Unyts is committed to saving and enhancing lives through organ, eye, tissue, and community blood donation. To achieve this mission, we raise awareness and educate throughout the community. We cannot do it alone. It is in partnership with medical professionals across WNY that we can successfully carry out this mission.
What is Unyts?
Unyts is a federally designated Organ Procurement Organization, also known as an OPO. There are approximately 50 OPOs throughout the country; Unyts is the smallest. We are a non-profit organization. As an OPO, we are responsible for the recovery and allocation of donated organs, tissues and eyes at 26 hospitals in the 8 counties of Western New York. Unyts’Donor Service Area, or DSA covers up to the Canadian border, down the Pennsylvania border and east to Lockport, Medina, and Batavia. Unyts’ Donor Referral Center, Organ Recovery, and Tissue recovery teams provide on-call donation services 24 hours a day, 7 days a week, every day of the year.
How to request more information or an in-service for your hospital or department?
To request more information or an in-service please submit the form below.
Why is Unyts involved at all Western New York’s hospitals?
In 1998, Federal Law implemented a requirement that all hospitals must have an agreement, known as a Memorandum of Agreement (MOA)with an OPO. The law required hospitals to maintain written protocols and policies pertaining to reporting of all deaths and imminent deaths to the OPO. This is required by all hospitals in order to maintain Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation and Center for Medicare and Medicaid Services (CMS) funding. The purpose of the law is to ensure that all families are informed of their options for organ tissue and eye donation. It is also intended to ensure that every family that has donation options is provided the opportunity to make an informed decision.
What can be donated?
Signing up on the registry does not automatically make anyone an organ donor. Less than 1% of the population can be an organ donor; due to the necessity of ventilator support. The organs that can be donated are the heart, lungs, liver, kidneys, pancreas, and intestine. One organ donor can save 8 lives.
The lungs may go to individual recipients, however they are more often transplanted together. This is sometimes referred to as a “double lung transplant”. The kidneys are often times transplanted into separate recipients. However, at times both kidneys may be allocated to one patient. The liver is generally transplanted into one recipient, however, because of the livers ability to regenerate it may be split and transplanted into two recipients. A split liver transplant is rare, though when this takes place one of the recipients is often a pediatric patient.
Tissue and eye donation is an option after all deaths, regardless of ventilation. A screening must be performed to identify the potential for transplantation. The tissues that may be donated are heart valves, bone, skin, tendons and ligaments, veins and nerves. For eye donation, the whole eye or just the cornea can be recovered and transplanted.
Unyts also works in collaboration with several research projects. Organs, tissues and eyes are always evaluated with transplantation as the priority, if the organ, tissue or eye is determined to not be suitable for transplantation Unyts next attempts to secure a research project for that tissue.
How does donated tissue help others?
Organ and tissue donation is a gift of life; it can save, prolong, or improve the lives of recipients. Many people have heard about the ways that transplanted organs can help others, however they are not familiar with the uses of donated tissue. Here are some examples of how donated tissue is typically used to help others:
Veins: Using a donated vein a surgeon is able to re-establish circulation to an affected area. Veins can also be used in cardiac surgery when a patient’s own veins are unable to be used.
Arteries: Donated arteries can be used for patients on dialysis to create AV fistulas necessary for access in long term patients. The aortic iliac artery can be recovered to repair life threatening aneurysms.
Bone: A patient with a malignant bone tumor can be transplanted with a segment of bone to prevent amputation of the limb. Bone can also be used in spinal surgery, the donated bone is used as an implant. Bone is also used to reconstruct joints that are damaged by arthritis.
Soft connective tissue: Soft connective tissue can be used to treat sport related injuries. Ex: torn ligaments. It is also used to repair tendon ,muscle and ligament deformities.
Heart Valves: Children under 15 years of age are the recipients of 70% of heart valves. Heart valves are also transplanted into women of child bearing ages. Human heart values are the preferred source for heart valve surgeries and are reserved for children and women of child bearing ages due the risks of blood thinners that are required with mechanical valves.
Pericardium: The pericardium is used in oral, neurological and urological surgeries.
Skin: Donated skin can help victims of severe burns, trauma patients and those that need reconstructive surgery. Using skin helps reduce post op pain and reduced the risk of post op infection.
Nerves: Nerves are used to repair damaged nerves. Nerve transplant improves sensation and movement and assists at facilitation nerve regeneration.
Corneas: The cornea is the clear part on the front of the eye and can restore vision in persons that cannot see.
Sclera: The sclera is the white part of the eye is used in glaucoma surgeries or to repair trauma in the eye. Also used in repair of periodontal disease.
Research samples from tissues may also be recovered to help generations to come and to find treatments and cure for a variety of conditions. Tissue recovery is a surgical procedure completed under a sterile environment. Every effort is made to minimize visible changes to the body. This ensures that those who prefer an open casket memorial may still do so.
Two types of death:
There are two types of death: cardiac death and brain death. Cardiac death is declared by circulatory criteria. Brain death is determined by neurological criteria. In order to determine brain death, the patient must have received medical treatment and must have been placed on a ventilator.
Brain death is the irreversible cessation of all functions of the entire brain including the brain stem. Brain death and cardiac death are permanent and cannot be reversed. Brain death is the result of trauma or injury to the brain, the body’s blood supply to the brain is blocked, the brain dies and it cannot be revived.
There are two different types of referrals made to Unyts’ Donor Referral Center; they include cardiac death referrals (for tissue and eye donation screening) and imminent death referrals (for organ donation screening). Cardiac death referrals are made after a patient has been pronounced dead at the hospital following cardiopulmonary arrest. Imminent death referrals are referrals made on ventilated patient’s meeting clinical triggers. (For more information on clinical triggers please see the separate section below.)
The Donor Referral Center is responsible for obtaining information from hospital staff calling in cardiac death referrals. The health care professionals that work in the referral center screen the information received to determine potential tissue and eye donation options. Once the option for donation is identified, the coordinator contacts the potential donor’s family over the phone to provide them the opportunity to improve another individual’s life through tissue and eye donation.
Imminent death referrals are made before the patient has passed from cardiac death. These patient’s may be pronounced brain dead or may have a brain injury. There is no recovery of any organ, tissue or eye made prior to a patient being pronounced with a time of death either by circulatory or neurological criteria. The Donor Referral Center does not provide screening of imminent death referrals. The coordinators in the Referral Center serve as a bridge in notifying an Organ Services Coordinator of the imminent death referral. Once this referral is made, the Organ Services Coordinator on-call, will contact the hospital personnel who made the referral to inform them of the receipt of the referral. At the time of this return call, the Organ Services Coordinator may obtain some further information prior to coming on site to follow up with a review of the patient’s chart. The hospital personnel must refrain from extubating a patient at end of life until Unyts have performed an evaluation. Once completed, the Organ Services Coordinator will either meet with the potential donor’s family or inform the hospital personnel to proceed with the family’s end of life wishes. After the evaluation for organ donation is completed, the patient will always need to be re-referred after they have been declared as a cardiac death referral.
Tissue and eye donation is considered to be life enhancing while organ donation is considered lifesaving. Due to this, the screening process for tissue and eye donation is more in depth and at times more restricting.
Standard clinical triggers are met when a ventilated patient meets any of the following criteria:
· Unresponsive/Glasgow Coma Scale (GCS) of 5 or less regardless of sedation
· Loss of one or more neurologic responses. Ex: cough, gag, pupillary, pain, respiratory drive
· Brain death testing is being discussed or started
· Anticipation of a family meeting regarding end of life, or family discussion of end of life
· Prior to limitation of treatment including extubation or discontinuation of pressors
· Family inquires about donation
An Imminent death referral should be made when a patient is ventilated and meets any one of the clinical triggers listed below. For an imminent death referral to be considered timely, the referral should be made within 3 hours of the patient meeting the first of any of the above listed items.
Cardiac death referrals should be made following pronouncement of cardiac death regardless of the standard clinical triggers listed. Cardiac death referral should be made within one hour of patient’s declaration of death.
Why donate? The U-Turn
When all treatment options have been exhausted and despite the medical team’s best efforts, the patient dies, the option of donation can provide a positive outcome to an otherwise tragic situation.
The Approach or Introduction of Donation and/or Unyts
The individual who approaches the family makes a difference in the decision to donate. Research continues to indicate that authorization for donation is highest when the request is made by a trained staff member. Federal regulations support the OPO in being what is called a, Designated Requestor. Unyts never approaches a family for donation without discussing with the medical team first.
In Buffalo, Unyts is the only Organ Procurement Organization, and the only team of trained professionals known as, Designated Requestors. The staff of Designated Requestors completes education throughout the year on appropriate ways to communicate to families their opportunity to donate. This training includes how to provide families with basic information about the donation process, guidelines for helping families through their grief and information that demonstrates the critical need for organs.
Hospitals that receive reimbursement from Center for Medicaid and Medicare Services (CMS) are required to report their effective requesting rate annually. When a hospital staff member introduces Unyts and/or donation discussion independent from Unyts’ Designated Requestor staff this is considered to be an ineffective request.
Although staff may feel they are doing the family a favor by bringing up the topic of donation, there is a multitude or reasons for the discussion of donation to be completed only by Designated Requestors. A family may not be understanding or accepting of the prognosis. Separating the team that discusses the prognosis, from the team that discusses donation ensures that the family is confident in the hospital staff’s goal to medically treat their loved one. If the hospital staff is the party to request donation, families fear that they are no longer treating their loved one for their health but for the health of a recipient. In addition, when donation is introduced to the family independent of the OPO’s evaluation the patient can be determined to not be a suitable candidate. If the family has voiced their support for donation, this is often seen as another defeat the family must process at an already difficult time.
The donation discussion only takes place after a family is told of the death or imminent death. The family is given time to understand and grieve after the prognosis or death is presented. In collaboration with palliative care clinicians, social work, pastoral care, nursing staff, and/or physicians and residents, Unyts will approach the family to discuss donation.
Donation begins with the wishes of the donor. If the potential donor has expressed wishes to be a donor, Unyts will honor their wishes. If the wishes are not known, the family will be approached for the opportunity to donate. Education is provided regarding the donation process and the benefits of donation. During the approach the family is provided the tools to make an informed decision.
The approach for organ donation is almost always done in person, the approach for tissue and eye donation is generally requested over the phone by a Designated Requestor after the family has returned home from the hospital, or after being informed of the patient’s passing.
How should I respond if the family brings up donation to me?
If a family brings up donation acknowledge the family’s comments, connect the family with Unyts and support the family and the patient. The best response in this situation is for the hospital staff and Unyts staff to provide the family support, as well as accurate information regarding donation. It is important to remain non-bias if the family brings up donation, do not bring overly negative or positive experiences regarding donation up to the family. Unyts has worked to provide hospital staff with the tools to communicate best with families when they introduce donation themselves.
Below are a few responses that are appropriate if the family inquires about donation.
· “Our hospital supports donation and making sure that all of your questions are answered. Let me get you in contact with someone who can better answer your questions.”
· “We work with an organization called Unyts, they are the specialists in donation. I’ll give them a call so I can connect them with you to answer your questions?”
Two Types of Organ Donation
As discussed in the previous section, there are two types of death: cardiac death and brain death. There are also two types of organ donation: Donation after Brain Death (DBD) and Donation after Circulatory Death (DCD).
Donation after Circulatory Death takes place when death is imminent and the family has decided to limit treatment and make the patient, what is known as comfort care. The limitation of treatment takes place as it would in any location of the hospital, normal comfort measures are provided. For donation after circulatory death, the limitation of treatment takes place in the Operating Room. For the families that wish to be with their loved one at the time of their passing, they are allowed to come into the Operating Room. The limitation of treatment is performed, the patient is extubated, all hemodynamic pressor support is removed and the patient is provided comfort care at the direction of the hospital physician and hospital nurse that are bedside in the OR. The patient is allowed 60 minutes to pass away naturally. If the patient does not pass away within the 60minutes, the opportunity for organ donation is eliminated and the patient is transferred to their hospital room or a room designated for comfort care patients. The family is notified of the patient’s status and location. If the patient does pass away within the 60 minutes, the recovery team is then allowed to enter the room following pronouncement of death and the recovery may take place. If the family is bedside, they are escorted out of the operating room prior to entry of the recovery team.
Donation after brain death takes place after declaration of brain death is completed. This declaration takes place in the ICU and is done by a physician that is credentialed to declare brain death. In donation after brain death the patient remains on the ventilator through the recovery. This is the only form of donation by which the heart and intestines can be recovered. This is often the only form of donation by which the lungs, liver and pancreas are recovered as well.
Cleveland Clinic’s portal for Death by Neurological Criteria