1. Organ Donation: A Collaborative Effort Mount Sinai Health System
Region 9 Donation and Transplantation Collaborative
March 20, 2018

2. The Mount Sinai Health System (MSHS)
Combines the Icahn School of Medicine at Mount Sinai and 7 hospital campuses, Mount Sinai Brooklyn, Mount Sinai Downtown, Mount Sinai Hospital, Mount Sinai Saint Luke’s, Mount Sinai Queens, Mount Sinai West, New York Eye and Ear Infirmary of Mount Sinai
Mount Sinai Transplant offers transplantation services, including heart, intestinal, liver, kidney, pancreas, corneas and bone marrow
The Recanati/Miller Transplantation Institute
Mount Sinai Heart
250 ICU beds (Adult, PICU and NICU)
481,000+ ED visits
145,000+ Inpatient admissions
Internationally recognized leader in Palliative Care

3. MSHS Program Background
University of Pittsburgh Medical Center reviewed 4 system hospitals: Mount Sinai Downtown, Mount Sinai Hospital, Mount Sinai Saint Luke’s and Mount Sinai West
Deficiencies in donors due to undefined referral process; resulting in low conversion rates and few organs transplanted per donor
Adopted recommendations:
Implement a nurse referral process that is timely; without MD permission
Establish a multidisciplinary Organ Donor Council at each hospital
Standardize policies and procedures regarding donation across MSHS
Promote donation as a system-wide initiative directly related to the Mount Sinai Transplant program
Approached by LiveOnNY to partner on a 3-year CMS Demonstration Project: implement a dedicated team of in-house OPO coordinators (IHC) to serve 6 of MSHS acute care hospitals

4. Background: Historical Approach Process
LiveOn Coordinator Approach
Advance Care Planning
Catastrophic Event / Grave Prognosis
Breaking Bad News
Family Decisions
End of Life
Process issues:
Referrals not being made within 1 hour of clinical triggers being met
Late in the process of decision making
End of life decisions may have already been made
Family may be unaware of patient wishes related to donation
LiveOnNY Coordinator not part of previous discussions and/or decisions
LiveOnNY Coordinator seen as “vulturistic” by care team and/or families

5. MSHS Organ Donation Program Goals
Increase the number of organ donors and organs transplanted across MSHS
Improve patient satisfaction, donors and families are offered compassionate end-of-life support
Build partnership and trust between MSHS clinical teams and LiveOnNY
Culture shift such that MSHS staff recognize and promote donation in eligible patients
Move initial discussions of organ donation upstream as part of goals of care discussions

6. LiveOnNY Partnership Future State
Organ donation
Cadaveric/scientific donation
Interviews/writing/life review / videography
Legacy art projects
Development (MSHS) / philanthropy (outside)
Care Team Approach that includes IHC
IHC integrated into the clinical team for “legacy building”
Advance Care Planning
Catastrophic Event / Grave Prognosis
Breaking Bad News
Family Decisions
End of Life

7. MSHS Organ Donation Initiative
Mount Sinai Health System Organ Donor Council
Nurse Driven Protocol
In-house Donor Coordinators
CNO & CMO Site Led
Donor Councils
Policy & Practice Standardization
Palliative Care Partnership
Centralized Daily Operations & Oversite

8. MSHS Organ Donation Council
Launched January 2018, meets bimonthly
Multidisciplinary Team: Chaired by MSHS CMO
Site CNOs
Site CMOs
Chaplaincy
Legal
LiveOnNY Senior Leadership
MSHS Operational Lead
Guiding Principles:
Create positive experiences built on compassion to enable conversion of referrals to consenting donors and families
Partner with LiveOnNY to build a robust organ donation program
Foster a multidisciplinary approach in patient and family engagement
Standardize policies and procedure related to organ donation across MSHS
Integrate organ donation into life planning and legacy building for all patients
Process Improvement Coordinator
Palliative Care
Regulatory
Social Work
Transplant Leadership

9. Implementation of Nurse-Driven Referral Protocol?
Nursing staff will call in all organ and tissue referrals to LiveOnNY
Timely referral within 1 hour of clinical trigger or cardiac death
Quick triage to In-house LON coordinators (Clinical Program Coordinators) for potential organ donation
Documentation of all referral information in the EMR
Ongoing monitoring to ensure all referrals are made and are timely

10. MSHS In-House LiveOnNY Coordinators (IHC)
Launched February 7, 2018
Team of 5 rotate across the 6 different sites
24/7 availability to respond to all organ referral across MSHS
Following cases from referral through to organ procurement
Operational integration into care teams:
Internal title Clinical Program Coordinator
MSHS badges, lab coats and scrubs; co- branded business cards
Dedicated workspace
IT setup: internal addresses, remote access to and EMR
EMR documentation: discussions, interventions, status of donor process
Participate in ICU and Pal Care rounds and goals of care discussions
Educating staff, patients, families, and visitors about organ donation
Participation in Organ Councils and process improvement activities

11. Hospital Specific Organ Donation Councils
Multidisciplinary Team: Chaired by site CNO and CMO
Chaplaincy
ED leadership
ICU leadership
In-house Coordinator
LiveOnNY Leadership
Operationally focused councils meet monthly or bimonthly
Review site specific data
Review recent cases: identification of best practices and improvement opportunities
Discuss local operational issues/barriers related to donation
Identify education and outreach opportunities
MSHS Operational Lead
Process Improvement Coordinator
Palliative Care
Regulatory
Social Work

12. Policy and Practice Standardization
Policies
Anatomical Gift Donations
Brain Death
Death after Circulatory Death (DCD)
Practice
EMR documentation
RN referrals
In-house Coordinators
Organ donor management
DCD OR support and preparation
DCD – MD pronouncement of death in the OR

13. Palliative Care Partnership
Short term goal: seamless integration of IHC into care team
Script development for family introductions for early engagement
Rounding with Palliative Care Teams
In-house Coordinator coaching/mentoring by Palliative Care MD leadership
Evaluating palliative care best-practices to leverage for IHC program
Developing tools and framework to integrate organ donation discussions upstream as part of Advance Care Planning
Long term goal: transform the IHC into a legacy building team

14. Questions