IOPO Indiana Organ Procurement Organization

1. IOPOIndiana Organ Procurement Organization Organ and Tissue Donation Review

2. Objectives At the end of this module the learner will be able to: • Acknowledge that all imminent and actual deaths must be reported to IOPO • List the potential types of donation • Utilize the resources for any questions regarding tissue/organ protocols • Identify the clinical triggers for a referral

3. Facts • There are over 90,000 people waiting for an organ transplant. • 17 people die each day waiting for an organ transplant. • It is estimated that 1 in 25 people will need a tissue transplant at some point in their life.

4. Organ Donation Can Be a Life-Saving Gift • Heart • Lungs (can be 1 or 2 recipients) • Kidney’s (usually 2 recipients) • Liver • Pancreas • Small Intestine

5. Tissue Donation Skin:Temporary covering for burn victims to prevent fluid loss and infection and it is used in surgical applications, such as abdominal wall and breast reconstruction and deep tissue burn repair. Bone and Tendons:Bones are made into putty, powder or other consistencies for procedures such as hip/knee replacements, spinal fusions and dental implants. Larger bone used for cancer and trauma victims to avoid amputation. Tendons used for ACL repairs. Heart for Valves:Replace defective valves (Aortic, Pulmonary). Many are transplanted into children with congenital heart defects. Vein/Artery:Coronary Artery Bypass and Peripheral Vascular Reconstruction. Corneas, sclera, whole eye:Gift of sight to 2 people with corneal blindness or can repair the eye from injury or trauma.

6. Organ Donors • Organs can be recovered from a patient that has been declared brain dead or through donation after cardiac death (DCD). • Brain death is defined as total & irreversible destruction of the brain & brainstem. Brain death is declared by patient’s MD • Donation after cardiac death is best described as a terminal wean from a ventilator in the operating room.

7. Tissue Donors For tissue to be donated, the donor must sustain a cardiac death or brain death. All deaths should be evaluated for tissue donation. That is why it is mandatory that each and every death be called to IOPO!

8. Donation After Cardiac Death (DCD) DCD is when a patient will not deteriorate to brain death (the irreversible cessation of blood flow to the brain.) Therefore, organ donation may become a possibility for families when they decide to terminally wean the patient. However, the family’s decision to do a terminal wean must come prior to evaluation for DCD.

9. More on Donation After Cardiac Death • With these patients, they are declared dead after cessation of cardiac and respiratory function when withdrawn from the ventilator in the operating room. • Families are permitted into the operating room to be by their loved one’s side during the terminal wean. • Per the Clarian policy, there is a 90 minute time frame set for terminal wean process to time of pronouncement of cardiac arrest.

10. Therefore… If the patient does not cardiac arrest within the 90 minute time frame the patient is then returned to either the ICU or designated floor for completion of end of life care.

11. Your Responsibilities… The Center for Medicaid and Medicare Services (CMS) and JCAHO has specific hospital conditions for participation. They require all hospital staff to call on every death and every imminent death. This is supported by Clarian Health Policies. “Imminent death is when a patient is not expected to survive their injury.”

12. Indiana’s Donor Choice Law • Effective July 1, 2001, the Indiana Donor Choice Law states that anyone 18 years of age or older can declare their decision to donate organs and tissues when obtaining/renewing a drivers license. • The law was designed to uphold the individual’s right and decision to donate, and prevents anyone from modifying or preventing the anatomical gift from being carried out. • IOPO (Indiana Organ Procurement Organization) will access the BMV and see if a patient has declared himself or herself a donor.

13. Clinical Triggers for When to Call IOPO 1-800-356-7757 • Call on any patient with a Glasgow Coma Scale (GCS) of 5 or less • Call at first mention of terminal wean from family or physician

14. Making the Referral to IOPO 1-800-356-7757 Per IOPO, ANYONE can call, secretaries, physicians, chaplains, social workers, nursing, and make the referral to IOPO. It is best to have the patient’s chart in front of you for the information that will be requested.

15. Questions You May Be Asked • Area code and phone of referring facility. Name of unit or floor the patient is located. • Name and title of person making phone call to IOPO • Does the patient have a heart beat? • Is patient currently on a ventilator (currently, previously, or never)? • Patient name, date of birth/age, race, sex, weight • Social security number (if available) • Date and time of death (if applicable) • Is this a Medical Examiner or coroner case • Documented medical history?

16. The Referral to IOPO 1-800-356-7757 Donation should not be discussed with the family by the hospital staff or physicians without the assistance of an IOPO trained requestor. CMS requires that only a trained requestor speak to the family about the option of donation. Remember….Call on all deaths within one hour. Sharing information with the IOPO team about a patient is not a HIPPA violation. Medical suitability must be determined prior to anyone approaching any family about donation.

17. Support for the Potential Organ Donor in the Ventilated Units • For those patients on ventilators, IOPO needs your help in order to better preserve organs for donation. • Remember the simple “Rules of 100”!! The goals for keeping patients vital signs: SBP >/= 100 U/O >/= 100 – 300 cc/hr pO2 >/= 100 Temperature WNL Electrolytes WNL

18. Now for donation myths…

19. Myth #1 MYTH:“Carrying a driver’s license with a red heart will affect the medical care I receive.” FACT: Your donation decision does not affect the quality of your medical care.

20. Myth #2 MYTH: “Donation will change my appearance and affect my funeral plans.” FACT: An open casket and normal viewing are still possible.

21. Myth #3 MYTH:“Donor families will be charged for donation.” FACT: The donor family will not incur any charges for donation expenses. When the patient becomes an organ donor their account number is changed so that IOPO incurs all costs from that point.

22. Myth #4 MYTH: “Rich or famous people receive donated organs and tissues more quickly than others.” FACT: Placement of organs is determined by a combination of medical factors such as degree of illness, blood type, the size of the organ needed and the length of time the patient has been waiting; not social status.

23. What is Your Responsibility? Call! Call!Call!Call! You must call IOPO for any imminent or actual death 1-800-356-7757

24. You are finished with the WBT Now you will need to take the assessment in order to complete your training.

25. Question 1 After a cardiac death there is no possibility for any donation? A. True B. False

26. Answer 1 A. Incorrect B. correct, there is a possibility of donation after cardiac death because the patient can be a organ donor through the DCD process or a tissue donor.

27. Question 2 Brain death is defined as irreversible? A. True B. False

28. Answer 2 A. correct, brain death is defined as the irreversible cessation of blood flow to the brain. Brain Death is Death. B. Incorrect

29. Question 3 The Indiana Donor Choice Law states that even though your driver’s license indicates your decision to be a donor, anyone can still prevent your decision to donate. A. True B. False

30. Answer 3 incorrect correct, The Indiana Donor Choice Law was designed to uphold the individual’s choice to be a donor.

31. Question 4 According to Center for Medicaid and Medicare Services (CMS) Hospital Conditions of Participation, all deaths must be called into IOPO: A. Prior to the removal of ventilators B. When brain death is imminent C. With cardiac time of death D. All of the above

32. Answer 4 A. Wrong answer, there is a better choice. B. Wrong answer, there is a better choice C. Wrong answer, there is a better choice Correct, all of the answers are correct. To be compliant with CMS regulations, terminal wean, brain death, and cardiac death must be referred.

33. Question 5 Discussing a patient with IOPO is a HIPPA violation. A. True B. False

34. Answer 5 A. incorrect • Correct, IOPO is exempt from HIPPA. It is OK for IOPO to inquire about a patient. IOPO maintains strict confidentiality with all information that is obtained about donors and potential donors.

35. Question 6 There is not a possibility of an open casket funeral with organ or tissue donation. A. True B. False

36. Answer 6 A. incorrect B. Correct, any patient who is a donor can certainly have an open casket funeral. IOPO will not procure tissues in areas that are visible.

37. Question 7 “Donation after cardiac death” is a terminal wean that occurs in the operating room. A. True B. False

38. Answer 7 Correct, DCD is a terminal wean that is done in the operating room if patient expires in less then 90 minutes

39. Question 8 A potential tissue donor is any: A. Patient off the ventilator and has sustained cardiac death B. Patient on the ventilator facing imminent death or brain death C. A and B D. None of the above

40. Answer 8 A. Wrong, there is a better answer. B. Wrong, there is a better answer. C. Correct, a potential tissue donor is anyone who is either on the vent with a heart beat or has suffered cardiac death. Someone on the ventilator does not become a tissue donor until cardiac time of death. D. incorrect

41. Question 9 Medical suitability for donation must be determined by IOPO prior to discussing donation with a family and only an IOPO representative should discuss donation with the family. A. True B. False

42. Answer 9 • Correct, IOPO does not wish to offer the option of donation to a family and then turn around and find out they may not be suitable. IOPO determines suitability first before giving the family the option. B. incorrect

43. Question 10 According to IOPO, eligible people to refer a patient to IOPO are: A. Secretary B. Nurse, Physician C. Chaplain, Social Worker D. All of the above

44. Answer 10 • Wrong, there is a better answer • Wrong, there is a better answer C. Wrong, there is a better answer D. Correct, an employee does not have to have a specific title to refer a patient to IOPO. It can be any hospital employee.

45. Question 11 Clinical triggers to make a referral consist of: A. GCS of 5 or less B. Prior to withdrawing any support C. At the first mention of terminal wean D. All of the above

46. Answer 11 Wrong, there is a better answer Wrong, there is a better answer c. Wrong, there is a better answer D. Correct, all these triggers are correct. By using these clinical triggers the hospital will remain compliant with CMS regulations.

47. THANK YOU Thank you for taking the time to review and understand the organ and tissue donation process. You can contact the referral line at any time should you have questions.