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OneLegacy: A Donate Life Organization


Objectives

• At the end of the presentation the learner will be able to:

– Identify when to refer patients to OneLegacy for Organ and Tissue Donation

– Understand the Donation process

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What are OPOs?

• Not-for-profit Organ Procurement Organizations (OPOs) like OneLegacy are federally designated and funded by CMS to serve specific regions of the country and were established to:

– Educate the public about benefits of organ donation and transplantation

– Recover, preserve and distribute donated organs – Increase the availability of organs for transplantation – Support, promote and assist tissue donation

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OneLegacyAn Organ and Tissue Donation Network

Our Mission OneLegacy is dedicated to achieving the donation of life-saving and life-

enhancing organs and tissue for those in need of transplants and to providing a sense of purpose and comfort to those families we serve.

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TransplantCenterHospital

To Save Lives, To Support Grieving Families, To Honor Donor Wishes


OneLegacy

• Not for Profit Founded in 1977• Federally funded and designated by Centers for Medicare

and Medicaid Services (CMS) as an Organ Procurement Organization (OPO)

• Licensed by California as a tissue bank• Accredited by the American Association of Tissue Banks

(AATB) and Eye Bank Association of America (EBAA) • Serving 220 hospitals, 11 transplant centers & 19 million

residents

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# of People waiting for organ transplants =

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112,839 www.unos.org


Waiting List Outcomes

• Over 112,000 on national waiting list

• 17-18 on waiting list die each day

• Another name is added to the list every 13 minutes

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• CMS regulations require all deaths to be reported

• OneLegacy monitors referral activity and to ensure compliance.– Imminent brain death: Report as soon as patient shows one or

more clinical signs of cessation of brain and brain stem functions

– Cardiac death: Report all deaths within 1 hour

• Organs can become non-viable during the time the family considers the donation option. Proper donor management enables adequate hydration, ocular care, etc.

Early Referral is Critical – and Required

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CMS & Joint Commission

• Conditions of Participation (CoPs)– Timely Referral:

• Imminent brain death– (GCS 5 or less, vent dependent, neuro

insult/injury) • Cardiac death (call within 1 hour for tissue donation)

- Do not approach the family – approach will be coordinated by OneLegacy following determination of medical suitability

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Imminent Brain Death

• Ventilator dependent / GCS ≤ 5*(*based on CMS guidelines)

• One or more clinical signs: – Pupils fixed and dilated– No cough– No gag reflex– No spontaneous respiration– No purposeful movement in response

to noxious stimuli10

CALL if pt meets any of

these triggers!


Clinical Trigger Card

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California Uniform Declaration of Death Act (1982)

California Health and Safety Code: Section 7180 et seq.

“A person shall be pronounced brain dead if it is determined by a physician that the person has suffered a total and irreversible cessation of all functions of the entire brain, including the brain stem. There shall be independent confirmation of the death by another physician.”

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Brain Death Declaration

• Brain Death Determination– Brain death documentation by 2 licensed physicians– Note should state “Patient is Brain Dead” – Sign, date & time notes

• Test(s) performed to determine brain death:– Clinical exam is required in the State of California– EEG or CBF is not mandatory– Discretion of the physician for confirmatory tests– Follow Hospital Policy and Procedure

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Approach

The Donation Process

SuitabilityDonor MgmtBrain Death DeclaredDonation After

Cardiac Death Assessment

Identification & Early Referral Based on Clinical Triggers

Family SupportHuddleEffectiveRequestingMedical/SocHistory

HospitalDevelopmentCommunity Outreach

Development Referral Evaluate

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Approach Process

Brain Death:• After a Huddle• Effective Requestor

usually approaches after 2nd Brain Death note

• One Legacy’s Family Care Coordinator approached family about the opportunity for donation

Tissue:• After the patient has been

identified as a suitable tissue donor

• The Family Care Center will call the family and approach over the phone.

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Recovery

Coroner ClearanceOrgan PlacementOrgan/Tissue RecoveryAfter Action Review

The Donation Process

SuitabilityDonor MgmtBrain Death DeclaredDonation After

Cardiac Death Assessment

Identification & Early Referral Based on Clinical Triggers

Family SupportHuddleEffectiveRequestingMedical/SocHistory

HospitalDevelopmentCommunity Outreach

Development Referral Evaluate Approach

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Recovery Process

• Brain Death organ recovery coordinated by One Legacy’s Procurement Transplant Coordinator (PTC)

• PTC will obtain Coroner release• PTC will provide donor management• PTC will coordinate organ placement with transplant centers• PTC will coordinate organ recovery time and process with the OR

• Tissue recovery coordinated by One Legacy Tissue Recovery Coordinators

• Tissue recovery occurs either in the OR, or hospital morgue if suitable, may also occur at the funeral home or coroner’s office

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Organs and Tissues That May Be Donated

KidneysLiver

Heart Lung

PancreasSmall Intestine

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Corneas/EyesBone

Heart valvesBlood Vessels

TendonsCartilage

Skin

ORGANS TISSUES


The Results Are Exponential

From 3 patients who become

donors…

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…10 lives are saved on average

through organ transplants…

…and up to 150 lives are improved due to

donated tissues


Lily

Liver tumor, awaiting transplant

1984

Matthew Bemis,Lily’s donor

2008 Lily’s wedding day

1985 post transplant20


For many families:• The Gift of Organ Donation is the only positive

experience in the tragic chain of events surrounding the loss of their loved one.

• It can help give meaning to an otherwise senseless event that has occurred.

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The Gift of Life

Download - OneLegacy: A Donate Life Organization

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