR timing (ODHD Coordinator will provide this information)
Chart in order and complete
Addressograph or patient labels on chart
Death Certificate completed and on chart
6. Family Follow up
Would the family like to be contacted following the recovery of the organs? Yes or No
By Whom?__________________________ Contact # for family/name________________________
7. Staff Follow up
Post case follow up / debriefing requested by hospital staff: PLEASE INFORM ODHD Coordinator
Additional Information:
__________________________________________________________________________
_____________________________________________________________________________
Please contact ODHD Coordinator with any questions or concerns during or after the case.
Doc: ODHD-PRE.08.005 Rev: 01 Rev. Date: 02-Nov-2009 Page 2 of 2