A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES 2010 ONELEGACY CELEBRATING OUR PARTNERS May 26, 2010 Allen P. Kong, MD 1, Cristobal Barrios, MD 1, Ali Salim, MD 2, Lynn Willis, MHA 1, Marianne E. Cinat, MD 1, Matthew O. Dolich, MD 1, Michael E. Lekawa, MD 1, David B. Hoyt, MD 1, Darren J. Malinoski, MD 1 1 University of California, Irvine, Medical Center, Orange, California 2 Cedars-Sinai Medical Center, Los Angeles, California

QUESTIONS TO RUN ON… What can my hospital do to improve its organ donation outcomes? What can I do to improve donation outcomes?

The Problem As of Jan 2010: 105,452 candidates 21,425 transplants in 2009 Waiting List Transplants Transplants from Deceased Donors Transplants from Living Donors

Goals of the Organ Donation Breakthrough Collaborative 3.75 organs transplanted per donor (OTPD) 10% donors after cardiac death (DCD) Increase conversion rate up to 75% Increase donations by 1,900/year Increase transplants by 6,000/year Conversion rate = # actual donors / # eligible donors

Improvement Strategies Make donation a priority at large hospitals Create DCD policies Use extended criteria donors (ECD) Catastrophic Brain Injury Guidelines Donor Management Goals

Hospital Requirements Centers for Medicare/Medicaid Services & American College of Surgeons Notification process Declaration of brain death Organ procurement organization (OPO) relationship Performance Improvement (PI) program Patient/family opportunity to donate

Current Status Organ donor council established in 2007 at UC Irvine

Hypothesis Establishment of an organ donor council and performance improvement initiative will lead to improved donation outcomes.

Organ Donor Council Multi-disciplinary Transplant Surgeons Intensivists Nurses Palliative Care Ethics OPO Clinical Champions Trauma Team Administration Chaplain Operating room Performance Improvement Risk Management Pharmacy Community Representative

Methods Prospectively collected data on all referrals to regional OPO from 2006 to 2009 Number of referrals Timely notification Conversion rate DCD rate ECD rate OTPD Total number of organs transplanted OTPED (organs transplanted per eligible death)

2007 Areas of Focus DCD policy Brain death determination policy/protocol Clinical triggers for notification Binders in every critical care unit Performance improvement process

ORGAN DONATION CLINICAL TRIGGERS CALL OneLegacy at within 1 HOUR Call OneLegacy at for TISSUE/EYE DONATION for ALL Cardiac Deaths within 1 hour of death

Results Number of referrals96139 (p<0.01 vs. 2006) 143 (p<0.01 vs. 2006) Timely notification rate 64%83% (p<0.01 vs. 2006) 83% (p<0.01 vs. 2006) DCD rate0%11% (p=0.07)

2008 Areas of Focus Devastating brain injury pathway Performance improvement process Case reviews to evaluate: Approach for consent Medical donor management Acceptance of organs for transplantation

Results Number of eligible deaths Number of actual donors Conversion rate53%76% (p=0.04) OTPD3.4 ± ± 1.5 (p=0.27) 3.5 ± 1.5 ECD rate6%38% (p=0.03) 6% Total organs transplanted (LIVES SAVED)

Results OTPED = effectiveness of an organ donation program Considers conversion rate & donor management p=0.45 vs p=0.20 vs. 2007

2009 Areas of focus Donate Life Flag raising ceremonies Donate Life Rose Parade Float team CEO/Dean Letters to staff about each donor Devastating Brain Injury Checklist Housestaff Resource Card

Conclusions Development of an organ donor council and performance improvement initiative led to improvements in: Timely notification Conversion rate DCD rate OTPED Overall number of organs transplanted remained stable, despite decreases in overall number of donors and organs transplanted in the region.

THANK YOU Darren Malinoski, MD UC Irvine Medical Center hereby expresses its thanks for the cooperation of OneLegacy and all the organ and tissue donors and their families, for giving the gift of life and the gift of knowledge, by their generous donation.

QUESTIONS TO RUN ON… What can my hospital do to improve its organ donation outcomes? What can I do to improve donation outcomes?