Organ Donation in the Emergency Department

Though it may not seem as important as some of the things we do in ED Critical Care, managing the potential organ donor can lead to many lives saved. In this episode I interview Isaac Tawil, an Emergency Intensivist of University of New Mexico Health Sciences and associate medical director of New Mexico Organ Donor Services.

Here are the current standards for determining brain death

Wijdicks et al. Evidence-based guideline update: Determining Brain Death in Adults

Brain Death Checklist

brain death statement

Tips on the Exam

from Wijdicks Crit Care 2020;24:648

Mesencephalon

Need only test pupil response to high-intensity flashlight. Pupils are mid-position (4-6 mm)

Use a Magnifying Glass if you don't have a pupilometer

Pons

Corneals (cotton swab or water)

Oculocephalic-Turn from middle to the side 90 degrees on both sides.

Cold calorics-30 mls of ice water. Normal response is slow deviation of eyes towards syringe

Pain Response to nailbeds, supraorbital

Medulla

Gag reflex with yankeur

No cough during deep suctioning

Checklist from the Paper

What to Exclude

J Crit Care 2019;53:212

Here is a video of Dr. Tawil demonstrating the brain death exam

EMCrit Site Links

* IBCC Brain Death

Now on to the Podcast...