OneLegacy: A Donate Life Organization

1. OneLegacy: A Donate Life Organization

2. Objectives • At the end of the presentation the learner will be able to: • Identify when to refer patients to OneLegacy for Organ and Tissue Donation • Understand the Donation process

3. What are OPOs? • Not-for-profit Organ Procurement Organizations (OPOs) like OneLegacy are federally designated and funded by CMS to serve specific regions of the country and were established to: • Educate the public about benefits of organ donation and transplantation • Recover, preserve and distribute donated organs • Increase the availability of organs for transplantation • Support, promote and assist tissue donation

4. OneLegacyAn Organ and Tissue Donation Network Our Mission OneLegacy is dedicated to achieving the donation of life-saving and life-enhancing organs and tissue for those in need of transplants and to providing a sense of purpose and comfort to those families we serve. TransplantCenter Hospital To Save Lives, To Support Grieving Families, To Honor Donor Wishes

5. OneLegacy • Not for Profit Founded in 1977 • Federally funded and designated by Centers for Medicare and Medicaid Services (CMS) as an Organ Procurement Organization (OPO) • Licensed by California as a tissue bank • Accredited by the American Association of Tissue Banks (AATB) and Eye Bank Association of America (EBAA) • Serving 220 hospitals, 11 transplant centers & 19 million residents

6. # of People waiting for organ transplants = 112,839www.unos.org

7. Waiting List Outcomes • Over 112,000 on national waiting list • 17-18 on waiting list die each day • Another name is added to the list every 13 minutes

8. Early Referral is Critical – and Required • CMS regulations require all deaths to be reported • OneLegacy monitors referral activity and to ensure compliance. • Imminent brain death:Report as soon as patient shows one or more clinical signs of cessation of brain and brain stem functions • Cardiac death: Report all deaths within 1 hour • Organs can become non-viable during the time the family considers the donation option. Proper donor management enables adequate hydration, ocular care, etc.

9. CMS & Joint Commission • Conditions of Participation (CoPs) • Timely Referral: • Imminent brain death • (GCS 5 or less, vent dependent, neuro insult/injury) • Cardiac death (call within 1 hour for tissue donation) - Do not approach the family – approach will be coordinated by OneLegacy following determination of medical suitability

10. Imminent Brain Death • Ventilator dependent / GCS ≤ 5*(*based on CMS guidelines) • One or more clinical signs: • Pupils fixed and dilated • No cough • No gag reflex • No spontaneous respiration • No purposeful movement in response to noxious stimuli CALL if pt meets any of these triggers!

11. Clinical Trigger Card

12. California Uniform Declaration of Death Act (1982) California Health and Safety Code: Section 7180 et seq. “A person shall be pronounced brain dead if it is determined by a physician that the person has suffered a total and irreversible cessation of all functions of the entire brain, including the brain stem. There shall be independent confirmation of the death by another physician.”

13. Brain Death Declaration • Brain Death Determination • Brain death documentation by 2 licensed physicians • 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 • Discretion of the physician for confirmatory tests • Follow Hospital Policy and Procedure

14. The Donation Process Approach Development Referral Evaluate HospitalDevelopment Community Outreach Identification & Early Referral Based on Clinical Triggers Suitability Donor Mgmt Brain Death Declared Donation After Cardiac Death Assessment Family Support Huddle EffectiveRequesting Medical/SocHistory

15. Approach Process Brain Death: • After a Huddle • Effective Requestor usually approaches after 2nd Brain Death note • One Legacy’s Family Care Coordinator approached family about the opportunity for donation Tissue: • After the patient has been identified as a suitable tissue donor • The Family Care Center will call the family and approach over the phone.

16. The Donation Process Recovery Development Referral Evaluate Approach Identification & Early Referral Based on Clinical Triggers HospitalDevelopment Community Outreach Suitability Donor Mgmt Brain Death Declared Donation After Cardiac Death Assessment Family Support Huddle EffectiveRequesting Medical/SocHistory Coroner Clearance Organ Placement Organ/Tissue Recovery After Action Review

17. Recovery Process • Brain Death organ recovery coordinated by One Legacy’s Procurement Transplant Coordinator (PTC) • PTC will obtain Coroner release • PTC will provide donor management • PTC will coordinate organ placement with transplant centers • PTC will coordinate organ recovery time and process with the OR • Tissue recovery coordinated by One Legacy Tissue Recovery Coordinators • Tissue recovery occurs either in the OR, or hospital morgue if suitable, may also occur at the funeral home or coroner’s office

18. Organs and Tissues That May Be Donated Kidneys Liver Heart Lung Pancreas Small Intestine ORGANS TISSUES Corneas/Eyes Bone Heart valves Blood Vessels Tendons Cartilage Skin

19. The Results Are Exponential From 3 patients who become donors… …10 lives are saved on averagethrough organ transplants… …and up to 150 lives are improved due todonated tissues

20. 2008 Lily’s wedding day 1984 Liver tumor, awaiting transplant Matthew Bemis,Lily’s donor 1985 post transplant Lily

21. The Gift of Life For many families: • The Gift of Organ Donation is the only positive experience in the tragic chain of events surrounding the loss of their loved one. • It can help give meaning to an otherwise senseless event that has occurred.