Table of Contents. Agenda. 6 + Eligible Hospitals Summary Current 12 month Previous 12 month. Donation Development Plan

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2 Table of Contents Agenda + Eligible Hospitals Summary Current month Previous month Donation Development Plan Regional Reports Summary Current Months Previous Months OneLegacy Performance Donor Designation Action Guide (Change Package) Schedule of Events Directory Notes Miscellaneous Tools/Resources

3 Region Collaborative Learning Session June 8, 00 Las Vegas, NV 0:00 Welcome and Call to Action Moderator: Jennifer Treece, Region RCL Christine Samuels, Region RCL 0:0 Sharing Regional Best Practices 0:0 Timely Referral Moderator: Megan Shaughnessy, CTDN Session Overview: This session will focus on the concept of timely referral from both the OPO and the hospital perspective. Speakers will review regulatory requirements and discuss high impact and low impact of timely referral. Participants will be actively engaged in conversation about the big picture goal of why timely referral matters and be provided with strategies on ways to maintain organizational focus towards improving our practice and making this a meaningful metric. : Sharing Regional Best Practices : Lunch : Sharing Regional Best Practices :0 Region DMG Project Moderator: Darren Malinoski, MD Session Overview: Participants will be provided with national trends in donor management goals. Regional DMG data will be presented and each DSA will be provided with an opportunity to review their own data and facilitate a discussion among their DSA partners. Information about the development of a regional web portal to facilitate the collection and analysis of donor management data will be presented. : Regional Success in Hand Transplant Moderator: Jill Stinebring, CASD :0 Sharing Regional Best Practices : The R Donor Potential Study Moderator: Jennifer Treece, AZOB Session Overview: After March s webinar on analyzing true donation potential, Region is moving forward on its next Regional project to determine our true potential. In this session, Region will define all potential eligible, non-eligible potential, and other factors to determine organ donation potential. We will also define the non-donor. We will also establish timeframes for submitting data and each OPO s responsibility. This will be an interactive session, please have a representative from each OPO there as we are voting on what to track and report. :0 The Question of Individual Authorization/Consent And Family Resistance Moderator: Carla Hentz, CAOP Session Overview: The session will involve participants to analyze their DSA practice when they are faced with the difficult question of how to honor the wish of an individual when the family of a prospective registered donor, disagrees with the intent to donate. The session will take a 0 approach to this situation by providing information on the ethical, legal and public perception issues involved in refusing that donor s explicit wishes. : Developing a Path for the 0 Regional Collaborative :00 A Moment of Silence A Powerful Practice :0 Closing and Reflections Moderator: Jennifer Treece, Region RCL Leaving In Action Christine Samuels, Region RCL

4 \ Agenda UNOS Region Hospital Partners and OneLegacy Team Meeting OneLegacy Figueroa Courtyard Conference Room Thursday April 8, 0 :0PM :00 to :00 Meet and Greet Luncheon Welcome - Question to Run On: What strategies can we implement to achieve successes in each of our three initiatives: Increased Conversion Rate, Increased Organs Transplanted Per Donor, and Increased DCD donations? :00 :0 Frame the Day Prasad Garimella, COO, OneLegacy Overview of the Binder Overview of DSA Data and Top Initiatives Carla Talley Hentz, OneLegacy Tasha Querantes, OneLegacy Advisory Board Update :0 :0 Donation after Cardiac Death Ervin Ruzics, M.D., St. Joseph Hospital of Orange Tasha Querantes, OneLegacy Break :0 :00 DCD, another End-of- Life decision DCD Data from other OPOs Update from OneLegacy DCD Program Specialist Suzanne Fidler, M.D.,J.D., Desert Regional Medical Center Margie Whittaker, Mission Hospital Tasha Querantes, OneLegacy Cherilynne Pugliese, OneLegacy :00 :0 Conversion Rate Effective Request Process DNR Status while still preserving Donation Opportunity :0 :0 Organs Transplanted Per Donor (OTPD) Catastrophic Brain Injury Guidelines (CBIGS) Diane Green, OneLegacy Darren Malinoski, M.D., Cedars-Sinai Medical Center Lydia Lam, M.D., LAC-USC Medical Center Darren Malinoski, M.D., Cedars-Sinai Medical Center Donor Management Goals (DMGs) Lung Recruitment Protocol :0 :0 Wrap-up and Actionable Items UNOS Region Meeting Next Local Meeting Date July 0, 0 Open Items Scott Bunting, OneLegacy Eric Carr, OneLegacy ALL

5 + Eligible Hospitals Click on the link below to access report

6 OneLegacy DSA Donation Development Plan Measurable P.I. Goals P.I. Strategies Primary Stakeholder Target Completion Date. Conversion Rate: Increase Conversion Rate from 8.% to % GAP:.%.. Donation after Cardiac Death: Increase DCD from.% to >0% of Total Donors GAP:.8%.. Organs Transplanted per Donor: Increase OTPD from. to. GAP: 0.0.

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8 Comprehensive DSA GAP Data Click on link below to access report Comprehensive Regional Data Click on link below to access report

9 Donation Development Prasad Garimella COO January, 0

10 Data Review How did we do..

11 OneLegacy Potential Referrals Total Potential Referrals ,9,,90,9,0 # Referrals ,9,8,,9,90, Year

12 OneLegacy Eligible Referrals 00 Eligible Referrals # Referrals Year

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15 Trauma Center Deaths YTD * Donation Service Area Trauma Center Deaths YTD Dec 0 Loma Linda University Riverside Community Medical 8 9 St. Bernardine Medical Center Desert Regional Medical Center N/A Kern Medical Center Riverside County Regional 9 Mission Hospital Western Medical UCI Medical Data represents DSA Trauma Deaths by Trauma Centers Riverside - San Bernardino Orange Kern Counties

16 Consent Rate

17 Approaches/Consents Approaches/Consents (BD+DCD) % % % % 00 % 0 % % % % 98 8 % % Approaches Consents Consent Rate 0% % 0% % 0% % 0%

18 00 Eligible Consent Rate 00% 00 Eligible Consent Rate 90% 80% 0% % % % 0% % 9% 8% % % % % 0% 0% % Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

19 00 Consent Rate by Ethnicity OL Jan 00 - Jul 00 vs. US 009 OL Jan 00 - Jul 00 vs US 009 Consent Rate 00% 80% 0% 0% 0% 0% 88% 8% % % 99% % % 9% 8% % 8% % 0% 00% 90% 80% 0% 0% 0% 0% 0% 0% 0% 0% OL vs US White Black Hispanic Asian O.L. U.S. OL vs US

20 00 Consent Rate by Ethnicity OL Jul 00 - Nov 00 vs. US 009 OL July 00 - Nov 00 vs US 009 Consent Rate 00% 80% 0% 0% 0% 0% 9% 8% 8% % 0% 08% 9% % 8% % % 0% 0% 00% 90% 80% 0% 0% 0% 0% 0% 0% 0% 0% OL vs US White Black Hispanic Asian O.L. U.S. OL vs US

21 Organ Consent Rate Trends and Initiatives Initiatives Pairing FCS s (continuous learning) Language and Ethnicity-based assignments Additional training in addressing immediate, uninformed No s Recognize the value of sitting and waiting

22 Conversion

23 Conversion of Eligibles Conversion of Eligibles (Eligible Donation Rate) % % 0 % % 9 0 % % % 9 9% 9% 0% % Eligible Referrals Eligible Donors Eligible Donation Rate 0.0%.0% 0.0%.0% 0.0%.0% 0.0%

24 00 CMS Conversion Rate by Month 00 CMS Conversion Rate 8% 80% % 0% % 0% % 0% 9% % % 0% 9% 8% % % % % 8% % Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month

25 Conversion Rate Percentage 009 vs Hopsitals Conv Rate Eligible Donors Organs Tx AA 80% A 0% 08 0 B 0 % 9 09 C 9 % 9 D 0% 0 0 Overall % Category Hopsitals Conv Rate Eligible Donors Organs Tx AA 9% 8 9 A % B 0 9% 09 8 C 9 % D 0% Overall 0% 8 8 Variance Conv Rate Eligible Donors Organs Tx AA % (8) () A 8% 0 9 B % () () () C % (8) () (9) D 0% 0 () () Overall % () () (8)

26 Donors

27 OneLegacy Deceased Organ Donors Total Donors # Donors Year

28 00 Donor Types: SCD Donors SCD Donors % 9 0.% 9 00.%.% 8.% 9.% SCD Total Donors % of Total 8% 80% % 0% % 0% % 0% Percent of Total

29 00 Donor Types: ECD Donors ECD Donors.8% 0.% % 8 9.9% 9.% 9.% ECD Total Donors % of Total % 0% % 0% % 0% Percent of Total

30 00 Donor Types: DCD Donors %.%.% DCD Donors %.% % 9 DCD Donors Total Donors % of Total 8.0%.0%.0%.0%.0%.0%.0%.0% 0.0% Percent of Total

31 Region and OL Percentage of All Donors SCD, ECD, DCD Jan - Aug 009 and 00 Region and OL Percentage of All Donors SCD, ECD, DCD Jan - Aug 009 & % 90.0% 80.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%.%.%.0%.80% 0.%.% 8.0%.0%.% 8.% 9.0% 8.0% OL SCD Region SCD OL ECD Region ECD OL DCD Region DCD Jan - Aug 009 Jan - Aug 00

32 Organs Transplanted

33 OneLegacy Organs Transplanted Organs Transplanted 00, # Transplanted ,00,0,089,,08,,8,8, Year

34 Organs Transplanted & OTPD # Organs Transplanted and OTPD ,0,8,,9,,,8,0 9,00, Donors Transplanted Organs OTPD # OTPD

35 Organs Transplanted Per Donor Trend and Initiatives Decrease in Kidney Discard Rate Increase in Liver and Kidney Utilization Two Procurement Transplant Coordinators on Cases Review of all cases to ensure placement by Manager of Organ Placement and Thoracic Liaison Initiatives Transplant Liaison Role Heart-Lung Committee Feedback and Guidance

36 GOALS FOR 0 ORGAN TISSUE 00 Donors.8 OTPD Transplanted,8 Donors

37 Donation Development Expectations Take OWNERSHIP Call to action (referrals) List of champions in the hospital Heads up (referral) Establish contact for PTC, FCS, etc. MRR Tissue Donation Development Digital Donor Notes, contact info for key hosp. personnel Policies Know your policies

38 Donation Development Educations Coroners Law Tests for determining suitability UAGA Authorization (Consent)» Family» Hospital TX Centers Schedules Time commitment Performance

39 EDUCATION AND TRAINING CMS» Certifications» Conditions of participation Coroners Law Tests for determining suitability UAGA Authorization (Consent)» Family» Hospital Hospital billing SAC fees

40 LET S TALK!!

41 Organ Performance & Utilization ( 0 ) As Of /0/0 :0: PM Organ Performance Jan Feb Mar Apr May Jun Jul 0 Aug Sep Oct Nov Dec YTD PRJ Referrals 09,,9 Potential Refs 8, Auto Ruleouts ,0 Eligible Refs 0 90 OL Consent Rate 9% % 8% % % Consents Eligible 88 Consent Rate Eligible % % 8% % % Consents DCD 0 Consent Rate DCD 8% 00% % 8% 8% Cons Non-Eligible 0 C/Rate Non-Eligible % 8% 00% 8% 9% CNRs 0 CMS Conversion Rate 0% 0% 8% 9% 9% Organ Disposition Jan Feb Mar Apr May Jun Jul 0 Aug Sep Oct Nov Dec YTD PRJ Donors Rec Organs ,8 Total Txp Organs OTPD ,8. Dsc Organs 9 08 Dsc Rate % 8% 0% % % Donors Rec Organs ,009 Standard Criteria Txp Organs OTPD Dsc Organs Dsc Rate % % % % % Donors 8 Rec Organs 9 9 Extended Criteria Txp Organs OTPD Dsc Organs Dsc Rate % 0% 9% % % Donors 0 Rec Organs DCD Txp Organs OTPD Dsc Organs Dsc Rate 8% % % Printed on /0/0 :0: PM by CORP\chentz Page of

42 Organ Statistics Jan Feb Mar Apr May Jun Jul 0 Aug Sep Oct Nov Dec YTD PRJ Rec 0 Txp 9 0 Dsc 0 Kidneys Rsh Imp 8 9 Rec Rate 88% 90% 9% 90% 89% Txp Rate % % 8% 0% 0% Dsc Rate % % % % % Rec Txp Dsc Hearts Rsh Rsh Only Rec Rate 9% 8% 0% % % Txp Rate 9% 8% 0% % % Dsc Rate Rec 0 Txp 0 Dsc Livers Rsh Splt Rec Rate % 9% 8% 0% 0% Txp Rate % % 80% % % Dsc Rate % % % % % Rec 9 Txp 9 Dsc Lungs Rsh Rsh Only Rec Rate % % 8% % % Txp Rate % % 8% % % Dsc Rate Rec 9 Txp 0 Dsc Pancreas Rsh Rsh Only Rec Rate 9% 0% 0% % % Txp Rate 9% % 0% % % Dsc Rate % 9% 0% Rec Txp Dsc Small Bowel Rsh Rsh Only Rec Rate % % % Txp Rate % % % Dsc Rate Printed on /0/0 :0: PM by CORP\chentz Page of

43 Page of Printed on //0 :0:09 PM by CORP\chentz 8% 8% % 0% % % % % 9% % % 0% % % % 8% 8% 9% % % 0% % % % 0% % % % 8% 8% 8% % % % % ,00, % % % % 9% 9% 8% % % 0% % % % % ,0, ,, Dsc Rate Dsc Organs OTPD Txp Organs Rec Organs Donors Dsc Rate Dsc Organs OTPD Txp Organs Rec Organs Donors Dsc Rate Dsc Organs OTPD Txp Organs Rec Organs Donors Dsc Rate Dsc Organs OTPD Txp Organs Rec Organs Donors DCD Extended Criteria Standard Criteria Total PRJ YTD Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan 00 Organ Disposition % 8% % 9% % % 9% % % 0% % % 0% 8% % % 0% % % % 00% % 0% % % 0% 0% % 8 % % 0% 0% 0% 0% % 8% 00% % 0% 8% % 9 9 % % % 8% % % 9% 9% % 0% % % 9% % % % % % % 9% % % % % 0% % 9% % ,0, ,, ,0, Eligible Donors CMS Conversion Rate CNRs C/Rate Non-Eligible Cons Non-Eligible Consent Rate DCD Consents DCD Consent Rate Eligible Consents Eligible Total Consent Rate Eligible Refs Auto Ruleouts Potential Refs Referrals PRJ YTD Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan 00 Organ Performance Organ Performance & Utilization ( 00 ) As Of //0 :0:09 PM

44 Page of Printed on //0 :0:09 PM by CORP\chentz % 8% % 0% % % % % % 0% 0% % % 0% 9% % % % % % % % 0% % % 9% 9% 0% % % % 8% % % % % % % % % 8% % 8% 8% % % % % % 0% 9% % % 8% 8% % 8% 8% % % % % % 0% 9% % % % 9% % % % % % % % % % % % % 9% 8% 8% 9% % 88% % 8% 8% % % % % % % % 9% 8% 8% 8% 8% % 8% % % % % 9% % % % % % 9% % % % % % % % 9% % % % % % 9% % % % % % 8 8 % % 8% % % % 9% 0% % % 8% % % % 8% 8% % % 9% 8% 90% % 9% % 88% 8% % % 9% 9% 90% 98% 00% 9% 99% 9% 00% 88% 9% 90% 9% 8% Dsc Rate Txp Rate Rec Rate Rsh Only Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Rsh Only Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Rsh Only Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Splt Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Rsh Only Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Imp Rsh Dsc Txp Rec Small Bowel Pancreas Lungs Livers Hearts Kidneys PRJ YTD Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan 00 Organ Statistics

45 Page of Printed on /0/0 :8:08 PM by CORP\chentz 8% 8% 0% 0% % 0% % % 0% % 8% % % % 8% % 9% % % % 8% % % 9% % % % % % % 0% % % 8% % % ,0, ,0, % % 8% 8% % 8% % % 8% % % 0% % % ,8, ,, Dsc Rate Dsc Organs OTPD Txp Organs Rec Organs Donors Dsc Rate Dsc Organs OTPD Txp Organs Rec Organs Donors Dsc Rate Dsc Organs OTPD Txp Organs Rec Organs Donors Dsc Rate Dsc Organs OTPD Txp Organs Rec Organs Donors DCD Extended Criteria Standard Criteria Total PRJ YTD Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan 009 Organ Disposition % % 8% % % % % % 0% 0% % % % % % % 8% 0% % 0% % % % 8% % % % 0% % % 0% % 8% % 0% 0% 0% 0% % % % 9 9 % % 8% % % 8% % % % % % % % % % % % % % % % % % % % % % 8% ,99, ,, CMS Conversion Rate CNRs C/Rate Non-Eligible Cons Non-Eligible Consent Rate DCD Consents DCD Consent Rate Eligible Consents Eligible OL Consent Rate Eligible Refs Auto Ruleouts Potential Refs Referrals PRJ YTD Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan 009 Organ Performance Organ Performance & Utilization ( 009 ) As Of /0/0 :8:08 PM

46 Page of Printed on /0/0 :8:08 PM by CORP\chentz % % % % % % % % % % % % % % % % % 0% % 80% 0% % % % % % % % % % % % 8% % % 9% % % % % 9% 9% 9% 0% % % 9% % 9% 8% % % % % 8 0 % % % 0% 0% 0% 0% % 0% 8% % % % % % % % % 0% 0% 0% % 0% 8% % % % % % % % % % % % % % % % % % 9% % % 8% 9% % 9% % % 8% 8% 9% 80% % % % % 8% 8% 8% % % % 8% 8% 8% 8% % 0% % % % % % 8% 8% % 9% % % % % 9% % % % % % 8% 8% % 9% % % % % 9% % % % % 9% % % % 0% % % 8% 0% % % % % 8% % 8% % 8% % % % 8% 8% % 9% 9% 8% 8% 9% 9% 9% 9% 9% 89% 9% 9% 9% 9% Dsc Rate Txp Rate Rec Rate Rsh Only Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Rsh Only Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Rsh Only Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Splt Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Rsh Only Rsh Dsc Txp Rec Dsc Rate Txp Rate Rec Rate Imp Rsh Dsc Txp Rec Small Bowel Pancreas Lungs Livers Hearts Kidneys PRJ YTD Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan 009 Organ Statistics

47 Donor Designation in California Q and Year 00 Bryan Stewart Vice President of Communications, OneLegacy Donate Life California Board of Directors Why a Searchable Donor Registry? Donor assured decision is honored Family comforted by certainty Approach & recovery may be accelerated More organs viable for transplant MORE LIVES SAVED National Goal: Million Registered Donors by End of 0 (approx. half of adult population) Summary: Donor Designations, Q 00 Donor Designation in the United States There are 9,9,08 designated donors nationwide The number of donor designations increased 9.% over the last months In 00, donor designation rate increased in 8 of states reporting 00,000,000 80,000,000 0,000,000 0,000,000 0,000,000 9,9,08 as of //0 0 Q 0 Q 08 Q 08 Q 08 Q 08 Q 09 Q 09 Q 09 Q 09 Q 0 Q 0 Q 0 Q 0

48 U.S. ADD Pop. 8+ Share, Q 00 Top 0 State Donor Registries, //0 9,9,08 U.S. Pop. Age 8+:,80,0 0 states and DC Period ending //0 ADD Pop. 8+ Share: 0.% Designated Donors State CA FL IL OH PA NC GA WA VA IN ADD,,8,,90,,,98,0,,0,0,,8,008,0,8,0,8,0,000* State MO WI CO MN MA NY NJ OR MD MI ADD,9,0,,,00,000*,,8,08,0,8,8,9,9,,88,,9,0,9 *Estimated Donor Designation Rate, 00 Published in 00 Report Card ADD Pop. 8+ Share, //0 State AK AZ CA CO CT DC FL HI IA ID IL KY DDR.0%.%.%*.% 8.%.%.%**.%.%*.% 9.%.% State LA MD MI MN MO MT NC NE NH NJ NV DDR.%.%.%.0% 9.%.%.%.%.%.%.% *Q-Q 00 **Q 00 State NY OH OR PA SC TN UT VA WA WI WY DDR.%.%.%.0%.0%.%.9%.8% 8.9%.% 9.% State AK MT UT WA OR IN ND OK CO NM MO WY MN Share % % % % % 9% % % % % 0% 0% 9% State VA ID IL OH NC WI LA AR SD IA GA AL NE Share 8% 8% % % % % % % % % % 9% 9% State MD ME HI DE MA PA RI NV FL CT DC WV AZ Share 8% 8% % % % % % 0% 9% 8% 8% % % State NJ KY KS TN CA MI MS NH SC NY TX VT ALL Share % 0% 0% 0% 8% % 9% 8% % % % 0% 0.% Impact on Donation, Designated Donors Among Recovered Donors % % 0% % 8% % % % 0% 0% 8% % % % % 9% 0% % 0% % 0% Organ Donors Tissue Donors Eye Donors Designated Donors Save Lives! Organ Donors Tissue Donors,00+ lives saved by organ donors!,000+ saved & healed by tissue donors!

49 Designated Donors in California Donor Designation Rate, California 8,000,000 0%,000,000,000,000,000,000 8,00,000 projected as of July 0 % 0% Q 00:.9%,000,000 %,000,000,000,000,000,000 0 Q 0 Q 0 Q 0 Q 0 Q 0 Q 0 Q 08 Q 08 Q 09 Q 09 Q 0 Q 0 0% % 0% Aug-0 Nov-0 Feb-0 May-0 Aug-0 Nov-0 Feb-08 May-08 Aug-08 Nov-08 Q by DMV Channel: Field Office: % Mail: % Online: 8% Feb-09 May-09 Aug-09 Nov-09 Feb-0 May-0 Aug-0 Impact on Donation, California Impact on Donation, OneLegacy DSA Registered Organ Donors Recovered Organ Donors Registered Organ Donors Recovered Organ Donors Organ Donors Reg d % % % % Organ Donors Regist d 0.%.0 %.9 %.8 %.% Registered Tissue Donors 8 Registered Tissue Donors Recovered Tissue Donors,8,9 8,80, Recovered Tissue Donors Tissue Donors Reg d,.9%,0.%,0.%, 0.% Tissue Donors Regist d. %.9 %. %. %.% OneLegacy Donation Service Area (DSA): Los Angeles, Kern, Orange, Riverside, Santa Barbara, San Bernardino and Ventura counties. Calif. UAGA (00): DMV or Online Donor Designation is Legally Binding 0.0 (a): A donor may make an anatomical gift through any of the following: () By authorizing a statement or symbol indicating that the donor has made an anatomical gift to be imprinted on the donor's driver's license or identification card and included on a donor database registry. Signing Up at the DMV Field Office Driver s License and ID Application/Renewal Forms: as of July, 0 () Directly through the Donate Life California Web site.

50 Signing Up Online The Donation Process Life-Saving Efforts by Hospital Referral to OPO Evaluate Potential Donor Approach Family Organ Recovery OPO Conducts Donor Search OPO Notifies Family, Presents Document of Gift Donor Search Donor Record No Limitations Limitations Family Notification Family Notification Document of Gift Document of Gift

51 It Rarely Happens, but What if the family objects to the donor s legally binding decision? Calif. UAGA (00): DMV or Online Donor Designation is Irrevocable 0. (a): Except as otherwise provided in subdivision (g) and subject to subdivision (f), in the absence of an express, contrary indication by the donor, a person other than the donor is barred from making, amending, or revoking an anatomical gift of a donor's body or part if the donor made an anatomical gift of the donor's body or part under Section Calif. UAGA (00): Revoking an Anatomical Gift When the Family Says No 0. (d): A donor may amend or revoke an anatomical gift that was not made in a will by any form of communication during a terminal illness or injury addressed to at least two adults, at least one of whom is a disinterested witness. The witnesses shall memorialize this communication in a writing and sign and date the writing. Usually happens when untrained hospital personnel discuss donation with the family Sets an expectation that it is the family s decision to make Most often correctable once family understands the patient s legally designated wishes What If We Meet Opposition? OneLegacy and Hospital will work collaboratively to support the family Our responsibility is to fulfill the donor s wishes OneLegacy will consult with Hospital Administration prior to making a decision OneLegacy will supply spokespeople

52 Partners for Life!

53 Community of Practice Action Guide In 0, this guide provides a framework for DSAs in the integration of all partners within the community of practice to achieve successful donation outcomes. Seven key strategies influence the overall direction for action, with specific change concepts providing actions to lead the DSAs. Community of Practice Partners Partnerships have a positive impact on service and results & together make a difference. Organ Procurement Organization Eye & Tissue Organization Donor Hospital Transplant Program State Donor Designation Team Representative Hospital Association

54 Key Strategies and Change Concepts for Success. Unrelenting Focus on Change, Improvement & Results Establish strong culture of accountability for results Establish active leadership & management support Integrate honoring donor designation into the goals of the organization.. Linkage Establish protocols to honor donor designation every time. Utilize opportunities to recognize donors (donor flag, memorial areas.) Support donor families in real time.. Integrated Donation Process Management Catastrophic Brain Injury Guidelines (CBIG) Advocate donation as the mission Education. Aggressive Pursuit of Every Donation Opportunity Advocate for donation Develop a Community of Practice Communication. Intent A culture of accountability for high yield (E/O/T every time) Culture a community of practice in which all participants walk the talk the mission of achieving high procurement and transplant rates Empowering Infrastructure: Develop effective governance structures across the donation system. Effective Relationships A rapid response network responsible for donor management, organ recovery, and placement Cultivating Commitment Motivating Results. Advanced Practice Accountability for aggressive clinical care of the potential donor, the donor, and all eyes, organs and tissues Intensive Patient Care Identify and deploy advanced critical practice expertise for advanced clinical donor management, aggressive organ acceptance and recover

55 Community of Practice Action Guide Strategy & Change Concepts Expected Outcomes Community of Practice Partners. Strategy: Unrelenting Focus on Change, Improvement & Results Hospitals, in partnership with local procurement organizations, maintain a rigorous focus on and joint accountability for increasing the number of donors and donor designees by developing and maintaining a seasoned staff and creating a culture of excellence where honoring donor designation and donation is a priority..0 Establish strong culture of accountability for results:.0. Review conversion rates, OTPD, DCD on scorecard, measure against team goals Identify opportunities for improvements and focus. Hospital, Transplant Center & OPO.0. Review local transplant center acceptance rates for donors Increased OTPD Transplant Center & OPO.0. Track compliance of referrals relative to timeliness, clinical triggers & continuity of care until OPO evaluation of potential. Increased referrals, conversion rate, OTPD & DCD Hospital & OPO Quality.0. Incorporate staff performance accountabilities. Quality Performance and increased donation rates..0 Establish active leadership & management support:.0. Provide timely, specific feedback to hospital/clinical leadership. Increased awareness of donation performance and opportunities for improvement..0 Integrate donor designation registry strategies into activities: Hospital, Transplant Center & OPO Quality Hospital, Transplant Center & OPO.0. Track donor designation percentages for the service area. Increase conversion rate OPO Leadership & State Donor Designation Team Rep.

56 .0. Integrate honoring donor designation into the goals of the organization..0. Share E/O/T outcomes and frequency of honoring donor Increased community awareness for registry. Increased donor designation awareness and opportunities for improvement. State Donor Designation Team Rep. Hospital & OPO designation among hospital personnel.. Strategy: Linkage Key hospital and procurement organization staff are linked in a timely manner to potential donor families..0 Establish protocols to honor donor designation every time. Increased conversion rates & registry Hospital & OPO.0 Utilize opportunities to recognize donors (donor flag, memorial Increased conversion rates Hospital & OPO areas.).0 Support donor families in real time. Increased conversion rates Hospital & OPO. Strategy: Integrated Donation Process Management Hospitals and procurement organizations establish and manage an integrated donation process that clearly defines roles and responsibilities and provides feedback..0 Catastrophic Brain Injury Guidelines (CBIG).0. Establish donor management guidelines to ensure donor quality and transplantable organ..0. Schedule after action reviews with key procurement organization, hospital, and transplant program staff to assess donor management, organ utilization, and transplant outcomes to identify what worked, why it worked, and what to do more of, better, or differently in future cases..0. Debrief staff performance and accountability relative to case outcome. Increased OTPD Increased OTPD Increase OTPD and meet regulatory compliance for quality performance. Hospital, Transplant Center & OPO Hospital, Transplant Center & OPO Hospital, Transplant Center & OPO Leadership/Quality

57 .0. Partner transplant surgeons with critical care physicians who are familiar with state of the art and emerging transplantation techniques and have experience with ECD and DCD organs. Increased OTPD Hospital, Transplant Center & OPO.0 Advocate donation as the mission:.0. Identify champions in each donor hospital and transplant center. Increase overall donation performance and support for process improvements..0. Establish DSA wide multi disciplinary donation council and/or individual hospital councils to review scorecards, donor cases, hospital plan, donation policies and processes. (Clinical Trigger, Timely Referral, Effective Request, After Action Reviews, etc.).0.. This one is kind of a duplicate of.0 Maintain a formal process for comprehensive immediate followup between procurement organization(s) and hospital on every donor referral regardless of the outcome (after action review); system to include guidelines for in person follow up, debriefing and mutual critique of process as well as written correspondence and communication to facilitate timely feedback where access is difficult. Identify areas for improvement and establish roles and responsibilities. Increase referral rate and conversion. Hospital, Transplant Center & OPO Hospital & OPO Hospital & OPO.0. Develop hospital action plan in collaboration with hospital champion/leadership to assure respective roles are known and understood..0 Education:.0. Provide physician and staff in services on the donation process, donor management and understanding of policies..0. Communication process in place for each donor case to monitor the actions of each organization that will affect the donation process. (Team Huddle). Strategy: Aggressive Pursuit of Every Donation Opportunity Every possibility for increased donation is maximized and routinely evaluated through death record reviews, evaluation of Increased conversion, OTPD, DCD and overall donation performance. Increased conversion, OTPD, DCD and overall donation performance. Increased conversion rate, OTPD & DCD Hospital & OPO Hospital, Transplant Center & OPO Hospital, Transplant Center & OPO

58 .0 Advocate for donation: donation benchmarks, frequency of honoring donor designation, re-approach, donor management and improved yield..0. Conduct death record reviews (DRR) to identify missed opportunities, follow up if needed with involved staff, and test indicated changes to prevent recurrence. Increase conversion rates Hospital & OPO.0. Maintain a quality review mechanism for ensuring hospital policies and procedures provide ) timely notification of all brain injured patients, and ) maintenance of physiologic function until the OPO) has determined suitability and families are offered the option of donation () mechanism to honor donor designation.0. Systematically implement DCD policies and procedures in the hospital..0. Partner with procurement organization(s) to devise a multi level decision process (medical director, administrator on call, and local, regional or national experts) to rule in all possible potential E/O/T donor cases..0. Establish a mutually agreed upon on site response time by procurement agency coordinator or designee to every appropriate referral, such as within one hour..0. Assess and re evaluate reasons family has declined donation and consider re approaching if appropriate. Increase conversion rates & OTPD Hospital & OPO Increase DCD rates Hospital & OPO Increase early referral rates, conversion rates and OTPD Increase conversion rates Hospital & OPO Management Hospital & OPO Hospital & OPO.0 Develop a Community of Practice Communication:.0. Integrate critical care professionals into organ donation process; assure an intensivist is involved in appropriate organ donation opportunities. Increase conversion rates, OTPD and DCD Hospital Intensivist & OPO

59 .0. Increase the interaction between OPO medical director and hospital physicians by identifying physician champions and establishing QI/QA processes with physicians through one on one case reviews and education..0. Hospital and procurement organizations partner with medical examiners/coroners to establish expectation of no (zero) denials. Improve donation process and increase donation opportunities. Decrease coroner declines Hospital physicians, OPO clinical staff and Medical Director Hospital, OPO and coroners.0.. Consider advocating legislation (see Sec...a, HHS Secretary's Advisory Committee on Organ Transplantation. Recommendation #0 states that legislative strategies are adopted that will encourage medical examiners and coroners not to withhold lifesaving E/O/Ts from qualified procurement organizations)..0. Establish hospital protocols that include a provision for maintaining hemodynamic support for potential donors, inclusive of cases where family has requested a DNR order without knowledge of donation options. Increase conversion rate and OTPD Hospital intensivist & OPO.0.. Educate hospital and procurement organization staff regarding impact of DNR/CMO status on the potential for E/O/T donation. Sessions will include knowledge, skills, practice, and role playing on authorization, communications, and discussions surrounding end of life decision making. Hospital & OPO. Strategy: Intent A culture of accountability for high yield (E/O/T every time) There is clear intent to maximize the number of organs, tissue, and eyes transplanted. It is expressed and tracked as a mission: every donor, every organ, every tissue, every time. Actions and interactions among donor hospital, procurement organizations, and transplant program staff demonstrate that everyone is committed to the mission. There is rigorous use of goals benchmarked with national best practice that are routinely

60 reviewed for performance..0 Culture within the community of practice in which all participants walk the talk the mission of achieving high procurement and transplant rates:.0. Integrate donation into the mission statement of the organization. Increase donation awareness and support of opportunities for improvement..0. Consistently recognize and commend outstanding achievements in E/O/T procurement in the hospital..0.. Identify and support a champion at the hospital to ground the work of the team..0. Develop and collect a dashboard of indicators on donation, donor designation, transplantation, and other key parameters to reflect hospital performance..0.. Benchmark hospital utilization rates (such as organs transplanted per donor or OTPD) to local, regional and national performance leaders..0. Utilize procurement agency and/or hospital effective requesters in every case..0. Test and implement improvements to the donation authorization process and practices using after action reviews..0.. Utilize re approach strategies when authorization for all 8 organs, eye, and tissue is not obtained. Identify and address the family s reasons for restricting authorization. Increase conversion rate and develop donation champions through recognition. Data driven process improvement. Increase conversion rate Increase conversion rates and identify areas of improvement for family authorization process. Hospital Hospital Leadership and OPO Hospital, Transplant Center & OPO Hospital, Family Support Staff and Effective Requestor Hospital, OPO Family Support and Hospital Development staff Increased OTPD Hospital, OPO Family Support, Clinical and Hospital Development 8

61 .0 Empowering Infrastructure: Develop effective governance structures across the donation system:.0. Participate in donor specific procurement organization committees to develop policies and evidence based clinical protocols to support high E/O/T utilization..0. Support hospital clinicians to participate on procurement organization boards and committees to advocate for all organ types..0. Systematically capture and make use of data across the continuum from frequency of honoring donor designation to pre donor management.0. Collaborate with procurement organizations to regularly monitor and report E/O/T specific utilization data to donor hospital leaders..0.. Partner with procurement organizations to create a dashboard report with clinical indicators for E/O/T utilization rates including reasons why E/O/Ts are not recovered and transplanted. Share performance benchmarks with other hospitals to foster DSA wide improvement.. Strategy: Effective Relationships A rapid response network responsible for donor management, organ recovery, and placement Build and sustain a network of quick response, collaborative relationships with donor families, hospital staff, E/O/T procurement organization staff, state-based donor designation teams, transplant physicians and surgeons, and transplant program staff. Necessary and sufficient skilled hospital, E/O/T procurement organization and transplant program staff are in place and ready to respond. Policies, processes and communication channels with partners are well defined, practiced, and monitored. Deep relationships assure timely and 9 Establish strong relationships and identify opportunities for improvement. Ensure clinician support on all donation cases. Increase performance, donation awareness and relationship building. Develop hospital leadership and support for the donation process. Hospital and OPO team Hospital leadership & OPO Hospital & OPO Hospital & OPO

62 correct responses that promote high E/O/T transplantation rates..0 Cultivating Commitment:.0. Participate in DSA E/O/T specific committees including transplantation, critical care, and procurement experts to review and discuss local protocols in light of national recommendations..0. Dedicate efforts to cultivate and maintain hospital commitment to achieving high rate of E/O/T utilization and honoring donor designation.0. Provide positive feedback to hospital unit staff about how their efforts have affected the lives of E/O/T transplant candidates. Improve overall donation process and relationship building. Hospital, Transplant Center & OPO Increase conversion rate Hospital & OPO Promote relationship building and increased donation rates. Hospital & OPO.0. Actively participate in achieving seamless integration among the procurement organizations, donor hospital, and transplant program to achieve a high transplantation rate Encourage procurement organization presence into the institutional functions of high volume donor hospitals. Create network among procurement organization(s), hospital, and transplant programs to identify specialists (cardiology, pulmonology, etc.) essential to donor evaluation..0. Establish multi disciplinary teams to test and implement effective changes..0. Treat increasing E/O/T transplanted per donor as an area of unrealized potential for narrowing the gap between the demand and supply of E/O/Ts..0. Conduct pre recovery briefings for OR staff in partnership with procurement organizations. 0 Strengthen communication between the organizations having an impact on the donation process. Ensure real time referral response, hospital development and education. Increase OTPD with proper clinical expertise. Quality Improvement Increase OTPD and narrow the gap. Real time OR education and relationship building. Hospital, Transplant Center & OPO Hospital & OPO Hospital & OPO Hospital & OPO Hospital, Transplant Center & OPO Hospital & OPO

63 .0.8 Standardize core competencies for critical care staff in regards to E/O/T donation and designation..0 Motivating Results: Increase expertise and knowledge base to support the donation process. Hospital & OPO.0. Nurture procurement organization, hospital, transplant program, and state based donor designation team relationships with accountability for data proven results..0. Celebrate and honor hospital (specific units) contributions to increasing E/O/T utilization..0. Embody an attitude that all types of donation are of equal importance to donor families..0. Support state registry by offering donor designation opportunities in the hospital and the local community. Structure and purpose of DSA Action Team Create donation champions and promote early referrals. Preserve the donation opportunity for all families and donors. Create donor designation education and awareness..0. Participate in the Workplace Partnership for Life program. Create community awareness and increase registry.. Strategy: Advanced Practice Accountability for aggressive clinical care of the potential donor, the donor, and all eyes, organs and tissues Practice continuity of aggressive clinical care for all E/O/Ts from timely referral, through brain death declaration, to recovery. Access and use advanced clinical practice support and best practices. Recognize the physiology of brain death and incipient herniation and implement standardized approaches to the declaration of death, obtaining donation authorization, and medically managing the donor. Optimal management ensures that the donor somatically survives to procurement and that the E/O/Ts are maintained in optimal condition leading to higher utilization rates..0 Intensive Patient Care: Community of Practice Partners Hospital & OPO Hospital & OPO Hospital, OPO Hospital Develop and State Donor Designation Team Rep. Hospital & OPO State Donor Designation Team Rep.

64 .0. Stress and maintain continuity of aggressive intensive clinical care throughout brain death declaration process..0.. Implement a standardized brain death declaration protocol that achieves timely declarations..0.. Continually re evaluate the status of all 8 organs and tissues including eyes throughout the donor management process. Reinvigorate organ placement efforts if clinical status improves..0 Identify and deploy advanced critical practice expertise for advanced clinical donor management, aggressive organ acceptance and recover:.0. Establish and maintain continuity of intensivist/pulmonary involvement in donor management in the peri and post pronouncement of death time period (in consultant role) joint OPO/intensivist involvement. Increase conversion and OTPD Increase conversion and OTPD Increase OTPD Hospital & OPO Hospital & OPO Hospital, Transplant Center & OPO Increase OTPD Hospital & OPO.0. Implement an evidence based donor critical pathway and track involvement..0. Assign OPO and/or hospital staff with critical care experience to manage the care of organ donors and utilize advanced practice clinical staff (NP/PA/other) for challenging cases..0. Partner with procurement organization to help develop advanced practitioners that are able to perform donor management procedures / that are typically performed by physicians or other advanced clinicians..0. Deploy highly skilled teams to participate in the organ procurement procedure. (Recovery Technicians).0. Schedule the timely transport of deceased donor to appropriate area of hospital for tissue and eye recovery. Increase overall donation rates. Increase conversion rate and OTPD Increase overall donation rates and identify champions. Increase O/E/TPD while establishing OR relationships Increase eye and tissue recovery Hospital & OPO Hospital & OPO Hospital & OPO Hospital & OPO Hospital & OPO

65 Regulatory & Data Resources: Centers for Medicare and Medicaid Resources: State Operations Manual Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals see: 8.(a)() ()) Conditions of participation: Organ, tissue, and eye procurement- The Joint Commission Resources: Revisions to Standard TS.0.0.0, EP 9 Applicable to Critical Access Hospitals and Hospitalshttp:// Data Resources: DSA, Hospital & Regional Gap Reports

66 Donation and Transplantation Community of Practice Meeting Events: Please mark your calendars! Meeting Date/Location Target Audience DSA/Regional Strategy Meeting Pediatric Forum Performance Improvement Summit Donor Management Summit CEO Summit National Learning Congress 0 March -, 0 Sheraton Crescent Phoenix, AZ July -, 0 Sheraton Downtown Denver, CO August, 0 Swissôtel Chicago, IL September 0-, 0 Westin Kansas City, KS October 8-9, 0 Ritz-Carlton St. Louis, MO October -, 0 Gaylord Texan Grapevine, TX DSA Action Leaders Regional Action Leaders DSA Team Members - OPO Executives and Staff - Donor Hospitals - Transplant Centers - Donor Designation - State Hosp. Assoc. Pediatric Critical Care Physicians and Nurses OPO Medical Director OPO Clinical Director & staff Pediatric Transplant Physicians OPO COO OPO CEO/Executive Director Performance/Quality Committee members Board members interested in performance improvement Chief Operating Officer Vice President/Director of Quality Critical Care Physicians and Nurses Transplant Physicians OPO Medical Director OPO Clinical Director OPO COO CEOs of OPOs, Hospitals, and State Hospital Associations OPO COO OPO Board members All members of the Donation and Transplantation Community of Practice

67 SAVE THE DATE OneLegacy will host its annual Organ & Tissue Donation Symposium Tuesday October, 0 Pasadena Convention Center 00 E. Green Street Pasadena, CA 90 Learn Best Practices to: Increase the Conversion Rate Increase Organs Transplanted per Donor Increase DCD Donation Increase the availability of life saving organs for transplantation New this year: A Physicians Track focused specifically on physician to physician education More details to follow as the date approaches

68 This June th and 8th In Las Vegas OneLegacy Is inviting you to: Continuing the Climb 0 the time is now! UNOS Region Conference Topics: Defining Our True Donor Potential Donor Management Goals and What s Next The Question of st Person Consent Region Data Review Strategies for narrowing the Gaps What to expect: Day One: Fly into Las Vegas the evening of June th Team Dinner 8 PM Day Two: Conference 0- Conference begins at 0:00 a.m. This Action Team will: Participate in building our DSA strategy for eliminating all gaps in order to achieve OTPD and Conversion Rates while identifying best practices for spread! Adjourns at p.m. RSVP with your airline preference to Clinique by May th. Contact person: Clinique Burrell 9- OneLegacy Is inviting you to: Attend the Region conference Bellagio Hotel 00 south Las Vegas Boulevard Las Vegas, Nevada 8909 Phone: 9- Fax: - Cburrell@onelegacy.org

69 From: Nherie T. Tellado Sent: Tuesday, February, 0 :0 PM Subject: SAVE THE DATE-0 REGION COLLABORATIVE WEBINAR SERIES Good Afternoon, On behalf of the Region Collaborative Faculty, I would like to announce the 0 Region Webinar Series. Additional call and live meeting information will be distributed closer to the date of each call. Thank you, Chrystal Graybill Regional Administrato r SAVE THE DATE 0 REGION COLLAB BORATIVE WEBINAR SERIES March, 0 0am PT May, 0 0am PT July 8, 0 0am PT

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