HONORING THE DONOR’S WISHES

Susan Mau LarsonPublic Affairs Director, LifeSource

April 28, 2011

Goal: to enhance and strengthen our ability to uphold a patient’s designated wishes and the law.

1. What is donor designation?2. What does it mean when someone has

designated him/herself to be a donor?3. What is our responsibility in honoring donor

designation?

HONORING THE DONOR’S WISHES

Donor Designation

Honoring an individual’s

documented wishes to be

an organ and tissue donor.

• 1968 – Uniform Anatomical Gift Act adopted by every state “Donation is a gift”

• 1987, 2001 (SD), 2002 (MN) Revisions

• 2007 – MN, ND, SD adopt revised UAGA reinforcing donor designation (To date 39 states and territories have adopted)

Legal Framework

In May 2003 LifeSource began honoring an individual’s documented wishes to donate

Preparation for implementation included:• Gathered stakeholder input• Established policies and procedures• Gained Board of Directors approval• Conducted training with staff and hospital partners• Shared progress with media• Incorporated donor designation into public messaging

Implementation

Law of Donation:Uniform Anatomical Gift Act

ESTATES OF DECEDENTS; GUARDIANSHIPSMN CHAPTER 525A

Preclusive Effect of Anatomical Gift, Amendment, Or Revocation.

(a) ... in the absence of 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 of the donor's body... An anatomical gift made in a will, a designation on a driver's license or identification card, or a health care directive . . ., and not revoked, establishes the intent of the person making the designation and may not be overridden by any other person.

Decision belonged to decedent when she was alive;...

Only if she decided “not to decide”does the decision belongs to the living.

Who Owns the Decision

• A Testamentary Decision--Cannot be Revoked except for Public Policy Reasons in a Court of Law

• A Statutory Right

• A Charitable Gift

Legal Status of Donation Decision

ESTATES OF DECEDENTS; GUARDIANSHIPS

• Document of Gift is like a Will, but acted on prior to probate

• The Organ Procurement Organization is the Executor, Both Empowered and Required to Carry Out the Wish

• The Intent of the Decedent is the Core Question

Testamentary Decision

Compassion– We identify with the Living– We want to help the Living

Fear– We fear the Living, and their lawyers– We want to maintain strong relationships with

hospital– We fear the media

Factors in Legal Noncompliance

Complete statutory immunity for persons who facilitate anatomical gifts pursuant to Anatomical Gift Act

Immunity

This obligation is shared by donation agencies and the hospital

• Its Your Risk, Too• Nowhere Does it say We Can Ignore this Gift• Statutory Immunity Covers This

Statutory Obligation

Organ Donors withDonor Designation

• From May 2003 through December 2009 LifeSource managed 1068 organ donation cases

• 14 potential cases (5/03-12/09) had some conflict or confusion

• 9 of these 14 situations resulted in organ donation

Experience

Experience: Factors in Conflict Situations

• Huddles with care team to discuss situation and plan

• Engagement of LifeSource and donor hospital leadership

• Adequate on-site resources from LifeSource

How We Proceed

– Consistent messaging for hospital and LifeSource.

– Avoid language which gives perception of choice.

– Stay engaged with the family during and after the donation.

– Provide document of donor designation and brochure

Family Interactions

Bringing life to an individuals’ gift relies on the support of all involved – procurement organizations and donor hospitals.

We must do this in partnership.

Honoring the Donor’s Wishes…

HONORING THE DONOR’S WISHES

KARE-11March 11, 2011

A lasting gift: Forest Lake boxer helps others in his death

LINO LAKES, Minn. -- A Forest Lake High School senior who collapsed in the boxing ring and later died continues to give to others."He was a giver. He was a giver. He wanted people to be taken care of," said Susan Smith about her son, Charlie, who has helped dozens of people by becoming an organ donor.

THANK YOU

Questions/Discussion

Honoring Donor Designation

Sheila Elledge, RN, BS Nurse Manager Burn Unit

Hennepin County Medical Center

Sue Weese, RN, BSN, CPTC Lifesource In-house CoordinatorHennepin County Medical Center

Who We Are

• 465 Staffed beds• 22,937 Inpatients per year• 101,658 ER visits per year• 3,000 1st time trauma admissions of which 31%

were referred to us by other hospitals• 327,165 Clinic visits per year

Who We Are

2006 – 2010 YTD Averages• Authorization and Conversion = 78%• % of Total LifeSource Donors = 12%• % of Total LifeSource DCD Donors = 34%• Organs transplanted per donor = 3.77• Number of Tissue Donors = 32• Donor Designation Cases = 48%• Medals of Honor Won = 4 2009 Gold Medal Winner

Why We Are Here

• First to adopt DCD and Resident Road Show• Media Stories and Promotion of Donation• Donate Life Month/Flag• MHA and CEO Summit• DD Letter in Family Folder• Experience w/ Donor Designation and

Conflict (4 cases)

DSA Leadership Position

We Are Also Here Because…

Excellent end of life careHonor the patient’s Gift

Follow Donor Designation Law Minimize Fear of Family

Maximize the gift

We Are Trying To…

Family considers taking brain-dead son off life support

Who We Are

A Story…

• May 6, 2008; 56 White M; SIGSW; + DD was transferred from a small rural hospital to HCMC

Story Continued

Story Continued

Story Continued

• Day 3 – Follow-up call to donor wife from LifeSource.

• Interested in donation outcome and what organs were transplanted.

• Day 15– Family called LifeSource to request additional Surgeon

General certificates for each family member.

Story Continued

Conflict resolution

• Ages: 20-51• Race: Two white, Two Black• Injury: 2 GSW, 2 aneurysms• All timely referrals• Mention of donation: Two by family• LNOK: Two-wife, Grandmother, parents• Leadership involved-both LS and HCMC• Organs recovered

Conflicts

• Ensure OPO and hospital leadership have a complete understanding of donor designation.

• Connect early with donor family.• Conflict resolution process.• Involve everyone in the Huddle – stops the rumor

mill.• Adequate resources available• When you uphold the law, you are doing the right

thing for the patient.

• Donation process built on confidence of doing the right thing

• Clear and consistent communication-HUDDLE• Deep rooted commitment to move forward with

donation…Regardless• Support until the end…acceptance by donor

family

Challenge

4 Donors = 19 Lives Saved