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, [email protected]
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.