A Panel DiscussionThe Donation and Transplantation Symposium

October 15, 2013

Presenters:Amy Durrant, OneLegacy Ambassador & Donor WifeRobert Coppel, Family Care Specialist, OneLegacy

Melanie Crowley, Clinical Manager Trauma Service,Northridge Hospital Medical Center

Moderator: Bryan Stewart, Vice President of Communications, OneLegacy

Donor Designation, Your Families and You

Kevin Durrant

Donor Designation

Robert CoppelFamily Care Specialist

OneLegacy

Working with Families in Conflict

Advance Health Care Directive Form

“You have the right to give instructions

about your own health care.”

(2.1) END-OF-LIFE DECISIONS: I direct my health care providers and others involved in my care to provide, withhold, or withdraw treatment in accordance with the choice I have marked below: a) Choice Not To Prolong: I do not want my life

to be prolonged if the likely risks and burdens of treatment would outweigh the expected benefits…b) Choice To Prolong: I want my life to be prolonged as long as possible within the limits of generally accepted medical treatment standards.

Upon my death (mark applicable box): I give any needed organs, tissues, or parts

Melanie Crowley, RN, MSN, CENClinical Manager, Trauma Service

Northridge Hospital Medical Center

Donor Designation

Protecting the Decision:A Case Study

• Admit 12/14 @ 00:46

• 20yr Female admitted s/p MVA

• Only ID is Credit Card in pocket

• GCS 3 on arrival / Severe Traumatic Brain Injury

• Referred to OneLegacy @ 08:34

• Family onsite +8hrs post ICU admit

• Registered Donor

Day 1• Day 2: CT Scan

shows herniation

• Day 3: EEG ordered, Na 119

• Family first voices objection to donation

• Day 4: First BD Note written 12/17 @ 19:10

• Pt too unstable for CBF/apnea test

Day 2-4• Second BD Note

written 12/18 @ 09:39

• Family refuses to meet with OneLegacy FCS

• Nursing staff voices discomfort with starting case against family’s wishes

• 19:00 Administrator On Duty (AOD) contacted

Day 5Case Overview

Overarching GoalStrive to meet the needs of

the

What happens when theseCONFLICT?

PatientFamilyStaff

Law & Policy Must Guide Practice

CA State Health & Safety CodeSection 7150.35 (a):

“…Absent an express, contrary indication by the donor,

a person other than the donor is barred from making, amending or revoking an anatomical

gift of a donor’s body or part if the donor made an anatomical gift…”

Anatomical gift that does not revoke before death is irrevocable

No permission from the donor’s family is warranted

The family does not have the power, right or authority to consent to, amend or revoke

?Law & Policy Must Guide Practice

Northridge Hospital Policy

Northridge Hospital Policy

Law & Policy Must Guide Practice

Utilize Your Resources

Follow your chain of command:• AOD• Unit Director• VP Medical Affairs• Bioethics• Legal Counsel• OneLegacy Hospital Liaison

Perception = RealityAddress Misconceptionsof Family & Staff

• Validate patient’s Donor Registry status (Document of Gift)

• Donor Registry Status cannot be overridden• Donation honors the patient’s wishes!

Next Steps

• 12/18 @ 24:00 (+14hrs post BD declaration) Charge RN & OneLegacy FCS meet with family in hospital lobby

• Additional family support provided by Social Work, Nursing Staff, OneLegacy Staff

• 12/19 @ 12:00 Family completes Med/Soc History

• Family provided with memory box, handprints, Aftercare Support Services

Day 5 Post Admit

Case Outcome4 Organs Recovered & Transplanted:• Left Kidney – 17yr Male• Right Kidney & Pancreas – 49yr

Male• Liver – 61yr Male

Tissues Recovered for Transplant:• Corneas• Bone

A Panel DiscussionThe Donation and Transplantation Symposium

October 15, 2013

Presenters:Amy Durrant, OneLegacy Ambassador & Donor WifeRobert Coppel, Family Care Specialist, OneLegacy

Melanie Crowley, Clinical Manager Trauma Service,Northridge Hospital Medical Center

Moderator: Bryan Stewart, Vice President of Communications, OneLegacy

Donor Designation, Your Families and You