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A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES. 2010 ONELEGACY CELEBRATING OUR PARTNERS May 26, 2010 Allen P. Kong, MD 1 , Cristobal Barrios, MD 1 , Ali Salim , MD 2 ,

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A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

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  1. 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, California 2Cedars-Sinai Medical Center, Los Angeles, California

  2. QUESTIONS TO RUN ON… • What can my hospital do to improve its organ donation outcomes? • What can I do to improve donation outcomes?

  3. The Problem As of Jan 2010: 105,452 candidates 21,425 transplants in 2009 Waiting List Transplants Transplants from Deceased Donors Transplants from Living Donors

  4. 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

  5. Improvement Strategies Make donation a priority at large hospitals Create DCD policies Use extended criteria donors (ECD) Catastrophic Brain Injury Guidelines Donor Management Goals

  6. 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

  7. Current Status • Organ donor council established in 2007 at UC Irvine

  8. Hypothesis Establishment of an organ donor council and performance improvement initiative will lead to improved donation outcomes.

  9. 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

  10. 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)

  11. 2007 Areas of Focus • DCD policy • Brain death determination policy/protocol • Clinical triggers for notification • Binders in every critical care unit • Performance improvement process

  12. ORGAN DONATION CLINICAL TRIGGERS CALL 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

  13. Results

  14. 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

  15. Results

  16. Results • OTPED = effectiveness of an organ donation program • Considers conversion rate & donor management p=0.20 vs. 2007 p=0.45 vs. 2007

  17. 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

  18. 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.

  19. THANK YOUDarren Malinoski, MDmalinosd@uci.edu 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.

  20. QUESTIONS TO RUN ON… • What can my hospital do to improve its organ donation outcomes? • What can I do to improve donation outcomes?

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