Donation Process: Preparing for the Gift

Breakout Session A

Presenters:Jennifer Do, RN, Unit Director, Surgical Transplant ICU, Ronald

Reagan UCLA Medical Center

Beverly Jacoby, Donation Development Coordinator, OneLegacy

Moderator:Marwa Kilani, MD, Providence Holy Cross Medical Center

• Understand how to identify organ and tissue donors and the importance of timely referrals

• Understand the importance of preserving the opportunity for donation to maximize organs transplanted per donor

• Understand the importance of the partnership between hospitals and organ procurement organization (OPO) in the Effective Request Process

Objectives

• Explain the concept of timely referrals in the donation process

• Describe how preserving the opportunity for donation can maximize organs recovered

• Identify the types of partnership opportunities shared between hospitals and organ procurement organizations (OPOs)

Questions to Run On

• Hospital Clinical Triggers Mutually agreed upon by Hospital and OPO* GCS, ventilator-dependent, acute brain injury

• Hospital Policy Identification of potential organ and tissue

donors* Medically maintain patients as potential donors*

Identify Organ and Tissue Donors

*CMS Regulations

• Imminent neurologically devastated, or patients who received optimal treatment but cannot recover from injury or illness, whose death is imminent

• As soon as these individuals are identified, refer to OneLegacy within an hour of meeting criteria*

• Answer preliminary screening questions that include basic patient medical history

Clinical Triggers / Timely Referrals

*CMS Regulations

UCLA Health SystemClinical Trigger ID Badges

• If not a candidate for organ donation, hospital issued a referral number so that it can be used at the time of cardiac death

• If patient is deemed medically suitable for organ donation at the time of referral, OneLegacy will send a Procurement Transplant Coordinator (PTC) or Referral Process Coordinator (RPC) to conduct further evaluation of patient

Timely Referrals

• Referred when the potential donor’s organs are still viable

• OneLegacy PTC will evaluate patient as potential donor

• Meet with hospital staff (unit director, bedside RN, physician, spiritual care, social services) to gain a better understanding of what the family is going through so approach is smooth

Hospital/OPO Partnership

• Determine if patient is a registered donor• Patient is declared brain death by two

physicians, the second note is the legal time of death

• Once the second death is done, assess the timing of approach with family*

Hospital/OPO Partnership

*Check with Hospital Policy on time interval of notes

Physician’s Responsibilities• Brain Death Determination

1) Brain death documentation by 2 licensed physicians not associated with transplantation

2) Note should state “Patient is Brain Dead” 3) Sign, date & time notes

• Test(s) performed to determine brain death:1) Clinical exam is required in the State of California2) EEG or CBF is not mandatory and may not be

conclusive in newborn3) Discretion of the physician for confirmatory tests4) Hospital Policy and Procedure

• Registered Donors (First Person Authorization)

have documented their decision to become a donor on the Donate Life California Registry website or through DMV

• Similar to Advanced Directive and legally binding

• Family is provided this information

Registered Donors

• Some families will ask “What’s next?”• Some families will mention “What about

organ donation?”• Difficult situation for hospital staff • Refer patient to OneLegacy, and they will send

a representative on-site

What if the Family Mentions Donation?

• Continue to optimize patient outcome according to standard medical practice

• Maximize the gift for the family and honoring the patient’s decision

• Hospital Policy• CMS Regulations

Preserving the Opportunity of Donation

• Patient has suffered an irreversible neurological injury

• Does not meet brain death criteria• Discussion for withdrawal of ventilator or

vasopressor support are initiated by family or physician

• Patient may be a suitable candidate for Donation after Cardiac Death (DCD); OneLegacy evaluates each case

Potential DCD and Withdrawal of Support

Brain Death vs. Donation after Cardiac Death

For both organ donation opportunities, patient suffered a severe brain injury and is ventilator dependent• Trauma: GSW, BHT, MVA • Cerebral Vascular

Accident: ICH, ICB • Anoxia:

MI, Drowning, Hanging

• Interdisciplinary discussion between OL and key hospital staff (MD, RN, SW, etc.) regarding a potential donor case

• Opportunity to get everyone “on the same page” regarding family care, medical preservation of the donation option and testing plan

• Plan the optimal first discussion of donation for each family of each potential donor patient

Effective Request and “Team Huddle”

• Identify, protect, and preserve the donation opportunity for patients and their families when donation may be a viable end of life option

• Provide excellent end of life care for optimum healing of the family

Effective Request and “Team Huddle”

• Timing is critical• Assessment of family dynamics• Quiet setting away from bedside• Physician provides finality of death• OneLegacy approaches family collaboratively

with hospital staff

Authorization Approach

• Explain the concept of timely referrals in the donation process

• Describe how preserving the opportunity for donation can maximize organs recovered

• Identify the types of partnership opportunities shared between hospitals and organ procurement organizations (OPOs)

Questions to Run On