9/26/2018 Disclosure Overview of the Donation Process No one - - PDF document

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Overview of the Donation Process and Family Care

Maria Nauman, RRT, CPTC Clinical Operations Manager

Disclosure 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

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20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Waiting List Transplant Donors

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

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REFERRALS

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

• 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

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• Age Range:

– Full term Infant - 80 y/o

• Numerous comorbidities
• Resuscitated Cardiac Arrest Victim
• Multi-System Trauma Victim
• Impaired Cardiopulmonary and

Renal Function

• Currently Incarcerated
• Current IVDA
• Currently Homeless
• Coroner’s Case

– Homicide/ suicide victim

• Hepatitis B or C positive
• HIV (Hope Act)

Bone Skin Veins Corneas Ligaments Valves Heart Lungs Pancreas Liver Kidneys Intestine

Organs Tissue

ORGAN DONORS

Donor Startup Workup 12‐24 hrs Allocation 4‐12 hrs Recovery 3‐8 hrs Follow up

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• 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
• rganizations – 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

9/26/2018 6 One Family’s Thank You to their Donor

Gathering and Sharing Information Brain Death Discussion Family Support/ Coping With Loss Donation Discussion Continued Support and Goodbye Aftercare I II III IV V VI

• 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

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• 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.

Clinical Operations Manager mnauman@dnwest.org 510‐882‐0041

Maria Nauman