Current through Register Vol. 39, No. 6, September 16, 2024
(a) The donor
surgical team shall have primary concern and responsibility for the donor's
care and welfare throughout his or her entire hospital stay. The donor surgical
team consists of the donor surgeon, his or her surgical and medical partners,
fellows, residents, and physician assistants or nurse practitioners.
(b) Preoperative Preparation
(1) The facility shall have the ability to
allow donors to bank a minimum of one unit of blood before surgery. Facilities
shall have the ability to store and transfuse autologous blood;
(2) The transplant coordinator or another
team member shall be assigned the responsibility of providing updates to the
families of both the donor and transplant recipient during the surgical
procedures; and
(3) For live donor
liver procedures, surgeries shall be scheduled only when staffing will be
available for the postoperative period. If surgery is scheduled on a Thursday
or Friday, the hospital shall ensure that there is adequate attending
physician, resident physician, physician assistant or nurse practitioner, and
registered nursing coverage during the weekend.
(c) Postoperative Care
(1) After live donor nephrectomy, the patient
shall receive post-operative care equivalent to that provided for abdominal
procedures under general anesthesia; and
(2) For live liver donors:
(A) Day 0-1: The live adult liver donor shall
receive care in the intensive care unit (ICU) or post-anesthesia care unit
(PACU);
(B) Day 2: If stable and
cleared for transfer by the donor surgical team, the donor shall be cared for
in a hospital unit that is dedicated to the care of transplant recipients or a
hospital unit in which patients who undergo hepatobiliary resectional surgery
are provided care. Liver donors shall not at any time be cared for on any other
unit unless a specific medical condition of the donor warrants such a
transfer;
(C) The donor shall be
evaluated at least daily by a liver transplant attending physician with
documentation in the medical record;
(D) The donor surgical team shall be
responsible for the clinical management of the donor;
(E) The patient care staff shall be familiar
with the common complications associated with the donor and transplant
recipient operations and have appropriate monitoring in place to detect these
problems if they arise; and
(F) If
there is an emergent complication requiring re-operation, these patients shall
be prioritized for access to the operating room based on the facility's
operating room policies and guidelines.
(d) Medical Staffing. For live donor
nephrectomy patients, there shall be continuous physician coverage available
for patient evaluation as needed. These patients shall be provided
post-operative care equivalent to patients undergoing a nephrectomy.
(e) Nurse Staffing
(1) Nursing staff shall be familiar with
recovery of nephrectomy patients. They shall be aware of the signs and symptoms
of hypovolemia due to post-operative bleeding or to excessive diuresis. They
shall have ready access to the surgical team responsible for the patient's
post-operative care;
(2) For live
liver donors, nursing staff shall have ongoing education and training in live
donor liver transplantation nursing care for both donors and recipients. This
shall include education on the pain management issues particular to the donor.
The registered nursing to patient ratio in the ICU or PACU level setting shall
be appropriate for the acuity level of the patients. For live liver donors, the
same registered nurse shall not take care of both the donor and the recipient.
For live liver donors, the nursing service shall provide the potential donor
with pre-surgical information including, if possible, a tour of the unit before
surgery; and
(3) For all donors,
the names and beeper numbers of the donor surgical team or team responsible for
the donor's post-operative surgical care (e.g. urology service or laparoscopic
general surgery service for some donor nephrectomy patients) shall be posted on
all units receiving transplant donors.
(f) Radiology. For facilities performing live
donor nephrectomies, radiological staff shall be available for pre-operative
assessment, peri-operative care, and post-operative follow-up as
required.
Authority
G.S.
131E-75;
131E-79;
143B-165;
Eff. April
1, 2006;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. July 22,
2017.
