Woody Marshall Manager, Hospital Services Intermountain Donor Services Donor Registry Challenge.

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Presentation transcript:

Woody Marshall Manager, Hospital Services Intermountain Donor Services Donor Registry Challenge

Patient Information: 21 year-old female. Jumped out of a moving car (or may have been pushed out) while arguing with her boyfriend. Spanish speaking family. Admitted to a rural Idaho Level II trauma center on 11/9/14. Clinical triggers met shortly after admission, IDS contacted. Located on the Idaho Donor Registry. Plan made to call daily to assess patient and family status.

Day 8 Patient declared on 11/17/14 via clinical/apnea and flow study. Hospital requested IDS ODC to be onsite to discuss donation options after family meeting. IDS Minority Outreach Specialist accompanied ODC to hospital. Family holding out for a miracle. County Coroner (Insurance Salesman) instructs hospital to extubate, and send the body to Boise for autopsy. Hospital Risk Management requests OPO/Hospital Agreement, UAGA, and registry document. Support donation. County Detectives intervene, express support for donation.

Day 9 IDS asked to be present for family meeting with Trauma Surgeon, Neurosurgeon, and Risk Management. Grave prognosis Family expresses distrust – questions why no surgical intervention. Family opposed to donation. Family requests 2 nd opinion – wants patient transferred to Salt Lake City or Boise area Trauma Center. Requests no mention be made that patient is declared. Requests no mention be made that patient is registered donor. Family to consult an Attorney. What would you do?

Day 10 Transfer explored, ultimately denied by both facilities. Risk Management informs family that neither hospital will accept transfer. Family also informed that hospital supports state law/registry, IDS, and the donation process. Father expresses dissatisfaction with the care his daughter received. States that if he had a gun, he would shoot everyone involved. Family quickly exits the ICU. Lockdown!! Hospital Security and Police notified, statements provided. What would you do? Due to safety concerns, IDS withdraws from donor case.

Takeaways: Because IDS was involved in the initial family meeting, it was perceived that the hospital and the OPO were working together just to get organs. Trust issues – especially related to brain death diagnosis. De-Couple. Family needed more time to understand her diagnosis before donation was introduced. Buy a bullet-proof vest, and learn how to run in a serpentine pattern.