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A Panel Discussion The Donation and Transplantation Symposium October 15, 2013

Donor Designation, Your Families and You. Presenters: Amy Durrant , OneLegacy Ambassador & Donor Wife Robert Coppel , Family Care Specialist, OneLegacy Melanie Crowley, Clinical Manager Trauma Service, Northridge Hospital Medical Center Moderator:

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A Panel Discussion The Donation and Transplantation Symposium October 15, 2013

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  1. Donor Designation, Your Families and You Presenters: Amy Durrant, OneLegacy Ambassador & Donor Wife Robert Coppel, Family Care Specialist, OneLegacy Melanie Crowley, Clinical Manager Trauma Service, Northridge Hospital Medical Center Moderator: Bryan Stewart, Vice President of Communications, OneLegacy A Panel DiscussionThe Donation and Transplantation SymposiumOctober 15, 2013

  2. Kevin Durrant

  3. Working with Families in Conflict Donor Designation Robert CoppelFamily Care SpecialistOneLegacy

  4. “You have the right to give instructions about your own health care.” Advance Health Care Directive Form

  5. (2.1) END-OF-LIFE DECISIONS: I direct my health care providers and others involved in my care to provide, withhold, or withdraw treatment in accordance with the choice I have marked below: • a) Choice Not To Prolong: I do not want my life to be prolonged if the likely risks and burdens of treatment would outweigh the expected benefits… • b) Choice To Prolong: I want my life to be prolonged as long as possible within the limits of generally accepted medical treatment standards. • Upon my death (mark applicable box): • I give any needed organs, tissues, or parts

  6. Donor Designation Protecting the Decision:A Case Study Melanie Crowley, RN, MSN, CEN Clinical Manager, Trauma Service Northridge Hospital Medical Center

  7. Case Overview Day 5 Day 2-4 Day 1 • Second BD Note written 12/18 @ 09:39 • Family refuses to meet with OneLegacy FCS • Nursing staff voices discomfort with starting case against family’s wishes • 19:00 Administrator On Duty (AOD) contacted • Admit 12/14 @ 00:46 • 20yr Female admitted s/p MVA • Only ID is Credit Card in pocket • GCS 3 on arrival / Severe Traumatic Brain Injury • Referred to OneLegacy @ 08:34 • Family onsite +8hrs post ICU admit • Registered Donor • Day 2: CT Scan shows herniation • Day 3: EEG ordered, Na 119 • Family first voices objection to donation • Day 4: First BD Note written 12/17 @ 19:10 • Pt too unstable for CBF/apnea test

  8. Overarching Goal Strive to meet the needs of the Patient Family Staff What happens when these CONFLICT?

  9. Law & Policy Must Guide Practice • CA State Health & Safety Code • Section 7150.35 (a): • “…Absent 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…” • Anatomical gift that does not revoke before death is irrevocable • No permission from the donor’s family is warranted • The family does not have the power, right or authority to consent to, amend or revoke

  10. Law & Policy Must Guide Practice Northridge Hospital Policy ?

  11. Law & Policy Must Guide Practice Northridge Hospital Policy

  12. Utilize Your Resources Follow your chain of command: AOD Unit Director VP Medical Affairs Bioethics Legal Counsel OneLegacy Hospital Liaison

  13. Perception = Reality Address Misconceptionsof Family & Staff Donor Registry Status cannot be overridden Validate patient’s Donor Registry status (Document of Gift) Donation honors the patient’s wishes!

  14. Next Steps Day 5 Post Admit • 12/18 @ 24:00 (+14hrs post BD declaration) Charge RN & OneLegacy FCS meet with family in hospital lobby • Additional family support provided by Social Work, Nursing Staff, OneLegacy Staff • 12/19 @ 12:00 Family completes Med/Soc History • Family provided with memory box, handprints, Aftercare Support Services

  15. Case Outcome • 4 Organs Recovered & Transplanted: • Left Kidney – 17yr Male • Right Kidney & Pancreas – 49yr Male • Liver – 61yr Male • Tissues Recovered for Transplant: • Corneas • Bone

  16. Donor Designation, Your Families and You Presenters: Amy Durrant, OneLegacy Ambassador & Donor Wife Robert Coppel, Family Care Specialist, OneLegacy Melanie Crowley, Clinical Manager Trauma Service, Northridge Hospital Medical Center Moderator: Bryan Stewart, Vice President of Communications, OneLegacy A Panel DiscussionThe Donation and Transplantation SymposiumOctober 15, 2013

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