9/26/2018 Disclosure Overview of the Donation Process No one involved in the planning or and Family Care presentation of this material has any relevant financial relationships with a commercial interest to disclose. Maria Nauman, RRT, CPTC Clinical Operations Manager • 114,410 waiting for a • Be familiar with the process of organ donation transplant in the U.S. • Identify a potential organ donor • 26,776 waiting in our • Be aware of the obstacles that come up during cases region • Understand how donation is authorized • 10,284 in DNW service • Be familiar with how we support donor families area • A new patient is added every 10 minutes 1
9/26/2018 180,000 160,000 140,000 120,000 100,000 Waiting List Transplant 80,000 Donors 60,000 40,000 20,000 through through ORGAN donation TISSUE donation 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 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
9/26/2018 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 REFERRALS •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. Auth Referral Response Review Approach 2-4 hrs 3
9/26/2018 Corneas • Age Range: • Currently Incarcerated – Full term Infant - 80 y/o Heart • Current IVDA Valves • Numerous comorbidities Lungs • Currently Homeless • Resuscitated Cardiac Arrest Victim Organs Tissue Skin Pancreas • Coroner’s Case • Multi-System Trauma Victim – Homicide/ suicide victim Bone Liver Veins Kidneys • Impaired Cardiopulmonary and • Hepatitis B or C positive Renal Function Ligaments Intestine • HIV (Hope Act) ORGAN DONORS Donor Workup Allocation Recovery Follow up Startup 12‐24 hrs 4‐12 hrs 3‐8 hrs 4
9/26/2018 • Brain Death Declaration • Make the referral when the patient meets clinical cues • Obtaining diagnostics • Update us with plan of care changes, if we are following • Cross‐matching • Maintain the option - perfusion/oxygenation • Transplant center OR timing requests • Donor Management Goals • Distance of the recipient to the transplant center • Donor hospital OR availability – MAP (60-110), CVP (4-11), PF ratio > 300, Na < 155, BS <180, • Family requests 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 FAMILY CARE • 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 5
9/26/2018 One Family’s Thank You to their Donor I II III IV V VI Gathering Brain Family Donation Continued Aftercare and Sharing Death Support/ Discussion Support Information Discussion Coping and With Loss Goodbye • 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
9/26/2018 Donor Network West saves and • One month letter – outcomes heals lives through organ and tissue donation. We honor and respect the donors we serve • 3 month call – check in/survey with compassionate care, and inspire our • 6 month letter – updated outcomes communities to donate life. • 1 year – letter/call • Donor Family Gatherings Maria Nauman Clinical Operations Manager mnauman@dnwest.org 510 ‐ 882 ‐ 0041 7
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