Be Someone’s Miracle

An Overview of Organ, Eye & Tissue Donation

and Your Role in the ProcessSAVING LIVES TOGETHER

2019

Florida Lions Eye Bank (FLEB)

Legacy Donor Services Foundation

(LDSF)

Life Alliance Organ Recovery Agency

(LAORA)

Organ, Eye & Tissue Donation

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

LAORA’s Designated Service Area (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 listoUrgency of needoTime of waitingoBlood/Tissue typeoSize

•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

Kidney 94,820

Liver 13,431

Pancreas 861

Kidney/Pancreas 1,622

Intestine 240

Heart 3,761

Heart/Lung 45

Lung 1,365

Total 113,590

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

0% 20% 40% 60% 80%

Hospital & OPO

OPO only

Hospital only

Source: “Improving the Request Process to Increase Family Consent for Organ Donation”;Gortmaker, et al. (Journal of Transplant Coordination 1998; 8:210-217)

Family approach must be done in collaboration with LAORA staff in order to ensure the highest possibility of obtaining consent

Front Back

Referral Consultation Note

Brain Death Law and DeterminationFlorida 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

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

Immediate rescue of organs within 60-90 minutes of extubation after asystole/cardiac death occurs.

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

Donation After Cardiac Death (DCD)

Organ Donation Process – Brain Death or WDLS

Referral

• Call in any vented referral trigger within 60 minutes to (800) 255-GIVE

• Have chart readily available when making the referral

Chart Review

• Coordinator will call back to review past medical history, lab results, current neurological status, etc. Please do not withdraw life support prior to call back.

• HIPAA Exempt

Organ Donation Process – Brain Death or WDLS

Coordination

• 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 brain injury guidelines/organ preservation orders

Care of FamilyPre-Donation

• Donation should not be mentioned to family• Reinforce family’s understanding of brain death

DonationCollaboration

• Team Huddle!!• LAORA’s designated requestor will make approach in

collaboration with hospital staff• Requestor to be introduced as “an extended member of

the healthcare team to discuss end of care decisions”

Organ Donation Process – Brain Death or WDLS

ConsentObtained

• Medical Examiner’s Case: LAORA will consult ME for any restrictions

• Serologies performed for communicable diseases, and specific diagnostic procedures are performed

Organ Recovery

• The organs are surgically removed in the hospital’s OR, unless family has consented for transfer to another recovery facility

• Organs are transported to the recipient hospital for transplant

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

•Packaging and labeling

•Research & Development

•Professional Education (Hospital Development & Medical Examiner Relations

•Donor Families, Bereavement & Community Awareness

Authorization & Donor

DesignationRecovery

Processing & DistributionTransplant

Vented ReferralsOnce a vented referral, always a vented referral

Select Option 1, for vented referrals, when providing any/all updates for vented patients

Examples for Option 1

GCS of ≤ 5

Plan to withdraw care

When a previously vented patient reaches cardiac death

Why?

Vented referrals are our priority, and Option 1 will escalate the call accordingly

Our database categorizes patient information based on how the referral came into the call center. A vented referral doesn’t change categories after cardiac death.

Toll free referral line:

1-800-255-4483

Reminder:

Toll free referral line:

1-800-255-4483

Cardiac Death Referrals Select Option 2, for cardiac death referrals and updates

If Call Goes to Voicemail: Leave a message with the following:

1. Hospital

2. Patient’s name

3. Contact info. (your name & number)

All voicemails go directly to email monitored by staff

Avg. response time 10 minutes

Why Leave a Voice Mail?

Time savings - by providing your contact info, the return call is direct & efficient

By not leaving voicemail, the telecommunication system only shows a missed call from the main number of the hospital and not the number to unit where the referral is being made thus not providing us enough information to call back the referring unit directly.

Will eliminate the need for repeated call backs by the hospital

Reminder:

Referral

• Death reported – (800) 255-GIVE within 1 hour• Have chart readily available when making the referral• Report patient’s name, age, call back number, hospital

unit and referrer name

Chart Review

• Date and time of admission, cause/date/time of death, fluids administered, current and past medical history, ME status and status of physician signing death certificate

• May need to fax records to (888) 488-8804 or provide access to electronic records, as tissue coordinator will not be on-site to evaluate

Tissue & Eye Donation Process – Cardiac Death

Tissue & Eye Donation Process – Important*Contact

Information

• Say: “A member of the healthcare team or the ME office MAY need to call you later. Could you please give me a couple of phone numbers where you can be reached?”

• If family asks, “What about?” – Respond: “For any questions or additional information needed.”

Tissue & Eye Donation Process – Important*

Tissue & Eye Donation Process – Cardiac Death

Release of Body

• Embalming prevents donation• Please contact LDSF before release of a potential

tissue donor to a funeral home. If funeral home has already picked up, please contact us right away with funeral home information.

Morgue Techs/Transport/Security

• Assure Potential Tissue Donor is placed in refrigerated portion of morgue

• Record/Document time placed in refrigeration

DonationOutcome

• Consent Granted: Hospital notified/Transportation organized/Consent provided to Hospital

• Donation Declined: Hospital notified/Release to funeral home

General Surgery Allografts

• Skin: grafts for burn victims, wound therapy & dental procedures

• Fascia: Urological surgeries & tendon repair for elderly patients

• Pericardium: Inner ear and eyelid repair

• Dura: Membrane barrier

Tissue Utilization and Benefits to Recipients

Sports Medicine

Tissue Utilization and Benefits to Recipients

• Joint Reconstruction in the knee, ankle, and hip• Tendons with attached bone blocks or

tendons held in place with interference screws or other fixation implant

• ACL, PCL, MCL and LCL reconstruction• Ligament repair of the hand and foot• Elbow ligament repair

• Cartilage Repair• Meniscus Transplantation and Repair

• Cervical fusions • Lumbar spinal fusions

Neurosurgery

Eye Donation and Benefits to Recipients

Florida Lions Eye Bank

Corneas Restores sight in patients with corneal blindness caused by corneal

diseases, traumas, or infections.

Sclera Used as a patch to cover tube shunts implanted during glaucoma

surgery. Used to wrap orbital implants for patients who have lost an eye due to

trauma, cancer or severe disease.

Whole Globes Used for research to advance the treatment of ocular disease Used to teach residents and fellows surgical procedures

Did You Know?

• Approximately every 31 hours a person dies in the State of Florida waiting for a transplant.

• One organ donor can save the lives of up to 8 People:Kidneys, Heart, Pancreas, Small Bowel, Lungs, and Liver

• One tissue donor can improve the lives of up to 250 people.

• Longest surviving organ recipient: Clinical Transplant 2014

Kidney 51 years (living donor) 43 years (deceased donor)

Kidney / Pancreas 28 years

Liver 43 years

Heart 34 years

Heart / Lung 29 years

Pancreas 28 years

Lung 26 years

Intestine 24 years

What Everyone Needs To Know About Donation

The following are addressed at the time of approach for donation:

• No disfiguration, open casket viewing is possible

• Religious considerations

• No cost to donate

• No pain to donor

• Timing

Organ donation is accomplished within approx. 24 - 72

hours after death

Tissue & eye donation is accomplished within approx. 24 hours after cardiac death

SashaTalia

Julio

Edna Mae M. & Edna Mae H.Christian

Organ Donors

Stephanie Double Lung Transplant

DeniseKidney Transplant

Gabie & GilbertLiver Transplants

Michael- Heart Transplant(With his son & Sasha’s mom)

Trine and RyanLiver Transplants

NealHeart Transplant

Organ Transplant Recipients

Tissue Donors

Tuly

J’siah

Anthony

Dorothy

Diego

Tissue Transplant Recipients

LauraCloward Dowel

(Cervical)

EricOsteoarticular Allograft(Femur/Tibia/Meniscus)

VivicaVivien

Osteoarticular Allograft(Pelvic)

AdriannePatellar Tendon

(Bone Tendon Bone)

Linda(Cornea)

Sam(Cornea)

Donna(Sclera)

Craig(Sclera)

Frednel(Sclera)

Juan(Cornea)

Cornea & Sclera Recipients

• Register at www.donatelifeflorida.org• Indicate your wishes when you renew your

driver’s license• Request a registration form from Life Alliance

Share your decision with your family!

Become an Organ and Tissue Donor

.

Become an Organ

and Tissue Donor

HOW ARE WE DOING?

• If you encounter any issues when making a referral, please write down the referral ID# and your LAORA Hospital Development Specialist will follow up.

• All calls to the Donor Referral Line are recorded. • Contact your LAORA Hospital Development Specialist

with any questions or concerns.

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LAORA/FLEB/LDSF Customer Service

There are more than 113,000 people awaiting vital organ transplants, and many more in need of corneas, bone and tissue.

When you refer a potential donor, you are giving someone the opportunity to save or enhance their quality of life.

We are deeply grateful for the important role you play in turning tragedies into miracles.

You Make a Difference!