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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

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

speakers
Speakers:
  • MarwaKilani, MD

Providence Holy Cross, Mission Hills

  • Marcia Penido, LCSW, MPH, ACM

Huntington Hospital, Pasadena

  • Robert Coppel, Family Care Specialist

OneLegacy, Los Angeles

question to run on
Question to Run On:
  • How do we safeguard this (DCD) opportunity for all potential donors and their families?
dcd referral approach
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
palliative care
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

palliative care2
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
dcd referral approach1
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
assessing medical suitability
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?
suitability determined
Suitability determined…

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

elements of an approach
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
timing elements
Timing Elements:
  • Family Considerations
  • Hospital policy
  • Pre-Approach Huddle
timing of the approach
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?”

summary
Summary:

Who Qualifies?

When Is the Right Time to Make the Referral?

question to run on1
Question to Run On:
  • How do we safeguard this (DCD) opportunity for all potential donors and their families?
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