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1. Michigan Health & Hospital Association and Gift of Life MichiganWelcome to the MHA Keystone: Gift of Life WebinarWednesday, September 19, 20121:00 pm – 2:00 pm Please stand by…The webinar will begin shortly… • Due to the attendance today, all participant lines will be muted upon entry. If you have a comment or question, please use the Chat function. Chats can be directed either privately to the host, or publically to all attendees. • If a pop-up box does not appear with instructions to receive a call-back, go to “Communicate” in the top menu, click “Teleconference”, and then “Join Teleconference”. Enter your phone number and the WebEx system will call you. • To receive technical assistance, please press *0 and you will be connected to a WebEx Specialist.

2. Today’s topic: Tissue 101: Exploring the Gift of Tissue Introductions: • Ashley Renkes Hospital Services Associate, Gift of Life Michigan Questions: • Please type questions into the chat box • A question and answer session will take place at 1:45pm • If you prefer to pose your question anonymously, please direct the chat to the “Host and Presenter” so that your question is sent only to them.

3. W E L C O M E ! 2012 Webinar Series • Partnership between MHA and Gift of Life Michigan Today’s speakers: Ashley Renkes Hospital Services Associate, Gift of Life Michigan Betsy Miner-Swartz Communications Specialist, Gift of Life Michigan Gina Reese Regional Director, Musculoskeletal Transplant Foundation

4. Questions to Run On… • What is tissue donation? • What can be donated? • When do hospitals refer tissue donors to Gift of Life? • How is the hospital involved in the tissue donation process? • How is Gift of Life working to increase tissue donations? • What happens to tissue after it leaves the donor hospital?

5. Tissue 101: An Overview of Tissue Donation Ashley Renkes Hospital Services Associate Gift of Life Michigan

6. Gift of Life Michigan • Federally designated organ and tissue recovery organization for Michigan since 1971 • Liaison between 175 critical-care hospitals and eight transplant centers • Independent, non-profit based in Ann Arbor • Maintains the confidential Michigan Organ Donor Registry in collaboration with the Secretary of State • Open 24/7/365

7. Tissue Donation Tissues: • Heart Valves • Bone • Arteries and Veins • Corneas • Ligaments & Tendons • Fascia • Nerves • Skin

8. Some Interesting Facts… • There is no cost to families to donate. • Funeral arrangements and open casket funerals are not affected by donation. • Most major religions approve of donation and consider it an act of charity. • Wealth and social status are not a factor in receiving an organ or tissue transplant. • People of all ages can become tissue donors. • Tissue recovery can occur up to 24 hours after death, 12 hours for corneas.

9. Facts about Tissue Donation Last year (2011) in Michigan: • 37,261 deaths were called in to Gift of Life by hospitals and medical examiners. • 887 donors gave the gift of tissue. • 1833 individuals donated corneas/eyes. • Human donor tissues were used at over 200 Michigan hospitals and surgical centers in over 750 different configurations.

10. Referral Process: Organ vs. Tissue Referring a potential ORGAN donor: Call Gift of Life within 1 hour when: • Vented patient with a GCS of 5 or less • Vented patient being evaluated for brain death • Vented patient being considered for withdrawal of treatment or change in resuscitation status Gift of Life approaches family at the hospital.

11. Referral Process: Organ vs. Tissue Referring a potential TISSUE donor: Call Gift of Life within 1 hour of death: • All hospital deaths are referred to Gift of Life for evaluation • Many non-hospital deaths are reported by Medical Examiner Offices A specially trained Designated Requestor from Gift of Life Michigan approaches the family over the phone.

12. Michigan Eye Bank and Donation • Gift of Life refers all patients to the Michigan Eye bank. • If a patient is only eligible to donate corneas, you will receive a follow-up phone call from the Michigan Eye Bank to coordinate the recovery. • Eye Prep Protocol to maintain corneal integrity, complete after family departs: • Instill two drops of sterile saline into each eye. • Paper tape the eyes closed. • Elevate the head (pillow or head block). • Cool the eye region. • Recovery must occur within 12 hours of death. • The Michigan Eye-Bank may call you back for more information.

13. Cornea Donation Restores Sight Before After

14. Referral Process • Gift of Life receives a referral from a hospital, ME or funeral home about an individual that died. • Donor eligibility is determined by Gift of Life based on basic criteria and available information. • The state donor registry is searched and family is contacted for a medical and social history.

15. Referral Process • If the donor is not found on the registry, the legal next of kin is given the opportunity to authorize the donation. • Tissue donation must be initiated within 24 hours of death, 12 hours for corneas.

16. Please Remember: • Age and medical rule-out criteria change often based on tissue needs. • All of the information Gift of Life collects is required by the Food and Drug Administration (FDA) and our tissue bank partners before we move forward with a donation. • This ensures the safety of technicians and recipients. • Gift of Life coordinates the time and location of the tissue recovery with the Medical Examiner, if appropriate. • Tissue donations happen in the hospital or at one of Gift of Life’s surgical centers. • Call us if you have questions during the donation process!

17. Hospital’s Responsibility • Report all deaths to Gift of Life within 1 hour. • Obtain (2) phone numbers where the family can be reached. • Refrain from discussing donation with the family – only trained designated requestors may do this.

18. Hospital’s Responsibility • If the family asks about donation, call Gift of Life immediately. Sometimes the donation discussion occurs over the phone with a Gift of Life requestor before the family leaves the hospital. • After the initial referral, be prepared to provide additional information about the patient from their medical chart to help facilitate the donation.

19. Gift of Life Michigan’s Responsibility • Ensure families are approached in a sensitive manner by a trained professional. • Provide complete and accurate information when obtaining authorization. • Abide by all FDA and American Association of Tissue Bank (AATB) standards when recovering and placing tissue.

20. Gift of Life Michigan’s Responsibility • Do everything possible to honor the wishes of individuals on the Michigan Donor Registry. • Ensure that families of potential donors are given the option to donate if their loved one is a candidate. • Work with Medical Examiners and funeral homes to facilitate tissue and eye donation.

21. Recovery and Post-recovery… • Tissue recovery is surgical procedure done by trained technicians in a sterile or aseptic environment. • Once tissues have been recovered, appropriate reconstruction occurs to ensure a natural appearance for the funeral. Gift of Life Michigan is committed to treating all donors with the utmost dignity and respect.

22. Increasing Tissue Donation in Michigan Betsy Miner-Swartz Communications Specialist Gift of Life Michigan

23. Growth in Tissue Donation • Medical examiner cases have contributed greatly to tissue donation in 2012 for three reasons: • Increased outreach to MEs and positive • reinforcement to those willing to make referrals. • New computer technology allows participating • counties to make referrals quickly and easily. • New medical examiner newsletter with statewide map • motivates MEs.

24. Newsletter Tracks ME Performance in Donation Winter 2011 Summer 2012

25. The Map

26. Most Significant Changes Highlighted The map page lists counties that made the most significant change in their map status. Here are some entries from Summer 2012: • Macomb County went from 0 to 77 referrals, resulting • in 8 tissue donors. • Genesee County went from 103 to 165 referrals. • Bay, Iron and Macomb counties had first-time • referrals.

27. Thank You for Making a Difference • The newsletter also recognizes ME offices that put forth a special effort to make tissue and eye donation possible. • Here are a few examples from the Summer 2012 edition: • Marquette County released a potential donor for tissue recovery before • the autopsy because time limits were about to expire. • Wayne County extended its release time and postponed an autopsy to • help with the logistics of a tissue recovery. • In Lapeer County, Dr. Jason Parks has consistently shown extreme • willingness to be available to Gift of Life tissue screeners for additional • information.

28. Tissue Donation Overview Gift of Life Michigan Michigan Hospital Association Gina Reese Regional Director Musculoskeletal Transplant Foundation

29. My Plan Today • Who is MTF • Tissue Transplantation • Donor Families

30. MTF’s Mission Statement MTF is a non-profit service organization dedicated to excellence in research, education and the care of donors, their families and recipients.

31. MTF’s Structure • 501 (c) 3 non-profit founded in 1987 • Largest Tissue Bank in the U.S. • Physician Driven • 5+ M allografts distributed • Estimated 30% of all allograft in the U.S. provided by MTF • Majority of tissue from Organ Procurement Organizations • 90,000 Tissue Donors since 1987 • In Michigan since 1987

32. Local Affiliations • Gift of Life: Recovery Member • Since 1987 • Rich Pietroski, Member of Donation Board of Trustees and Medical Board of Trustees • Henry Ford Hospital: Academic Member • Stephen Bartol, MD – Medical Board of Trustees Member • Tissue Grafts in Michigan: 15,583 in 2011

33. TissueDonation Basics • Tissue = catch all phrase for musculoskeletal, cardiovascular and skin • Recovery only after Cardiac Death (Cessation of heart beat) • Number of potential donors limited only by donor criteria • May be organ and/or cornea donors as well • FDA Oversight • MTF and Gift of Life both AATB Accredited

34. MTF and Gift of Life • Partners in screening and recovery • MTF accepts donors before recovery • MTF one of the few aseptic tissue processors • Thorough screening = safe and effective tissue grafts • Maintain the biological function of the tissue • Better outcomes for patients

35. U.S. Statistics • 100% of OPOs are involved with tissue donor referrals • 93% of OPOs are involved with tissue recovery (54/58) • Recovery Rates • 25,000 to 30,000 Tissue Donors • Tissue Transplants (bone, skin, CV) • 1.7M/Year • 85% MS Tissues • MTF: 492,000 in 2011

36. General Orthopedic Tissues

37. Sports Medicine Tissues Osteochondral Graft (Cartilage) Meniscus Bone-Tendon-Bone Achilles Tendon

38. Demineralized Bone Matrix (DBX®)

39. Trinity Evolution: Native Stem Cells, Cancellous Chips & DBM

40. Clinical Applications • Spinal Fusion • Sports Medicine (ACLs) • Bone Void Fillers – Trauma, Joint Reconstruction • Orthopaedic Oncology • Skin for Burns • Acellular Dermis for Ventral Hernia, Breast Reconstruction post Mastectomy • Heart Valve/Vein Replacement

41. Supporting Donor Families • Donor Families are at the heart of what we all do • Take our responsibility very seriously to be good stewards of a family’s gift • Make information available to donor families • Tissue Trace: Information card sent back by hospital • Linking Lives Program: Information directly from recipients • Insert in the package of each tissue graft • Instructions on how a recipient can write a thank you letter to the donor family • Very successful: Over 10,000 letters received since start of program

42. Thank you… • Thank you for your support of donation • You’ve made a huge difference in the lives of donor families and recipients • We couldn’t do it with you!

43. Donor Family Follow Up Organ and Tissue Donation • Certificate of Honor • Donor Family Ceremony • Donor Quilt • Grief Resources • Communication with Recipients • Donor Family Advisory Board

44. Join the Michigan Donor Registry If you don’t have a red heart emblem on your driver’s license or state ID, you’re not registered. Go to www.giftoflifemichigan.org or call 800.482.4881

45. Resources Gift of Life Michigan www.giftoflifemichigan.org Michigan Health & Hospital Association www.mha.org Musculoskeletal Transplant Foundation (MTF) www.mtf.org

46. Question & Answer Session • Ashley Renkes (Moderator) Hospital Services Associate, Gift of Life Michigan

47. To ask a question… • Please type questions into the chat box • If you prefer to pose your question anonymously, please direct the chat to the “Host and Presenter” so that your question is sent only to them.

48. Evaluation • Please take time to complete an evaluation as you log out of today’s webinar – your feedback is greatly appreciated. Thanks for joining us! • Upon exit from today’s webinar, you should be directed to the evaluation. Please log out by clicking “File” “Exit”.

49. Thank You for Joining Us! For additional information contact: Ashley Renkes Hospital Services Associate Gift of Life Michigan arenkes@giftoflifemichigan.org