A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

2010 ONELEGACY CELEBRATING OUR PARTNERS May 26, 2010

Allen P. Kong, MD1, Cristobal Barrios, MD1, Ali Salim, MD2,Lynn Willis, MHA1, Marianne E. Cinat, MD1, Matthew O. Dolich, MD1,

Michael E. Lekawa, MD1, David B. Hoyt, MD1, Darren J. Malinoski, MD1

1University of California, Irvine, Medical Center, Orange, California2Cedars-Sinai Medical Center, Los Angeles, California

QUESTIONS TO RUN ON… What can my hospital do to improve its

organ donation outcomes?

What can I do to improve donation outcomes?

The ProblemAs of Jan 2010:

105,452 candidates21,425 transplants in

2009

Waiting List

Transplants

Transplants from Deceased Donors

Transplants from Living Donors

Goals of the Organ Donation Breakthrough Collaborative

3.75 organs transplanted per donor (OTPD) 10% donors after cardiac death (DCD) Increase conversion rate up to 75% Increase donations by 1,900/year Increase transplants by 6,000/year

Conversion rate = # actual donors / # eligible donors

Improvement Strategies Make donation a priority at large

hospitals Create DCD policies Use extended criteria donors (ECD) Catastrophic Brain Injury Guidelines Donor Management Goals

Hospital Requirements Centers for Medicare/Medicaid Services

& American College of Surgeons Notification process Declaration of brain death Organ procurement organization (OPO)

relationship Performance Improvement (PI) program Patient/family opportunity to donate

Current Status

Organ donor council established in 2007 at UC Irvine

Donors in Southern California

433

395401

382

330

350

370

390

410

430

450

2006 2007 2008 2009

Organs Transplanted in Southern California

1338

1233 1234

1182

1050

1100

1150

1200

1250

1300

1350

1400

2006 2007 2008 2009

Hypothesis Establishment of an organ donor council

and performance improvement initiative will lead to improved donation outcomes.

Organ Donor Council

Multi-disciplinary

Transplant Surgeons Intensivists Nurses Palliative Care Ethics OPO Clinical Champions

Trauma Team

Administration Chaplain Operating room Performance

Improvement Risk Management Pharmacy Community

Representative

Methods Prospectively collected data on all referrals to

regional OPO from 2006 to 2009 Number of referrals Timely notification Conversion rate DCD rate ECD rate OTPD Total number of organs transplanted OTPED (organs transplanted per eligible death)

2007 Areas of Focus DCD policy Brain death determination policy/protocol Clinical triggers for notification Binders in every critical care unit Performance improvement process

ORGAN DONATION CLINICAL TRIGGERSCALL OneLegacy at 1-800-338-6112 within 1

HOUR

Call OneLegacy at 1-800-338-6112 for TISSUE/EYE DONATION

for ALL Cardiac Deaths within 1 hour of death

NEUROLOGICAL INJURY

(traumatic, anoxic or stroke)

VENTILATED

WITH ONE OR MORE OF THESE TRIGGERS

Loss of one or more brain stems reflexes:

(e.g. pupils fixes/dilated, no corneal reflex, no cough, no gag, no response to

painful stimuli)

Non-survivable injury/illness

Initiating discussions for:· End of life care

· Withdrawal of life support

Results

2006 2007 2008

Number of referrals 96 139(p<0.01 vs. 2006)

143(p<0.01 vs. 2006)

Timely notification rate

64% 83%(p<0.01 vs. 2006)

83%(p<0.01 vs. 2006)

DCD rate 0% 11%(p=0.07)

2008 Areas of Focus Devastating brain injury pathway Performance improvement process Case reviews to evaluate:

Approach for consent Medical donor management Acceptance of organs for transplantation

Results2007 2008 2009

Number of eligible deaths 30 27 22

Number of actual donors 16 21 16

Conversion rate 53% 76%(p=0.04)

OTPD 3.4 ± 1.5 2.8 ± 1.5(p=0.27)

3.5 ± 1.5

ECD rate 6% 38%(p=0.03)

6%

Total organs transplanted(LIVES SAVED)

54 59 56

Results

OTPED = effectiveness of an organ donation program Considers conversion rate & donor management

Southern California Region

2.091.97 2.04

11.21.41.61.8

22.22.42.62.8

3

2007 2008 2009

UC Irvine

1.8

2.18

2.54

11.21.41.61.8

22.22.42.62.8

3

2007 2008 2009

p=0.45 vs.

2007

p=0.20 vs.

2007

2009 Areas of focus Donate Life Flag raising ceremonies Donate Life Rose Parade Float team CEO/Dean Letters to staff about each

donor Devastating Brain Injury Checklist Housestaff Resource Card

Conclusions Development of an organ donor council and

performance improvement initiative led to improvements in:

Timely notification Conversion rate DCD rate OTPED

Overall number of organs transplanted remained stable, despite decreases in overall number of donors and organs transplanted in the region.

THANK YOU

Darren Malinoski, MDmalinosd@uci.edu

UC Irvine Medical Center hereby expresses its thanks for the cooperation of OneLegacy and all the organ and tissue donors and their families, for giving the gift of life and the gift of knowledge, by their generous donation.

QUESTIONS TO RUN ON… What can my hospital do to improve its

organ donation outcomes?

What can I do to improve donation outcomes?