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DCD: Identification – Who Qualifies and When is it the Right Time to Make that Referral?

DCD: Identification – Who Qualifies and When is it the Right Time to Make that Referral? . 2013 National Donor Management Summit Los Angeles, California September 25, 2013. Speakers:. Marwa Kilani , MD Providence Holy Cross, Mission Hills Marcia Penido , LCSW, MPH, ACM

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DCD: Identification – Who Qualifies and When is it the Right Time to Make that Referral?

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  1. DCD: Identification – Who Qualifies and When is it the Right Time to Make that Referral? 2013 National Donor Management SummitLos Angeles, California September 25, 2013

  2. Speakers: • MarwaKilani, MD Providence Holy Cross, Mission Hills • Marcia Penido, LCSW, MPH, ACM Huntington Hospital, Pasadena • Robert Coppel, Family Care Specialist OneLegacy, Los Angeles

  3. Question to Run On: • How do we safeguard this (DCD) opportunity for all potential donors and their families?

  4. DCD: Referral / Approach • Providence Holy Cross Medical Center • 6/10/13 - 38yr old female admitted - ALOC & Respiratory Distress / Hospitalist Attending • 6/12/13 – Referral to OneLegacy • 6/16/13 – Referral closed / NBD/WNP • 6/21/13 – Re-Referral / Compassionate Extubation under discussion • 6/25/13 – Referral closed again

  5. Palliative Care “The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies… Palliative care affirms life by supporting the patient and family’s goals for the future, including their hopes for cure or life-prolongation, as well as their hopes for peace and dignity throughout the course of illness, the dying process and death.” Excerpted from Clinical Practice Guidelines for Quality Palliative Care, AAHPM

  6. Palliative Care

  7. Palliative Care Provided by a Team: MD, RN, MSW, Chaplain • Experts at Communication • Specialized Pain and Symptom Management • Guidance with Options for Medical Treatment • Help Navigate the Complex Healthcare System • Provide Spiritual and Emotional Support

  8. Palliative Care

  9. DCD: Referral / Approach • PHCMC – Palliative Care • 6/15/13 – Palliative Care Consult • 6/20/13 – 1st Family Conference • 7/3/13 – 2nd Family Conference • 7/3/13 – Re-Referral to OneLegacy • 7/3/13 - Approach / Authorization for DCD

  10. Huddle with OPO

  11. Assessing Medical Suitability: HUDDLE and DETERMINE: • What is the family planning? • Patient profile (contraindications) • Respiratory Effort • Neurological profile (imminent BD) • What is the probability that this patient will expire in the 60 minutes?

  12. Suitability determined… Now how do you determine the “right time to provide this family with their opportunity/option to donate.

  13. Huddle with Care Team:

  14. Elements of An Approach: • Is the Family Ready • Who do we include and why • When is the best time for this family • Where is a quiet, private setting

  15. Timing Elements: • Family Considerations • Hospital policy • Pre-Approach Huddle

  16. Timing of the Approach The Institute of Medicine (IOM) recommends that the decision to withdraw life-sustaining treatment should be made independently of and prior to any staff-initiated discussion of organ and tissue. “Would this patient be removed from life-sustaining treatment whether OneLegacywas there or not?”

  17. Pre-Approach Enactment:

  18. Summary: Who Qualifies? When Is the Right Time to Make the Referral?

  19. Question to Run On: • How do we safeguard this (DCD) opportunity for all potential donors and their families?

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