Learning Objectives. The Case of Sarah and Andrea

Transcription

1 Cindy K. Brown, LMSW, ACSW Clinical Social Worker Living Donor Advocate University of Michigan Transplant Center Learning Objectives Enhance the audience s understanding of current requirements about the separation of care of the live organ donor from the organ recipient Enhance the audience s appreciation of salient clinical issues in the separation of care of live organ donors Enhance the audience s consideration of matters of informed consent, communication, and development of a therapeutic relationship in the context of the separation of care of the live organ donor The Case of Sarah and Andrea

2 Consensus Group Group convened in 2000 to reexamine the medical and ethical issues of living donation Fundamental belief that live donors interests are of equal importance to those of recipients Resulting Consensus Statement recommends the identification of a living donor advocate at every U.S. transplant center to promote the safety and best interests of the living donor Consensus Statement on the Live Organ Donor, 2000 Consensus Group Recommendation an independent advocate for the donor should be identified whose only focus is the best interests of the donor. Ideally, this would involve 2 separate medical teams 1 informing donors and 1 informing recipients Donor advocates should be empowered with full veto authority if they believe donation to be ill advised. Consensus Statement on the Live Organ Donor, 2000 Centers for Medicare and Medicaid Services (CMS) In March of 2007, The Centers for Medicare and Medicaid Services published a new requirement in its Conditions of Participation calling for all transplant centers to identify an Independent Living Donor Advocate (ILDA) or Living Donor Advocate Team (LDAT) to ensure the protection of the rights of living donors and prospective living donors. Federal Register / Vol. 72, No. 61 / Friday, March 30, 2007 / Rules and Regulations

3 Centers for Medicare and Medicaid Services (CMS) The LDA must be knowledgeable of living organ donation, transplantation, medical ethics, and informed consent. The LDA is responsible for representing and advising the donor, protecting and promoting the best interests of the donor, and respecting the donor s decision and ensuring that it is informed and free from coercion. Federal Register / Vol. 72, No. 61 / Friday, March 30, 2007 / Rules and Regulations Centers for Medicare and Medicaid Services (CMS) The living donor advocate or living donor advocate team must not be involved in transplantation activities on a routine basis. Federal Register / Vol. 72, No. 61 / Friday, March 30, 2007 / Rules and Regulations United Network for Organ Sharing (UNOS) In September of 2007, the OPTN/UNOS approved new bylaw requirements for living liver and living kidney donor programs. The bylaws required the identification of an LDA who is not involved with the potential recipient evaluation, is independent of the decision to transplant the potential recipient, and is a knowledgeable advocate for the potential donor. OPTN/UNOS Bylaws, Appendix B, Attachment I, Section XIII, C (2)

4 Are there aspects of the care of the live organ donor that could only be enhanced by direct knowledge of the recipient? 1. Informed Consent 2. Communication 3. Therapeutic Relationship Informed Consent

5 Communication Therapeutic Relationship Questions?

6 References Live Organ Donor Consensus Group. (2000) Consensus Statement on the Live Organ Donor. JAMA, 284: CMS COP 42 CFR Parts 405, 482, 488, and 498. Federal Register. 2007;72(61). Enrollment and /M /P id t d Certification/CertificationandComplianc/downloads/transplantfinal.pdf. Accessed October 10, OPTN/UNOS Bylaws, Appendix B, Attachment I, Section XIII, C (2) Kidney Transplant Programs that Perform Living Donor Kidney Transplantation. Cindy K. Brown, LMSW, ACSW Clinical Social Worker Living Donor Advocate University of Michigan Health System L1252 WH 1500 East Medical Center Drive Ann Arbor, MI Phone: ckoslows@umich.edu