1. The Arkansas Regional Organ Recovery Agency Welcomes You To New Nurse Orientation

2. Donation and Transplantation: How does it work?

3. CMS Conditions of Participation There are many Conditions of Participation regarding organ, tissue and eye donation. These apply to you in your nursing capacity in the hospital.

4. Conditions of Participation All deaths occurring in the hospital must be called to ARORA. ARORA determines suitability for donation. ARORA discusses donation with the family. The Hospital gives ARORA full access to patient medical records. The Hospital works with ARORA to maintain potential donors. The Hospital works with ARORA to encourage discretion and sensitivity toward families of potential donors.

5. Calling Deaths to ARORA ARORA Resource Center is located in Little Rock and operates 24/7/365. All phone conversations are recorded. Death must be called within one hour of cardiac death or meeting clinical triggers. ARORA Resource Center provides referral number for the hospital chart documentation.

6. Determine Medical Suitability When calling the ARORA Resource Center, many questions will be asked regarding the patient. ARORA Tissue Referral and Clinical Trigger Card will guide through questions that will be asked while calling in a referral.

8. Determining Medical Suitability Helpful Tips For all referrals, offer Past Medical History red flags including: – Any infectious disease process – Hepatitis – Cancer – Dementia/Alzheimer’s

9. Determining Medical Suitability Helpful Tips For Organ Referrals, also have available: – Pressor Support – Sedation/Paralytics – Stability of Patient – Plan of Care An ARORA Administrator will provide a short follow up call to the nurse verifying this information and will provide the nurse with ARORA’s plan of action.

10. Determining Medical Suitability Less than 1% of deaths can donate organs Less than 3% of deaths can donate tissue Since so few patients are medically suitable to be donors, it is imperative that the Hospital and ARORA collaborate to insure the family of each suitable donor is informed of the patient’s donation opportunity.

11. First Person Authorization If someone is a registered donor (most often on a driver’s license) it is considered first person authorization for donation. Authorization from legal authorizing person is not required. Sign up online www.donatelifearkansas.org You choose to authorize the recovery of  Organ  Tissue  Eye

12. The Donation Discussion When a patient has been determined medically suitable to be a donor, ARORA staff will discuss the donation opportunity with the family. Hospital staff are an integral part of this ARORA-led process.

13. The Gift of Tissue Donation Bone, Skin, Veins, Corneas, Heart Valves Pediatric Patients (< 13yo) = Heart Valves only Tissue donors have an asystolic Time of Death and come from all areas of the hospital. Your responsibility - call within 1 hour of Time of Death. ARORA Resource Center Representative discusses the donation process with the potential donor’s family. Generally, the donor is transported to ARORA’s surgical suite in Little Rock. As an alternative, the recovery may take place in the hospital’s surgery department. One tissue donor can enhance the lives of 50 or more.

14. Skin Donation used for Breast Reconstruction

15. Skin Donation used for Hernia Repair

16. Skin Donation used for Abdominal Wall Reconstruction

17. Bone Bone cement Precision spine grafts Bone struts

18. Saphenous Vein, Femoral Vein and Artery, and AI Saphenous Veins and Femoral Veins and Arteries AI graft

19. Tendons ACL Reconstructions Hamstring repairs Restore range of motion

20. The Gift of Organ & Tissue Donation After Brain Death has been declared Definition of Brain Death When someone sustains a brain injury that permanently stops the flow of blood and oxygen to the brain; the entire brain including the brainstem has irreversibly lost all function. Brain death is a non-recoverable and non- survivable injury to the brain and brainstem.

21. The Gift of Organ & Tissue Donation After Brain Death has been declared (continued) If the patient meets Clinical Triggers – Brain injury + On a Vent + GCS 5 or less +/or loss of one cranial nerve reflex; or – Hypothermia protocol initiation Hospital staff responsibility - Call within 1 hour of the patient meeting these triggers. ARORA will determine if the patient is a candidate for Organ, Tissue and/or Eye Donation. Potentially, 8 Organs can be recovered for transplant: Heart, 2 Lungs, Liver, 2 Kidneys, Pancreas, Intestine. Tissue and Eye donation opportunity remains unchanged.

22. The Gift of Organ & Tissue Donation Donation after Circulatory Determination of Death (DCD) A patient who is on a ventilator and the medical team & family have made the decision to discontinue ventilator support to allow the patient’s natural death to occur. Hospital staff responsibility - Call ASAP when Palliative Care is consulted or a plan is being discussed to withdraw life sustaining therapies. Call BEFORE extubation Wait for decision by ARORA before extubation ARORA will determine if the patient is a candidate for DCD. Potentially, 5 Organs that can be recovered during DCD: Liver, 2 Kidneys and 2 Lungs Tissue and Eye donation opportunity remains unchanged.

23. ARORA Donor Family Care Comfort Shawls Giving comfort to organ donor’s families during the donation process. Kept by family as a reminder of their loved one’s great gift of donation. Handmade by Shawls of Compassion volunteers

24. ARORA Donor Family Care Donor Memorial Cards Many families honor their loved one’s memory by sharing their gift of donation though Donor Memorial Cards provided by ARORA.

25. ARORA Donor Family Resources All Donor families are offered the opportunity to stay involved with ARORA after their loved one’s gift of donation. ARORA offers a variety of events for families – Memorial events to honor their loved one – Bereavement materials and support groups – Volunteer opportunities – Communication with their loved one’s recipient(s)

26. Important Statistics Over 120,000 people currently waiting for a life-saving organ transplant. Three transplant centers in Arkansas – University Hospital (UAMS): Liver, Kidney – Baptist Medical Center Little Rock: Heart – Arkansas Children’s Hospital: Heart, Kidney Over 1 Million tissue transplants take place each year

27. Recap Notify ARORA within 1 hour when a death occurs in the hospital. Notify ARORA within 1 hour when a ventilated patient meets any of the clinical triggers. Notify ARORA immediately upon discussion to withdraw life sustaining therapies. Do not mention donation to patient’s family members. ARORA is available 24/7/365

28. Recipient Story Life is a journey for all of us. My journey has been a bit unusual. Through the grace of God and because of the decisions made by two donors and their families, I am alive today. I received a heart transplant in 2004 and another heart transplant in 2007. My goals are to always honor the memory of donors and the incredible gifts they gave so others could live and have a better life; to educate others concerning donation; and to live every day to the fullest with a thankful heart. —Carolyn Berry

29. Donor Story My dad was an amazing man and my hero. The two loves of his life were his family and softball. For his family he was a constant source of strength and guidance. He was always there to offer support and help when needed. For softball he was a coach, umpire, and someone the athletes could look up to. When he died I heard from so many adults he coached as kids about the impact he made on their lives. I miss him every day, but I am comforted by the fact that he saved two lives through organ donation. Audra LaRue-Donor Daughter Audie Wade

30. Additional Resources www.ARORA.org www.donatelifearkansas.org www.unos.org www.donatelifeamerica.org To arrange a donation presentation for a community or civic group, please contact ARORA at 501-907-9150.

31. Hospital Specific?

32. ARORA Together we are Restoring Lives