Organ procurements

[Gas]

Private practice at small community hospital. We do these very rarely, but lately we have had a couple and it swallows an entire OR and anesthesia team for many hours. We have one anesthesiologist on call for OR addons/emergencies, and another for OB. We don't like having the first call anesthesiologist tied up for hours in case a true emergency comes in. Even though we have a second call, we kind of reserve them for OB.

Do we even have to staff these procurement cases? If so, are we there for the entire duration? Just wondering what other places do.

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[anbuitachi]

Private practice at small community hospital. We do these very rarely, but lately we have had a couple and it swallows an entire OR and anesthesia team for many hours. We have one anesthesiologist on call for OR addons/emergencies, and another for OB. We don't like having the first call anesthesiologist tied up for hours in case a true emergency comes in. Even though we have a second call, we kind of reserve them for OB.

Do we even have to staff these procurement cases? If so, are we there for the entire duration? Just wondering what other places do.

It usually isn't for hours... But yea we usually staff these, it depends on what type of procurements they are, are they donation after brain death, or cardiac death. For cardiac death, we extubate, wait like 30 min or so (may vary depending on protocol) for cardiac death, and we leave the room after pronouncing. If no death after, we re intubate and no case. I think the actual case it self takes <1hr, but there is a lot of coordinating involved to actually get it going. Brain death are longer since you have to keep the organs well perfused while the surgeons take them out.

 

[psychbender]

You don't just leave after cross-clamp? Seriously, a procurement case should only require your presence for about twenty minutes.

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[IlDestriero]

You have to staff them to protect the organs until they clamp everything off. Then we turn off the machine and monitors and leave. They continue without us and transfer the remains to the morgue. It’s usually about 2 hours. They’re not that common overnight, fortunately.
I don’t know why you’d have to be there for many hours. You certainly don’t have to be there after circulation stops no matter how long they take for the rest.


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Il Destriero

 

[Gas]

Thanks. The reason it takes so long is because of timing - our team is kind of waiting around for the surgeons. At our small hospital, they fly in from elsewhere and they want to get going the minute they land. We are a fast moving practice and don't like to be idle.

Thanks for the responses.

 

[Mman]

You don't just leave after cross-clamp? Seriously, a procurement case should only require your presence for about twenty minutes.

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20 minutes? What exactly are they procuring in 20 minutes? Heart, Lungs, Liver, Kidneys, maybe pancreas and that can be like 2+ hours of dissecting stuff out and getting ready. Just kidneys is the fastest but that's usually not 20 minutes either. Just liver, heart, or lungs and you are signing up for > an hour almost without fail.

 

[austintr]

Second what @psychbender said. I used to work in procurement and anesthesia would always peace out after x-clamp. A brain death recovery should take longer obviously for the reasons noted above, but at least where I worked, the vast majority of cases were on cardiac death. If they're not taking heart/lungs, there's generally no need to do brain death over cardiac death. So a pretty short case.

 

[jwk]

Thanks. The reason it takes so long is because of timing - our team is kind of waiting around for the surgeons. At our small hospital, they fly in from elsewhere and they want to get going the minute they land. We are a fast moving practice and don't like to be idle.

Thanks for the responses.

Sure timing is everything, but it doesn't become critical until the organs actually come out. If they have to wait a little bit for availability of anesthesia, they'll have to wait. We continue doing all our usual cases, and when the time comes, then we'll take care of staffing it appropriately.