2019 Be Someone’s Miracle An Overview of Organ, Eye & Tissue Donation and Your Role in the Process SAVING LIVES TOGETHER
Organ, Eye & Tissue Donation Life Alliance Organ Legacy Donor Florida Lions Eye Recovery Agency Services Foundation Bank (FLEB) (LAORA) (LDSF)
LAORA’s Designated Service Area (DSA) LAORA’s area of certification is designated by the Department of Health and Human Services: • Miami-Dade • Broward • Monroe • Palm Beach • Collier • St. Lucie • Commonwealth of the Bahamas Over 90 hospitals in DSA
Responsibilities of LAORA, LDSF & FLEB Evaluate potential organ and tissue donors Collaborate with hospital to maintain donor before and after brain death declaration Obtain consent from family in collaboration with the hospital Allocation of organs Coordinate all recovery and preservation activities Support services to the donor family Provide donor education programs
Legislation • 1968 Uniform Anatomical Gift Act Allowed the gift of donation through documentation, such as a donor card • • 2003 Nick Oelrich Gift of Life Act (FL) An individual has the right to designate their wishes regarding donation. This • designation may not be overruled by a family member. • 2009 Uniform Anatomical Gift Act (revised) A donor designation does not require consent from the legal NOK/healthcare • surrogate. This designation is recognized as first person consent www.DonateLifeFlorida.org • Our Practice on First Person Consent Disclosure form and copy of donor designation (in lieu of consent form) will be • provided to family
Laws That Impact Hospital Processes • 1996 Required Request Law • Families have the right to be given the option of donation at/near the time of death of their loved one • 1998 Required Referral Law • All deaths and imminent deaths must be reported to the OPO by calling 1-800-255 GIVE (4483) Personal perception that a family’s grief, race, ethnicity, religion or socioeconomic background would prevent donation should never be used as a reason not to approach a family.
Clinical Triggers
CBIG’s
Clinical Triggers and DMG’s
What is ? With more than 116,000 people waiting for an organ transplant in the United States. • Every day this number gets bigger, but there are not enough organ donors to help all of these people get the organ transplants they need. On November 21, 2013 the HOPE Act (HIV Organ Policy Equity Act) was signed into law. • This law makes it possible for us to transplant organs from HIV positive people for organ donation, with other HIV positive people as the recipients. We can also use research to better understand how HIV positive organs can help those in need receive life-saving transplants. By using organs from HIV positive, brain dead donors for organ donation, we can reduce • the number of people waiting for transplants, saving lives of both HIV positive and in turn decreasing the list/waiting times for HIV negative people. In 2017, 6 HIV positive organs recovered for transplant, 1 co-infected HIV/Hep-C • transplant, and 10 research samples. Currently in research for HIV positive DCD donor potential. •
Donation Related Legislation & Regulations CMS Conditions of Participation Requires hospitals to establish relationship with their federally designated OPO Hospitals must establish protocols for identifying and referring potential donors and for informing families of their opportunity to donate TJC Requirements (Standard PI.1.10) Requires hospitals to measure the effectiveness of their organ procurement efforts including the conversion rate Review donation related data to improve conversion rates
United Network for Organ Sharing (UNOS) UNOS is the private, non-profit organization that manages the nation's organ transplant system under contract with the federal government. • Established by the NOTA of 1984, which also outlawed the buying and selling of organs for donation and transplant • UNOS ensures an equitable system for organ sharing • Maintains patient waiting list o Urgency of need o Time of waiting o Blood/Tissue type o Size • Matches recipients with donors • Responsible for increasing organ donation • Develops and monitors compliance • Reports outcomes and costs
National Waiting List Type of Transplant Patients Waiting 94,820 Kidney 13,431 Liver 861 Pancreas 1,622 Kidney/Pancreas 240 Intestine 3,761 Heart 45 Heart/Lung 1,365 Lung 113,590 Total Based on OPTN data as of Jan. 25, 2019 Totals may be less than the sums due to patients included in multiple categories.
The Growing Gap between Organ Donation and Transplantation Data from optn.transplant.hrsa.gov and OPTN/SRTR Annual Report .
Organ Donation Breakthrough Collaborative The Organ Donation Breakthrough Collaborative began in 2003 as one of the components of U.S. Dept. of Health and Human Services Gift of Life Initiative. The aim is to dramatically increase the number of organs transplanted. Best practices include: - Early referral rapid response - Preserving the option of donation The goal: An average donation rate of 75% thereby saving or enhancing hundreds more lives each year.
Avoid Mention of Donation LAORA Coordinator will not discuss donation with families until patient is evaluated for medical suitability, to avoid giving families false hope for donation .
Collaboration = Higher Consent Rate Family approach must be done in collaboration with LAORA staff in order to ensure the highest possibility of obtaining consent Hospital only OPO only Hospital & OPO 0% 20% 40% 60% 80% Source: “Improving the Request Process to Increase Family Consent for Organ Donation”; Gortmaker, et al. (Journal of Transplant Coordination 1998; 8:210-217)
Referral Consultation Note Front Back
Brain Death Law and Determination Florida Statute 382.085 • Irreversible cessation of brain function including brain stem • Two board eligible or board certified physicians by clinical exam • Reversible etiology must be considered and excluded prior to diagnosing brain death • May confirm brain death by: o Negative cerebral flow o Flat EEG and/or o Apnea test
Donation After Cardiac Death (DCD) Immediate rescue of organs within 60-90 minutes of extubation after asystole/cardiac death occurs. WDLS trigger must be called within one hour to 1-800-255-GIVE These patients are: • On Mechanical Ventilation • Are terminally ill or have sustained an irreversible brain injury • Do not meet brain death criteria • For whom further treatment is deemed futile and are predicted to die • Families Have Made Decision To Withdraw Life Sustaining Therapies
Donation After Cardiac Death (DCD) • Donation Opportunity offered AFTER decision to withdraw life sustaining therapies • Inform family of process in the event patient does not expire • Family can be present in OR if hospital policy permits, a donor family advocate will remain with the family for support • Pronouncement is made by Hospital Physician • Withdrawal is done by Hospital Staff • OPO coordinator present to document vitals ONLY • First incision is made 3-5 Minutes after pronouncement • Organs that can be donated for transplant are liver, kidneys, pancreas, heart valves, potentially lungs • All organs can be donated for research
Organ Donation Process – Brain Death or WDLS • Call in any vented referral trigger within 60 minutes to (800) 255-GIVE • Have chart readily available when making the Referral referral • Coordinator will call back to review past medical history, lab results, current neurological status, etc. Please do not withdraw life support Chart prior to call back. • HIPAA Exempt Review
Organ Donation Process – Brain Death or WDLS • Provide updates accordingly such as status change or additional testing/diagnostic change • Coordinate care with the physicians to support patient until brain death is declared, by initiating catastrophic Coordination brain injury guidelines/organ preservation orders • Donation should not be mentioned to family Care of Family • Reinforce family’s understanding of brain death Pre-Donation • Team Huddle!! • LAORA’s designated requestor will make approach in collaboration with hospital staff Donation • Requestor to be introduced as “ an extended member of Collaboration the healthcare team to discuss end of care decisions ”
Organ Donation Process – Brain Death or WDLS • Medical Examiner’s Case: LAORA will consult ME for any restrictions • Serologies performed for communicable Consent diseases, and specific diagnostic procedures are performed Obtained • The organs are surgically removed in the hospital’s OR, unless family has consented for transfer to another recovery facility Organ • Organs are transported to the recipient hospital for transplant Recovery
Life Alliance Organ Recovery Agency Consent Form NOTE - OR/Anesthesia forms are NOT REQUIRED for ANY organ donor case.
Circle of Life Legacy Donor Services Foundation • Donor Families, • Professional Bereavement & Education (Hospital Community Development & Awareness Medical Examiner Relations Authorization & Donor Recovery Designation Processing & Transplant Distribution • Research & • Packaging and Development labeling
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