Donation Process: Preparing for the Gift

1. Donation Process: Preparing for the Gift Breakout Session A • Presenters: Jennifer Do, RN, Unit Director,Surgical Transplant ICU, Ronald Reagan UCLA Medical Center Beverly Jacoby, Donation Development Coordinator, OneLegacy • Moderator: MarwaKilani, MD, Providence Holy Cross Medical Center

2. Objectives • Understand how to identify organ and tissue donors and the importance of timely referrals • Understand the importance of preserving the opportunity for donation to maximize organs transplanted per donor • Understand the importance of the partnership between hospitals and organ procurement organization (OPO) in the Effective Request Process

3. Questions to Run On • Explain the concept of timely referrals in the donation process • Describe how preserving the opportunity for donation can maximize organs recovered • Identify the types of partnership opportunities shared between hospitals and organ procurement organizations (OPOs)

4. Identify Organ and Tissue Donors • Hospital Clinical Triggers • Mutually agreed upon by Hospital and OPO* • GCS, ventilator-dependent, acute brain injury • Hospital Policy • Identification of potential organ and tissue donors* • Medically maintain patients as potential donors* *CMS Regulations

5. Clinical Triggers / Timely Referrals • Imminent neurologically devastated, or patients who received optimal treatment but cannot recover from injury or illness, whose death is imminent • As soon as these individuals are identified, refer to OneLegacy within an hour of meeting criteria* • Answer preliminary screening questions that include basic patient medical history *CMS Regulations

6. UCLA Health System Clinical Trigger ID Badges

7. Timely Referrals • If not a candidate for organ donation, hospital issued a referral number so that it can be used at the time of cardiac death • If patient is deemed medically suitable for organ donation at the time of referral, OneLegacy will send a Procurement Transplant Coordinator (PTC) or Referral Process Coordinator (RPC) to conduct further evaluation of patient

8. Hospital/OPO Partnership • Referred when the potential donor’s organs are still viable • OneLegacy PTC will evaluate patient as potential donor • Meet with hospital staff (unit director, bedside RN, physician, spiritual care, social services) to gain a better understanding of what the family is going through so approach is smooth

9. Hospital/OPO Partnership • Determine if patient is a registered donor • Patient is declared brain death by two physicians, the second note is the legal time of death • Once the second death is done, assess the timing of approach with family* *Check with Hospital Policy on time interval of notes

10. Physician’s Responsibilities • Brain Death Determination • Brain death documentation by 2 licensed physicians not associated with transplantation • Note should state “Patient is Brain Dead” • Sign, date & time notes • Test(s) performed to determine brain death: • Clinical exam is required in the State of California • EEG or CBF is not mandatory and may not be conclusive in newborn • Discretion of the physician for confirmatory tests • Hospital Policy and Procedure

11. Registered Donors • Registered Donors (First Person Authorization) have documented their decision to become a donor on the Donate Life California Registry website or through DMV • Similar to Advanced Directive and legally binding • Family is provided this information

12. What if the Family Mentions Donation? • Some families will ask “What’s next?” • Some families will mention “What about organ donation?” • Difficult situation for hospital staff • Refer patient to OneLegacy, and they will send a representative on-site

13. Preserving the Opportunity of Donation • Continue to optimize patient outcome according to standard medical practice • Maximize the gift for the family and honoring the patient’s decision • Hospital Policy • CMS Regulations

14. Potential DCD and Withdrawal of Support • Patient has suffered an irreversible neurological injury • Does not meet brain death criteria • Discussion for withdrawal of ventilator or vasopressor support are initiated by family or physician • Patient may be a suitable candidate for Donation after Cardiac Death (DCD); OneLegacy evaluates each case

15. Brain Death vs. Donation after Cardiac Death For both organ donation opportunities, patient suffered a severe brain injury and is ventilator dependent • Trauma: GSW, BHT, MVA • Cerebral Vascular Accident: ICH, ICB • Anoxia: MI, Drowning, Hanging

16. Effective Request and “Team Huddle” • Interdisciplinary discussion between OL and key hospital staff (MD, RN, SW, etc.) regarding a potential donor case • Opportunity to get everyone “on the same page” regarding family care, medical preservation of the donation option and testing plan • Plan the optimal first discussion of donation for each family of each potential donor patient

17. Effective Request and “Team Huddle” • Identify, protect, and preserve the donation opportunity for patients and their families when donation may be a viable end of life option • Provide excellent end of life care for optimum healing of the family

18. Authorization Approach • Timing is critical • Assessment of family dynamics • Quiet setting away from bedside • Physician provides finality of death • OneLegacy approaches family collaboratively with hospital staff

19. Questions to Run On • Explain the concept of timely referrals in the donation process • Describe how preserving the opportunity for donation can maximize organs recovered • Identify the types of partnership opportunities shared between hospitals and organ procurement organizations (OPOs)