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First-Person Authorization and DCDs

First-Person Authorization and DCDs. Amanda Cole, RN, BSN, CCRN, MPH Organ Procurement Coordinator Lifesharing. Lifesharing Authorization Data. Eligible Authorization Rates. Registered Donors (FPA). Data Source: National DSA Dashboard, July 2018. FPA All Approaches. n=41. n=39. n=60.

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First-Person Authorization and DCDs

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  1. First-Person Authorization and DCDs • Amanda Cole, RN, BSN, CCRN, MPH • Organ Procurement Coordinator • Lifesharing

  2. Lifesharing Authorization Data Eligible Authorization Rates Registered Donors (FPA) Data Source: National DSA Dashboard, July 2018

  3. FPA All Approaches n=41 n=39 n=60 n=59 n=40 n=46 n=25 n=39 Data Source: Internal MRR Database

  4. Case Study - • Admitted 7/18/2019 – 1541 • 55F, Assault with SAH/SDH • Intubated during craniotomy same day • Referral 7/20/2019 – 0142 • Hospital referral to OPO - neuro insult and plan to withdrawal care • On site 7/20/2019 – within 1 hour • Patient is registered in California • History – ESLD, COPD/Asthma, past CVA • Neuro – Pupils unequal/reactive, +c/g/obv, decorticate posturing • Plan to withdrawal care that afternoon

  5. 7/20/2019 – Morning • No family on site, staff states family is waiting on 1 more person to arrive and then plan to withdrawal immediately • 7/20/2019 – 09:00 • Huddle • 7/20/2019 – 09:20 • Phone approach, LNOK verbally authorized donation • 7/20/2019 – 10:45 • BSRN reported that LNOK has changed mind on donation…

  6. 7/20/2019 – 11:15 • OPO Team meet with family • Daughter stated that they had changed their mind about donation • Two immediate concerns: • Patient’s organs weren’t good enough • Timing • Our response: • Explained organ function for transplant, using specific recipient example • We asked “hypothetically” if they could donate today would they want to proceed • They immediately said yes, and we said outcome was not a promise, but we would make some calls and try

  7. Process was aided by: • Kidneys only viable organs • Morning phone authorization got process started • Medical Examiner notified after phone approach • Blood sent at noon • Ample staffing available to help Process was hindered by: • Family timeline needed to be that day • Hospital ICU MD tried to talk family out of withdrawal • Difficulty getting hospital ABO results Withdrawal time set for 10pm 20 family members present Patient did not expire but family was extremely grateful

  8. Lessons Learned • Reasons for family opposition to FPA can sometimes be mitigated quickly • Early conversations with family re: FPA are essential • Approaching families when they are “ready to withdraw” can be a dis-service to family and donor • OPOs should guide hospitals to allow for OPO staff to engage families earlier in end-of-life conversations

  9. Applications • Talking about patient’s “decision” instead of their “wish” • Using concrete examples about recipients to explain concerns, instead of just answering with facts • Asking hypothetical questions (re: timeline, designated donation, etc..) can make family think more in depth about decision • Inform family about FPA and describe process to families after goals of care discussion, even if no decisions have been made

  10. Thank you!

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