Physician best practices
Information provided by LifeCenter Northwest
ST. PETER HOSPITAL – Physician decisions around referral timing, physiologic support and goals-of-care conversations can directly affect whether organ donation remains a viable option. The best practices below and examples from Providence St. Peter Hospital outline how early collaboration with LifeCenter Northwest helps preserve donation opportunities, support families and honor patient wishes.
Refer early. Notify LifeCenter Northwest as soon as a ventilated patient meets referral criteria so donation potential can be evaluated before key care decisions are finalized.
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In practice: After a 60+-year-old patient with CVA was transferred from the ED to the Critical Care, the care team placed an early referral to the Donation Hotline. LifeCenter began the initial suitability evaluation before an anticipated goals-of-care conversation, allowing time to assess donation potential, coordinate with the care team and support a family conversation. The family ultimately authorized organ donation.
Maintain physiologic support. Continue appropriate hemodynamic and pharmacologic support until LifeCenter completes its assessment and donation potential is determined.
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Common barrier scenario: A 60+-year-old patient was transferred to Critical Care after an unwitnessed cardiac arrest. The care team placed a timely referral, and LifeCenter continued to follow the case while the patient’s family was being identified. After several days of hospitalization and consulting with the critical care team, the family elected compassionate extubation. Because withdrawal occurred before LifeCenter was notified, the donation evaluation could not be completed.
Coordinate before withdrawal of life-sustaining treatment. Engage LifeCenter before goals-of-care discussions and compassionate extubation whenever feasible so donation options can be evaluated and incorporated into a coordinated plan.
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Common barrier scenario: A 60+-year-old patient with unknown downtime was intubated by EMS and admitted to the ED. After the physician discussed prognosis with the patient’s power of attorney, life-sustaining treatment was withdrawn and extubation occurred within the hour. Because the donation referral was not placed before extubation, LifeCenter could not complete a medical suitability assessment or discuss donation options.
Partner throughout the case. Maintain physician-to-LifeCenter communication as the care plan evolves to support timely decision-making, aligned family communication and high-quality end-of-life care.
- In practice: A 30+-year-old patient presented to the ED with shortness of breath, coded, achieved ROSC and was transferred to the Critical Care. After the family discussed code status with the ED physician, the care team placed a donation referral and kept LifeCenter updated as the plan evolved. The physician later huddled with LifeCenter to coordinate the timing of a potential donation conversation after the anticipated goals-of-care discussion.
Early physician involvement and coordinated communication can:
- Improve family understanding and satisfaction with end-of-life care.
- Honor patient donation decisions and reduce missed donation opportunities.
- Support regulatory compliance and best practices for high-quality, patient- and family-centered care.
References
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Centers for Medicare & Medicaid Services (CMS), Medicare and Medicaid Programs. Conditions for coverage for organ procurement organizations: final rule. https://www.cms.gov/regulations-and-guidance/regulations-and-policies/quarterlyproviderupdates/downloads/cms3064f.pdf.
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Conditions of participation: Organ, tissue, and eye procurement. 42 CFR §482.45. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482/subpart-C/section-482.45.
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The Alliance. Donation after circulatory death (DCD) educational guide. https://www.organdonationalliance.org/wp-content/uploads/2025/08/DCD-Educational-Guide-2nd-Edition.pdf.
