OPO Best Practices. Optimal Recovery of Donor Hearts, Lungs, Livers & Kidneys

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1 OPO Best Practices Optimal Recovery of Donor Hearts, Lungs, Livers & Kidneys

2 What is the Cost of Delayed/Missed Organs? Serial ECHO impacts hearts recovered per donor & increases recovery of multiple transplantable organs. We introduce a structured approach to serial ECHO. Prolonged donor management results in improvement in ejection fraction (regional left ventricular dysfunction) in 40-78% of donors. 2, 5 2

3 Phases Phase I * Faster Results Phase II Phase III * More Time for * Return on Recovery Team Investment 3

4 Phase I: Faster Results Improve quality of interpretations, receive faster results, save 3-12 hours per donor case & increase transplantable organs. 4

5 Our Doctors Optimize Donor Recovery. Receive immediate reports for ECHOs, ECGs, CT angios & chest x-rays. On-line images/results for your transplant centers/surgeons. We have a national network of Board-Certified cardiologists Our Medical Director and OPO Clinical Lead are Cedars-Sinai Medical Center affiliated cardiologists We expand your team s clinical capabilities. We do this by lowering your imaging costs, moving donors quickly and improving outcomes. Our solution includes 24/7 customer support, cloud-based images/reports and the highest level of clinical care from on-call cardiologists, radiologists and pulmonologists. We also provide reports for upload to lifeimage, SeeMyRadiology, radconnect and emix. 5

6 Donor Hearts Have Unique Clinical Factors. Implement a uniform, consistent selection criteria. Wall thickness 1, 3, 4 Frequency and Pattern of Left Ventricular Dysfunction 1, 3, 4 LVEDD (Left Ventricular End Diastolic Diameter) 1, 3, 4 Qualitative assessment of LV size/contractile function and right ventricular contractility 1, 3, 4 Degree of myocardial hypertrophy, cardiomyopathy and occult coronary artery disease 1, 3, 4 Wall motion abnormalities, aortic stenosis, significant mitral valve abnormalities, valvular dysfunction and anatomical congenital disorders 1, 3, 4 6

7 Donor Hearts Have Unique Clinical Factors. Implement a uniform, consistent selection criteria. Cardiologists have varying levels of experience in interpretation of ECHOs and may not be familiar with the classic patterns of LV regional wall motion abnormalities that often result after brain death. 3 Measurement of LV wall thickness is subject to error in potential donors and may lead to over-calling LVH. 3 If the interpreting cardiologist chooses to use an M-Mode technique, which emphasizes basal septal contractile function, the result many significantly underestimate the true LV systolic function. 3 Obtaining an ECHO at a suboptimal time may result in a falsely low measure of LV systolic function. 3 Hearts with severe Regional Wall Motion Abnormalities resulting from hypokinesis of the basal septum/basal anterior wall (associated with brain death) can be successfully transplanted, with normalization of LV function post-transplant. 3 7

8 We Lower Donor Case Times with Immediate Results & Cloud-based Images/Reports. Receive faster results & save 3-12 hours per donor case. We provide fast interpretations and a comprehensive cloud-based system to automate the interpretation process, quickly upload exams and share cloud-based images/reports with your transplant centers/surgeons. 8

9 Our Doctors Enhance Your Donor Programs. Enhance your recovery of hearts, lungs, livers & kidneys. Immediate/Accurate Results: We eliminate delayed reports and help to maximize every donor case. Your recovery team will gain the advantage of cardiologists, radiologists and pulmonologists available to immediately consult on ECHOs, ECGs, CT angios, chest x-rays and vent/hemodynamic management. Saving Multiple Transplantable Organs: We improve the timing of ECHOs to ensure the best possible results for saving multiple transplantable organs (i.e. maximizing the optimal timing of lung transplantation). Fast Image Uploads: We save your recovery team time by routing studies through the cloud directly to our doctors for interpretation. Image upload times are seconds with a T1 line and 3-4 minutes with mobile wireless. Our customer service organization also automates ECHO uploads for your recovery team. Mirroring your Current Process: We include OPO codes on your ECHO reports to identify patients and facilities. Our cloud-based system ensures that images/reports are only viewable by each facility/transplant center and their associated providers. 9

10 Phase II: More Time for Recovery Team Enable your recovery team to perform serial ECHO & spend more time focused on actively replacing hearts/lungs on every single donor case. 10

11 Our Doctors Train Your Recovery Team to Perform Serial ECHOs. We provide ECHO/ultrasound training for hearts, lungs, livers & kidneys. Increase your recovery staff retention & skill knowledge. Our doctors train your recovery team and ensure their long-term success with ongoing medical oversight, quality assurance and education. We offer structured, week-long two-year certification training through a Beverly Hills ultrasound training institute where we teach your recovery team how to perform ECHOs with pocket ultrasound and full diagnostic ultrasound. We teach your recovery team how to produce quality images, including identification of the right acoustic window, wall motion abnormalities and diastolic function. Our trainers include top academic cardiologists and cardiac echo techs experienced with the unique pathologies of donor hearts. Ongoing medical oversight, technical support, quality control and a pathway for continuing medical education (and recertification) are all included. Accreditation by The Society of Diagnostic Medical Sonography. 11

12 Pocket Ultrasound GE Vscan allows for a quick look to identify donors for serial ECHO. 12

13 Our Doctors Enhance Your Donor Programs. Enhance your recovery of hearts, lungs, livers & kidneys. Empower your Clinical Team: We provide your recovery team with the clinical capability to scan hearts/lungs (ECHO/ECG) and livers/kidneys (ultrasound). Our doctors provide guidance with imaging, results, quality control and donor management to make your process more efficient. Our solution expands your team s clinical capabilities and maximizes your ability to save lives. Ongoing Medical Oversight & Continuous Support: Our OPO clinical team provides ongoing, direct feedback and quality assurance for all ECHOs/studies performed by your recovery team (i.e. suboptimal, can't see images; change the angle of the ultrasound probe to view short axis images from the aortic root down to the apex). Save your Program Money: Lower hospital imaging expenses by performing your own ECHO, ultrasound and ECG exams. You will also gain the clinical advantages of serial ECHO. Continuity for your Program: We ensure loaner ultrasound machines for repairs when/if your ultrasound machines require service. 13

14 Phase III: Return on Investment (ROI) Enhance your clinical recovery capabilities with serial ECHO & reduce your donor imaging expenses. 14

15 Your OPO will save at least 48 donor case hours per month with faster turnaround. Post implementation results are tracked for program enhancement to statistically impact organs recovered per donor. Baseline stats are collected to measure lowering of donor case times and recovery of multiple transplantable organs. 4 Cases Time Savings Single Case (per month) Immediate results. No more wait hours hours 15

16 What Our Customers Are Saying CompuMed s services have helped us immensely with turnaround time, ease of uploading studies, quick and accurate interpretations, and critical care consults that have helped us to place more hearts than in years past. We especially like partnering with CompuMed because their team is dedicated, available at a moment s notice 24/7, and very responsive. Jessica Roth Clinical Services Manager Nebraska Recovery Organ System 16

17 We Offer Critical Care Decision Support. Our cardiologists and pulmonologists serve as an available resource for your recovery team to discuss clinical decision strategies to optimize outcomes. We are available for vent/hemodynamic management. We re able to guarantee on-call availability for weekends/holidays. 17

18 Referenced Donor Heart Publications 1 Burhan Mohamedali, MD; Geetha Bhat, PhD, MD; Allan Zelinger, MD. Frequency and Pattern of Left Ventricular Dysfunction in Potential Heart Donors: Implications regarding Use of Dysfunctional Hearts for Successful Transplantation. Journal of the American College of Cardiology, 2012;60(3): ). 2 Marilena Casartelli; Tonino Bombardini; Davide Simion; Maria Grazia Gaspari; Francesco Procaccio. Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart. Cardiovascular Ultrasound, 2012, 10: Kiran K. Khush, MD, MAS. Use of Echocardiography in Cardiac Donor Assessment. International Society for Heart & Lung Transplantation, Dec. 2012; 4(8): Onnen Grauhan, MD, PhD. Screening and assessment of the donor heart. Applied Cardiopulmonary Pathophysiology, 2011; 15: R.V. Venkateswaran; R.S. Bonser; R.P. Steeds. The echocardiographic assessment of donor heart function prior to cardiac transplantation. European Heart Journal Cardiovascular Imaging, 2004, 6(4):

19 We Are Physicians Helping Physicians. CompuMed, Inc. has been in business for over 25 years and has over 1,000 customer sites. We offer on-call daytime and after-hours support to increase the uniformity, accuracy and timeliness of diagnostic imaging for donor hearts, lungs, livers and kidneys. Headquarters CompuMed, Inc W. Century Blvd., Suite 360 Los Angeles, CA Phone: W. Scott Rombach President & CEO, CompuMed, Inc. Office: Mobile: