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HONORING THE DONOR’S WISHES

HONORING THE DONOR’S WISHES. Susan Mau Larson Public Affairs Director, LifeSource April 28, 2011. Honoring the Donor’s Wishes. Goal: to enhance and strengthen our ability to uphold a patient’s designated wishes and the law. What is donor designation?

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HONORING THE DONOR’S WISHES

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  1. HONORING THE DONOR’S WISHES Susan Mau Larson Public Affairs Director, LifeSource April 28, 2011

  2. Honoring the Donor’s Wishes Goal: to enhance and strengthen our ability to uphold a patient’s designated wishes and the law. • What is donor designation? • What does it mean when someone has designated him/herself to be a donor? • What is our responsibility in honoring donor designation?

  3. Donor Designation Honoring an individual’s documented wishes to be an organ and tissue donor.

  4. Legal Framework • 1968 – Uniform Anatomical Gift Act adopted by every state “Donation is a gift” • 1987, 2001 (SD), 2002 (MN) Revisions • 2007 – MN, ND, SD adopt revised UAGA reinforcing donor designation (To date 39 states and territories have adopted)

  5. Implementation In May 2003 LifeSource began honoring an individual’s documented wishes to donate Preparation for implementation included: • Gathered stakeholder input • Established policies and procedures • Gained Board of Directors approval • Conducted training with staff and hospital partners • Shared progress with media • Incorporated donor designation into public messaging

  6. Law of Donation:Uniform Anatomical Gift Act ESTATES OF DECEDENTS; GUARDIANSHIPS MN CHAPTER 525A Preclusive Effect of Anatomical Gift, Amendment, Or Revocation. (a) ... in the absence of 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 of the donor's body... An anatomical gift made in a will, a designation on a driver's license or identification card, or a health care directive . . ., and not revoked, establishes the intent of the person making the designation and may not be overridden by any other person.

  7. Who Owns the Decision Decision belonged to decedent when she was alive;... Only if she decided “not to decide” does the decision belongs to the living.

  8. Legal Status of Donation Decision • A Testamentary Decision--Cannot be Revoked except for Public Policy Reasons in a Court of Law • A Statutory Right • A Charitable Gift

  9. Testamentary Decision ESTATES OF DECEDENTS; GUARDIANSHIPS • Document of Gift is like a Will, but acted on prior to probate • The Organ Procurement Organization is the Executor, Both Empowered and Required to Carry Out the Wish • The Intent of the Decedent is the Core Question

  10. Factors in Legal Noncompliance Compassion • We identify with the Living • We want to help the Living Fear • We fear the Living, and their lawyers • We want to maintain strong relationships with hospital • We fear the media

  11. Immunity Complete statutory immunity for persons who facilitate anatomical gifts pursuant to Anatomical Gift Act

  12. Statutory Obligation This obligation is shared by donation agencies and the hospital • Its Your Risk, Too • Nowhere Does it say We Can Ignore this Gift • Statutory Immunity Covers This

  13. Organ Donors with Donor Designation

  14. Experience • From May 2003 through December 2009 LifeSource managed 1068 organ donation cases • 14 potential cases (5/03-12/09) had some conflict or confusion • 9 of these 14 situations resulted in organ donation

  15. Experience: Factors in Conflict Situations

  16. How We Proceed • Huddles with care team to discuss situation and plan • Engagement of LifeSource and donor hospital leadership • Adequate on-site resources from LifeSource

  17. Family Interactions • Consistent messaging for hospital and LifeSource. • Avoid language which gives perception of choice. • Stay engaged with the family during and after the donation. • Provide document of donor designation and brochure

  18. Honoring the Donor’s Wishes… Bringing life to an individuals’ gift relies on the support of all involved – procurement organizations and donor hospitals. We must do this in partnership.

  19. Honoring the Donor’s Wishes KARE-11 March 11, 2011 A lasting gift: Forest Lake boxer helps others in his death LINO LAKES, Minn. -- A Forest Lake High School senior who collapsed in the boxing ring and later died continues to give to others. "He was a giver.  He was a giver.  He wanted people to be taken care of," said Susan Smith about her son, Charlie, who has helped dozens of people by becoming an organ donor.

  20. Questions/Discussion THANK YOU

  21. Who We Are Honoring Donor Designation Sheila Elledge, RN, BS Nurse Manager Burn Unit Hennepin County Medical Center Sue Weese, RN, BSN, CPTC Lifesource In-house Coordinator Hennepin County Medical Center

  22. Who We Are • 465 Staffed beds • 22,937 Inpatients per year • 101,658 ER visits per year • 3,000 1st time trauma admissions of which 31% were referred to us by other hospitals • 327,165 Clinic visits per year

  23. 2006 – 2010 YTD Averages Authorization and Conversion = 78% % of Total LifeSource Donors = 12% % of Total LifeSource DCD Donors = 34% Organs transplanted per donor = 3.77 Number of Tissue Donors = 32 Donor Designation Cases = 48% Medals of Honor Won = 4 2009 Gold Medal Winner Why We Are Here

  24. First to adopt DCD and Resident Road Show Media Stories and Promotion of Donation Donate Life Month/Flag MHA and CEO Summit DD Letter in Family Folder Experience w/ Donor Designation and Conflict (4 cases) We Are Also Here Because… DSA Leadership Position

  25. Excellent end of life care Honor the patient’s Gift Follow Donor Designation Law Minimize Fear of Family Maximize the gift We Are Trying To…

  26. Who We Are Family considers taking brain-dead son off life support

  27. A Story… • May 6, 2008; 56 White M; SIGSW; + DD was transferred from a small rural hospital to HCMC

  28. StoryContinued

  29. Story Continued

  30. Story Continued

  31. Day 3 Follow-up call to donor wife from LifeSource. Interested in donation outcome and what organs were transplanted. Day 15 Family called LifeSource to request additional Surgeon General certificates for each family member. Story Continued

  32. Conflict resolution

  33. Ages: 20-51 Race: Two white, Two Black Injury: 2 GSW, 2 aneurysms All timely referrals Mention of donation: Two by family LNOK: Two-wife, Grandmother, parents Leadership involved-both LS and HCMC Organs recovered Conflicts

  34. Ensure OPO and hospital leadership have a complete understanding of donor designation. Connect early with donor family. Conflict resolution process. Involve everyone in the Huddle – stops the rumor mill. Adequate resources available When you uphold the law, you are doing the right thing for the patient.

  35. Donation process built on confidence of doing the right thing Clear and consistent communication-HUDDLE Deep rooted commitment to move forward with donation…Regardless Support until the end…acceptance by donor family Challenge

  36. 4 Donors = 19 Lives Saved

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