HONORING THE DONOR’S WISHES Susan Mau Larson Public Affairs Director, LifeSource April 28, 2011

Honoring the Donor’s Wishes Goal: to enhance and strengthen our ability to uphold a patient’s designated wishes and the law. What is donor designation? What does it mean when someone has designated him/herself to be a donor? What is our responsibility in honoring donor designation?

Donor Designation Honoring an individual’s documented wishes to be an organ and tissue donor.

Legal Framework 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)

Implementation 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

Law of Donation: Uniform Anatomical Gift Act ESTATES OF DECEDENTS; GUARDIANSHIPS MN 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. Tim Sullivan

Who Owns the Decision Decision belonged to decedent when she was alive;... Only if she decided “not to decide” does the decision belongs to the living. Tim Sullivan

Legal Status of Donation Decision A Testamentary Decision--Cannot be Revoked except for Public Policy Reasons in a Court of Law A Statutory Right A Charitable Gift Tim Sullivan

Testamentary 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 Tim Sullivan

Factors in Legal Noncompliance 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 Tim Sullivan

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

Statutory Obligation 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 Tim Sullivan

Organ Donors with Donor Designation

Experience 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 Susan Mau Larson

Experience: Factors in Conflict Situations Susan Mau Larson

How We Proceed Huddles with care team to discuss situation and plan Engagement of LifeSource and donor hospital leadership Adequate on-site resources from LifeSource Susan Mau Larson

Family Interactions 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 Susan Mau Larson

Honoring the Donor’s Wishes… 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 KARE-11 March 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. Susan Mau Larson

Questions/Discussion Susan Mau Larson THANK YOU

Honoring Donor Designation Who We Are Honoring Donor Designation Sheila Elledge, RN, BS Nurse Manager Burn Unit Hennepin County Medical Center Sue Weese, RN, BSN, CPTC Lifesource In-house Coordinator

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 22

Why We Are Here 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 23

We Are Also Here Because… DSA Leadership Position 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) 24

Honor the patient’s Gift Follow Donor Designation Law We Are Trying To… Excellent end of life care Honor the patient’s Gift Follow Donor Designation Law Minimize Fear of Family Maximize the gift 25

Who We Are Family considers taking brain-dead son off life support 26

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

Story Continued 28

Story Continued

Story Continued 30

Story Continued Day 3 Day 15 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. 31

Conflict resolution

Conflicts 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 33

Connect early with donor family. Conflict resolution process. 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. 34

Challenge 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 35

4 Donors = 19 Lives Saved