9/26/2018. Disclosure Overview of the Donation Process and Family Care

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1 Disclosure Overview of the Donation Process and Family Care Maria Nauman, RRT, CPTC Clinical Operations Manager No one involved in the planning or presentation of this material has any relevant financial relationships with a commercial interest to disclose. Be familiar with the process of organ donation Identify a potential organ donor Be aware of the obstacles that come up during cases Understand how donation is authorized Be familiar with how we support donor families 114,410 waiting for a transplant in the U.S. 26,776 waiting in our region 10,284 in DNW service area A new patient is added every 10 minutes 1

2 180, , , , ,000 80,000 Waiting List Transplant Donors 60,000 40,000 20, through ORGAN donation through TISSUE donation 40 Counties Serving Northern California & Nevada 175 Hospitals 44 Coroners & Medical Examiners 500+ Funeral Homes 5 Transplant Centers 14 Million People 1987 Year Founded 100,000 Square miles 2

3 CMS and Joint Commission Conditions of Participation CMS requires hospitals to refer all cardiac deaths and imminent deaths to the local organ procurement organization in a timely manner REFERRALS CMS requires that a designated requestor initiate the donation discussion with potential donor families. DNW is the agreed upon designated requestor CMS makes it clear that it is the responsibility of DNW to determine medical suitability of potential donors CMS makes it clear that every family has the right to hear information about donation and make their own decision about whether they want their loved one to donate. Referral Response Review Approach Auth 2-4 hrs 3

4 Age Range: Full term Infant - 80 y/o Numerous comorbidities Resuscitated Cardiac Arrest Victim Multi-System Trauma Victim Currently Incarcerated Current IVDA Currently Homeless Coroner s Case Homicide/ suicide victim Organs Heart Liver Lungs Pancreas Skin Corneas Bone Valves Tissue Impaired Cardiopulmonary and Renal Function Hepatitis B or C positive HIV (Hope Act) Intestine Kidneys Veins Ligaments ORGAN DONORS Donor Startup Workup hrs Allocation 4 12 hrs Recovery 3 8 hrs Follow up 4

5 Brain Death Declaration Obtaining diagnostics Cross matching Transplant center OR timing requests Distance of the recipient to the transplant center Donor hospital OR availability Family requests Make the referral when the patient meets clinical cues Update us with plan of care changes, if we are following Maintain the option - perfusion/oxygenation Donor Management Goals MAP (60-110), CVP (4-11), PF ratio > 300, Na < 155, BS <180, UOP > 0.5 ml/kg/hr, EF >50% Achieving donor management goals before deceased donor procurement is associated with more organs transplanted per donor. Region 5 study including 8 organ procurement organizations each sharing data from 40 donors 10 critical care end points 320 Standard Criteria Donors Conclusion: Meeting DMGs before procurement resulted in more organs transplanted per donor 4.4 organs/donor vs 3.3 organs/donor More likely (70% vs 39%) to have > 4 organs/donor FAMILY CARE 5

6 One Family s Thank You to their Donor I II III IV V VI Gathering and Sharing Information Brain Death Discussion Family Support/ Coping With Loss Donation Discussion Continued Support and Goodbye Aftercare Facilitates quality conversations with families Provides a calm and safe space in the midst of unimaginable distress Creates an opportunity for deep and meaningful conversations Encourages reflection on a family s personal values Simultaneously advocates for families and recipients Organ donation authorization rate highest when hospital staff and OPO approach together J Transp Coord. 1998,Dec;8(4):210 7 Improving the request process to increase family consent for donation 6

7 One month letter outcomes 3 month call check in/survey 6 month letter updated outcomes 1 year letter/call Donor Family Gatherings Donor Network West saves and heals lives through organ and tissue donation. We honor and respect the donors we serve with compassionate care, and inspire our communities to donate life. Maria Nauman Clinical Operations Manager mnauman@dnwest.org