Patient Information: 21 year-old female. Jumped out of a moving
car (or may have been pushed out) while arguing with her boyfriend.
Spanish speaking family. Admitted to a rural Idaho Level II trauma
center on 11/9/14. Clinical triggers met shortly after admission,
IDS contacted. Located on the Idaho Donor Registry. Plan made to
call daily to assess patient and family status.
Slide 3
Day 8 Patient declared on 11/17/14 via clinical/apnea and flow
study. Hospital requested IDS ODC to be onsite to discuss donation
options after family meeting. IDS Minority Outreach Specialist
accompanied ODC to hospital. Family holding out for a miracle.
County Coroner (Insurance Salesman) instructs hospital to extubate,
and send the body to Boise for autopsy. Hospital Risk Management
requests OPO/Hospital Agreement, UAGA, and registry document.
Support donation. County Detectives intervene, express support for
donation.
Slide 4
Day 9 IDS asked to be present for family meeting with Trauma
Surgeon, Neurosurgeon, and Risk Management. Grave prognosis Family
expresses distrust questions why no surgical intervention. Family
opposed to donation. Family requests 2 nd opinion wants patient
transferred to Salt Lake City or Boise area Trauma Center. Requests
no mention be made that patient is declared. Requests no mention be
made that patient is registered donor. Family to consult an
Attorney. What would you do?
Slide 5
Day 10 Transfer explored, ultimately denied by both facilities.
Risk Management informs family that neither hospital will accept
transfer. Family also informed that hospital supports state
law/registry, IDS, and the donation process. Father expresses
dissatisfaction with the care his daughter received. States that if
he had a gun, he would shoot everyone involved. Family quickly
exits the ICU. Lockdown!! Hospital Security and Police notified,
statements provided. What would you do? Due to safety concerns, IDS
withdraws from donor case.
Slide 6
Takeaways: Because IDS was involved in the initial family
meeting, it was perceived that the hospital and the OPO were
working together just to get organs. Trust issues especially
related to brain death diagnosis. De-Couple. Family needed more
time to understand her diagnosis before donation was introduced.
Buy a bullet-proof vest, and learn how to run in a serpentine
pattern.
