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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 ,

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A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

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A MULTIDISCIPLINARY ORGAN DONOR COUNCIL AND PERFORMANCE IMPROVEMENT INITIATIVE CAN HELP SAVE LIVES

2010 ONELEGACY CELEBRATING OUR PARTNERS May 26, 2010

Allen P. Kong, MD1, Cristobal Barrios, MD1, Ali Salim, MD2,

Lynn Willis, MHA1, Marianne E. Cinat, MD1, Matthew O. Dolich, MD1,

Michael E. Lekawa, MD1, David B. Hoyt, MD1, Darren J. Malinoski, MD1

1University of California, Irvine, Medical Center, Orange, California

2Cedars-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 1-800-338-6112 within 1 HOUR

Call OneLegacy at 1-800-338-6112 for TISSUE/EYE DONATION

for ALL Cardiac Deaths within 1 hour of death


Results


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


Results

  • OTPED = effectiveness of an organ donation program

    • Considers conversion rate & donor management

p=0.20 vs. 2007

p=0.45 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 YOUDarren Malinoski, MDmalinosd@uci.edu

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?


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