Moderator:• Cristian Nunez, OneLegacy Presenters:• Marcia Penido, LCSW, Huntington Hospital• Robert Coppel, OneLegacy• Michelle Post, LMFT, OneLegacy

Breakout Session B:

The Donation Process –

The Continuum of Care

Questions to Run On

How can the hospital’s family support staff help guide

the donation process?

How can you help ensure a family is approached

effectively and appropriately?

What happens with a donor family AFTER an organ or

tissue donation?

But How Does this Relate to My Job?

A Guide for the Hospital Social Worker & Chaplain

Marcia Penido, LCSW, MPHCo-Chair, Organ & Tissue Donation

CommitteeHuntington Hospital

Objectives

At the end of this presentation, the participant will be able to:1. Understand their hospital’s

donation policy (timely referrals, diligent search, administrative consent).

2. Understand how they can impact the momentum of a referral/donor case.

Prompt the Referral

Know the clinical triggers for referring

patients:

Loss of >1 brainstem reflex

&/or

DNR & terminal extubation being considered

Ensure referral is on the radar of the MD/RN

Follow-up until referral is made

Trigger Card

Identify Patient/N.O.K.

Do you have a diligent search protocol?

Have you thought of everything?

Do you have a time limit set?

Legally-recognized decision-maker vs

N.O.K.

Does your hospital allow administrative

consent?

Support the Support System

Prepare them for MD’s dx/px Attend care conference(s) if possible Validate their grief Reinforce medical info, if needed Assist with concrete issues/answers Get spiritual care provider, if needed Offset anger directed at hospital/healthcare

team Run interference vs. withdraw into the

background

Follow the Referral

Is the patient ruled in or out? What did OL write? What does the MD/RN know? Does OL’s understanding match the MD’s?

DCD vs BD? Map out the process for what will happen Ensure unit staff understand &

communicate in shift report

Pave the Way for Approach

N.O.K. Decision-maker(s) Influencers Saboteurs MIAs Careful responses if donation questions are

asked Observe/listen for family dynamics Ask about documents/listen for clues as to

patient’s wishes

Huddle with the Team

Have a Team Huddle Worksheet on which to document collaboration/plan Part of Medical Record

Huddle upon OL’s arrival Huddle upon FCS’s arrival Huddle prior to approach Huddle whenever helpful

(Did I mention you should huddle?)

Follow after the Approach

Support family regardless of decision Ensure they know their decision is not

judged or rewarded Answer questions Provide referrals Run interference with potential saboteurs Observe/listen for information helpful to

After Action Review & pass it onto Donor Council

Learn, Learn, Learn

Review every case Celebrate perfect collaboration Learn from challenges & declines Success is

an effective request what the patient would have wanted or the

N.O.K. needed to do

Wait! There’s More for You to Do!

Do you have a Donor Council/Donation Committee?

Is your discipline/department represented? Is the nursing unit where donors are

referred represented? Do you have a method for giving feedback

after cases are identified? Do you receive recognition when there’s a

success or challenging case? Do you celebrate donor families?

Maximizing Outcomes…

Support….the family/support system Diffuse…any distrust, misunderstandings,

misperceptions, dissatisfaction Follow closely…the process so that all

policies are followed & opportunity for donation is being protected

Liaison…between medical staff & OL, ensuring collaboration

What Factors Can Affect an

Approach?

Robert CoppelFamily Care Specialist

OneLegacy

Objectives

At the end of this presentation, the participant will be

able to:

1. Understand what constitutes an effective or

ineffective approach.

2. Understand of what a OneLegacy family approach

consists.

Why Huddle?

• Collaboration• Fact finding

– First Person Consent / Advance Directives– Identify LNOK, Family Support System– Understanding family dynamics, key decision-makers– Spiritual and Cultural needs of each family

• Establishing Hospital family support system: – SW, Pastoral, etc.

Negative Factors Affecting Consent

• Inappropriate mention of donation registered or

otherwise

• Inadequate explanation of grave prognosis

• Inaccurate assessment of family

• Timing

• Hospital supports organ donation

• Team huddles

• Appropriate requestor

• Family satisfied with quality of care and

communication

Positive Factors Affecting Consent

• Reasonable time allowed with loved one

• Understanding of brain death

• MD coordinates end-of-life discussion

Positive Factors Affecting Consent

• Has the doctor talked with you?

• What did he/she tell you?

• What does that mean to you?

What Happens Behind Closed Doors?

• Explain brain death, even if family understands.

Keep in simple terms.

• Discuss funeral arrangements.

• Discuss coroner’s case and possible autopsy.

What Happens Behind Closed Doors?

Thank You

AFTERcare

Continuum of Care….What Happens Next?

Michelle Post, MA, LMFTOneLegacy Clinical Aftercare Specialist

Chair of AOPO Donor Family Service Councilmpost@onelegacy.org

Objectives

At the end of this presentation, the participant will be able to:

1. Recognize how OneLegacy’s Aftercare Department

supports donor families.

2. Verbalize which aftercare programs, events, and

correspondence is available to donor families.

Our Philosophy

• AFTERcare = “Companioning” a bereaved

family (Alan Wolfelt, Ph.D.)

– Not experts on grief; take cues & offer support…

Do not lead~ Walk WITH

Our Philosophy

• AFTERcare = Consistency

– After a family consents to donation, regardless of

medically closing the case and not transplant…

– Minimum of 2 years of support from OneLegacy

Aftercare Department

Who Supports the Family?

OneLegacy Aftercare Staff & Interns =Interdisciplinary team: RN, LCSW, LMFT, MSW,

Chaplain

Aftercare Program ~ 2 yrs Sympathy Card

Aftercare Program ~ 2 yrs

Anniversary Card on One Year Anniversary of Loved One’s Death

Aftercare Program ~ 2 yrs

• Letters of Support

• Grief literature

• Timed intervals from

the death through

2 yrs

“The Companion”, a Donor Family Newsletter

• 3 times a year for as

long as they want to

continue to be on our

mailing list

Aftercare Program

• Phone calls

of support

Monthly Grief Groups

• Saturday Mornings ~

– Downtown LA – Kids, Teens, Adults (Span & Eng)

– Redlands (Spanish – hope to start Eng)

– O.C. (Hope to start Eng, Fall)

Building Hope Through Companioning

Day of the Dead Craft Day & Cultural Diversity in Grief Wrkshp

Surviving the Holidays Workshop

• Frames,

Ornaments, Plates

in memory of donors

Aftercare Intern Program

Short-Term Grief Support Services

ON-LINE

Private Facebook

Group for

Donor

Families

“Fields of Gold” Donor Remembrance Ceremonies

Each family receives a Life Bridges Donor

Pin & Pendant set

Hundreds of donor family members gather at three annual events

Terry Harrington, heart recipient and the ‘voice’ of Lisa’s sax on the “Simpsons,” performs

Donate Life Rose Parade Float Decorating Days & Family Circle Rose Dedication

A donor family gathers to decorate in

honor of their loved one

Donor parents dedicating a rose

Donor Sister works on the Donate Life Float

Donate Life Run/Walk

Donor families formed teams of all sizes and walked in honor of their loved ones.

T-shirts personalized with each donor’s picture &

Family Circle Garden Posters

Bridging Lives Quilt

Donor families can create a quilt block which becomes a community based quilt Kern County Bridging

Lives Quilt with project leader Becky Pitre

• Organ Recipient Medical Updates

• Tissue Disposition updates

• Donor Family and Recipient

Meetings

Other Aftercare Services

Long after the donation is complete...

AFTERcare is available

Michelle Post, MA, LMFTOneLegacy Clinical Aftercare Specialist

Chair of AOPO Donor Family Service Councilmpost@onelegacy.org

Questions to Run On

How can the hospital’s family support staff help guide

the donation process?

How can you help ensure a family is approached

effectively and appropriately?

What happens with a donor family AFTER an organ or

tissue donation?