OneLegacy: A Donate Life Organization

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OneLegacy: A Donate Life Organization

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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

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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

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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.

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TransplantCenterHospital

To Save Lives, To Support Grieving Families, To Honor Donor Wishes

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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

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# of People waiting for organ transplants =

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112,839 www.unos.org

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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

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• 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.

Early Referral is Critical – and Required

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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

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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 stimuli10

CALL if pt meets any of

these triggers!

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Clinical Trigger Card

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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.”

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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

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Approach

The Donation Process

SuitabilityDonor MgmtBrain Death DeclaredDonation After

Cardiac Death Assessment

Identification & Early Referral Based on Clinical Triggers

Family SupportHuddleEffectiveRequestingMedical/SocHistory

HospitalDevelopmentCommunity Outreach

Development Referral Evaluate

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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.

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Recovery

Coroner ClearanceOrgan PlacementOrgan/Tissue RecoveryAfter Action Review

The Donation Process

SuitabilityDonor MgmtBrain Death DeclaredDonation After

Cardiac Death Assessment

Identification & Early Referral Based on Clinical Triggers

Family SupportHuddleEffectiveRequestingMedical/SocHistory

HospitalDevelopmentCommunity Outreach

Development Referral Evaluate Approach

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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

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Organs and Tissues That May Be Donated

KidneysLiver

Heart Lung

PancreasSmall Intestine

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Corneas/EyesBone

Heart valvesBlood Vessels

TendonsCartilage

Skin

ORGANS TISSUES

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The Results Are Exponential

From 3 patients who become

donors…

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…10 lives are saved on average

through organ transplants…

…and up to 150 lives are improved due to

donated tissues

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Lily

Liver tumor, awaiting transplant

1984

Matthew Bemis,Lily’s donor

2008 Lily’s wedding day

1985 post transplant20

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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.

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The Gift of Life