Recognizing When Patients May Meet Criteria for Referral

This page is a resource for hospital partners of the LifeNet Health Organ Procurement Organization.

Timely referral of patients who meet criteria as potential organ and tissue donors is crucial – not only for hospitals, but also for families. This process depends on health care partners identifying when patients meet the criteria to be referred as potential donors, followed by appropriate medical management, working hand in hand with their Organ Procurement Organization. LifeNet Health is the OPO for most of Virginia, three counties in West Virginia, and one county in North Carolina. We support more than 70 hospitals across the state. Learn more about our service area.

There are many advantages to getting LifeNet Health involved as early as possible once a patient meets criteria. We can play a key role in supporting the family as they navigate the complexities of these challenging situations.

Patients who meet the criteria outlined below must be referred within 60 minutes by calling LifeNet Health at 1-866-543-3638 or by using our electronic referral process. Timely referral is a requirement of the Centers for Medicare & Medicaid Services. Learn more about the standards supporting donation programs.

Criteria for Organ Donor Referrals

Patient is maintained on a ventilator and meets one or more of the following triggers:

GCS ≤ 4 or other indication of non-recoverable neurological injury (anoxia, CVA, head trauma). Note: HCA, UVA, and Bon Secours Mercy Health use GCS of ≤ 5.
Impending brain death testing.
Family discussion (anticipated or planned) regarding code status change or withdrawal of support.
Talk of transition to comfort measures or hospice.

Refer all patients who meet any of these criteria within 60 minutes by calling 1-866-543-3638 (option 1) or by using our electronic referral process.

Organ donation pathways include:

Death by neurological criteria (brain death) — Patient is declared deceased in accordance with state law and hospital policy.
Donation after cardiac death (DCD) — Family has made the decision to transition to comfort care.

A patient who meets the criteria for brain death or donation after cardiac death could potentially donate a heart, lungs, liver, kidneys, pancreas, and small intestine.

Clinical management of organ donors

These Catastrophic Brain Injury Guidelines are intended to support hospitals in providing appropriate clinical care to maintain the option of organ donation in adult and pediatric patients. These recommendations do not override the need to consult and abide by your hospital policy. If you have questions, please call LifeNet Health at 1-866-543-3638.

Download these guidelines as a PDF: Adult | Pediatric

Maintain blood pressure

Maintain systolic blood pressure >100 (MAP >60)
Fluid resuscitation
Consider inotropic agents/vasopressor support
Consider invasive hemodynamic monitoring

Maintain urine output

Treat diabetes insipidus with Vasopressin 1-2.5 units/hr
Maintain urine output >0.5ml/kg/hr

Oxygenation and ventilation

Maintain the following: PaO2 >100 mmHg | PaCO2 35-45 mmHg | Arterial pH 7.35-7.45
PEEP 5.0-8.0
Aggressive pulmonary hygiene
Respiratory treatments as needed

Normalize Temperature

Maintain core temperature between 36° and 37.5°C

Maintain homeostasis

Monitor labs, including basic metabolic panel, magnesium, phosphate, heme8, ABGs
Maintain Hgb >7g/dL and Hct >24%
Monitor and treat electrolytes
Monitor glucose and treat with insulin drip (keep 80-200)
Maintain NA18, give 2 units FFP
Blood bank sample for ABO typing

What to Expect Following Organ Donor Referral

LifeNet Health staff will speak to you to determine a patient’s status and donation potential, including admission course, labs and vitals, plan of care, and any other relevant information. If the patient is deemed a candidate for donation, a coordinator will be dispatched to your facility.

Our team will work with you to determine when it is appropriate for LifeNet Health to make contact with the patient’s next of kin. Donation should only be mentioned to patients or families by LifeNet Health staff.

We will remain in close contact with the hospital team, reaching out at least once per shift. Please contact us should any of the following occur with the patient:

Loss of additional reflexes or hemodynamic instability
Planned brain death testing
Grave prognosis discussion
Goals of care meeting scheduled
Code status changes
Palliative care or hospice consult
Family considering transitioning care
Family discussion about donation

Criteria for Identifying Potential Tissue Donors

Every patient declared deceased in the hospital is a candidate for tissue donation and should be referred to LifeNet Health at 1-866-543-3638 (option 2) or by using our electronic referral process. LifeNet Health will determine medical suitability. Referral should be made within 60 minutes of time of death.

Patients who are deemed medically suitable for clinical tissue donation can donate the following: