1. Referral Process… Organ & Tissue Donation Tami R. Dewell, CTBS Manager, Family Care Center Cell: 213.760.7336 Direct office: 213.989.2425 Fax: 213.977.1075 1001 Wilshire Blvd. Suite 200 Los Angeles, CA 90017 tdewell@onelegacy.org "The Heart that Gives..........Gathers"

2. Objectives - ~ Ensure Participants understand the referral process for Organ and Tissue Donation ~ Participants take a pro-active role in identifying improvement areas within their current donor referral practice

3. Run with It !!... ~ What can you identify within OneLegacy’s current referral process that presents an opportunity for improvement? ~ What do you see within YOUR current internal referral process that presents an opportunity for improvement?

4. THE BASICS…. 800-338-6112 • WHY do you make the referral call?? ~CMS Conditions of participation ~ It’s the Right Thing To Do • WHEN do you make the referral ?? Organ? Tissue? ~ Clinical Triggers ~ Cardiac Death

5. Potential Organ Donor ~ 800-338-6112 • “First” Call – Press 1 when prompted. ~ Direct routing to OL Care Center ~ Initial Intake evaluation: Hospital Name / Unit Phone Number Referring person’s name / Unit / Floor / Bed # Patient Name / DOB / Race / Gender / Medical Record # Confirm Vent dependency status / Confirm + Heartbeat Medical HX: Active Cancer, Infectious Disease? Current GCS / Brain Death notes? Admission date / time / Admitting Diagnosis Current Sedation? Blood Pressure / Creatinine / Total Bili / AST / ALT Plans to Extubate? If yes, When?

6. Organ Referral – Deferral… • Your Patient does not meet organ criteria… What now?? ~ The Family Care Coordinator will inform you the patient does not meet the criteria and inform you of one of the following: ~ Please call at the time of cardiac death ~ Please call the Referral line if any change in neuro status ~ Please call if plans are to extubate (as soon as possible)

7. Organ Referral – Evaluation… • Your Patient does meet initial organ criteria… What now?? ~ The Family Care Coordinator will inform you the patient potentially does meet the criteria and inform of the following: ~ We will call the Organ Team Lead (OTL) to inform him/her of the referral and a decision will be made about a site visit. ~ We will call you back with the decision. ~If we conduct a site visit, a Procurement Transplant Coordinator (PTC) will arrive in approx. 1 hour. ~If we continue to follow (no site visit), the PTC will make a follow-up phone call. ~If we defer, we will inform you of one of the previously mentioned during the “deferral” discussion

8. Summary… Organ Referral 800-338-6112 • One Call to the Referral Line • Initial Intake call should take approx. 5 – 8 min. • Informed of deferral or further evaluation • Family Care Coord will call back re: further eval • PTC will follow-up with callback or site visit ~ HOW HAS THE PROCESS CHANGED ???

9. Potential Tissue Donor ~ 800-338-6112 • “First” Call – Press 2 when prompted. ~ Routing to central Triage Group ~ Initial Intake evaluation: Hospital Name / Unit Phone Number Referring person’s name / Unit / Floor Patient Name / DOB / Race / Gender / Weight / Medical Record # Date / Time of Death / Cause of Death (if known) Admission date / time NOK information, including contact #’s This call should be less than 5 minutes

10. Tissue Donor - Deferral • Your Patient does not meet tissue criteria… What now?? The Triage Coordinator will inform you of the deferral, no further follow-up necessary and decedent may be released to the Funeral Home You will receive the referral #

11. Tissue Referral… Evaluation • Your Patient does meet initial tissue criteria… What now?? ~ Triage will forward the referral to OneLegacy Care Center for further evaluation ~ OL Family Care Coord (FCC) will call you to ask for additional information to determine eligibility of offering the family donation options ~ Circumstances that brought patient to the hospital ~ Course of treatment, including WBC x3, Temp x3, X-Rays, CTs, Cultures, Antibiotics (start/stop), Blood Product / Fluids given ~ Medical History listed on the H & P in chart / Height ~ Date / Time of Extubation (if applicable) ~ Physician info: Attending / Primary / Who is signing DC? ~ CME Status / NOK Status / Funeral Home chosen?

12. Evaluation Outcome… • Following further evaluation, if decedent does notmeet tissue criteria, the FCC will inform you and you can release the decedent to the Funeral Home the Family has Chosen. • If decedent meets tissue criteria, the FCC will inform you and ask that you not release the decedent to the Funeral Home until we are able to provide donation options to the family and follow-up with the hospital with consent outcome. Secondary evaluation call will take approx.10 – 25 min

13. Potential Tissue Donor… The “Inside Scoop” … what we want you to know… • “Sepsis” is an automatic ruleout ??… • We have a contact # for the NOK, that should be enough… • Under no circumstances are you to release the body to the Funeral Home when OL has requested that you not… • ER Deaths: Pronounced time of death should be all you need, why do you ask about LKA or status upon arrival • Lab Results, the importance of getting the info = eligibility • Previous organ referral, OL no longer following and now the patient has died, calling back at time of cardiac death…why? • Pre-Transfusion blood samples…what’s the big deal??? • Time metrics…why the rush??? • HIPPA

14. A New Perspective on Life Spinal curvature After bone grafts

15. Corneas • 35,000 corneal surgeries performed annually in the states • Restore or improve impaired or lost sight • 90% of all corneal transplants successfully restore vision • Recipients range from 2 days to 103 years old • Over 1000 recipients have received the gift of sight through cornea provided by OneLegacy

17. QUESTIONS ????