This graph shows our experience since Gift of Life began.As you can see, we’ve seen significant increases in both organ and bone donation, especially in 1994 when PA Act 102 was enacted.However, we owe most of this success to the partnership and dedication of the hospital staff, who make timely referrals so that the rest of the process can proceed.
1. Dual Advocacy: Innovative and Sensitive Training Model for Coordinators InApproaching Donor Families for Consent Presented by: Howard Nathan President and CEO, Gift of Life Donor Program Founder and President, Gift of Life Institute Philadelphia, PA, USA
2. Gift of Life Donor ProgramPhiladelphia, Pennsylvania USA • Non-Profit OPO/Tissue Recovery/Eye Bank • Established in 1974 • Federally designated OPO (by Medicare) for eastern PA, Southern NJ & Delaware - 130 Acute Care Hospitals - 15 Transplant Centers, 43 Programs - 10.3 Million Population Gift of Life Donor Program Office (Philadelphia, PA) • 2011* Projected Data: - 440 Organ Donors / 42.7 Donors/MM - 1,236 Bone Donors and 2,551 Cornea Donors • Over 31,000 organs for transplantation and over 375,000 tissue allografts • Accredited by: Association of Organ Procurement Organizations (AOPO); American Assoc. of Tissue Banks (AATB) & Eye Bank Assoc. of America (EBAA); UNOS/OPTN member OPO Team Philadelphia Transplant Recipient Athletes Competing *Source: Gift of Life data. 2011 Projection Based on YTD performance through 11/15/2011 at the 2010 U.S. Transplant Games in Madison, WI
3. U.S. Overview• OPO‟s have variation in roles, responsibilities and process Specialized Requestors (family focus with minimal if any clinical responsibility) vs. Transplant Coordinators w/ Full Case Responsibilities (referral through the OR) Approach for Authorization (non-designated donors) vs. Approach for Disclosure (designated donors)
4. Gift of Life Donor Program Best Demonstrated Practices• OPO Referral Trigger: „Refer all vent-dependent patients with a non- recoverable neurological injury‟• OPO Commitment - Immediate on-site response to evaluate every organ donor referral• Hospital - OPO team approach to clinical management & family centered care Family• Strong OPO emphasis on – Consistency in clinical practice – „Timely referral‟ – „Effective requestors‟ Hospital OPO – Family empowerment• Routine open dialogue w/care team; reinforcing environment of joint accountability for outcomes
5. U.S. OPO Transplant Coordinator Background & Staffing ModelTypical Backgrounds:• Critical Care Nurses• Paramedics• Respiratory TherapistsOPO Staffing Model:• Transplant Coordinators• Referral Coordinator• Advanced Practice Coordinators• Specialized Requestors• In-House Coordinators
6. Gift Of Life Donor Program Transplant Coordinator Responsibilities Check DMV Family Support Referral & Intake & Communication On-site Response OR SchedulingClinical Assessment Communication Diagnostic Testing & PrepDonor Management Organ Allocation & SurgicalCollaboration with Recovery Care Team Coordination Team Huddles Real Time Education Post Mortem Care Follow-up Letters
7. Consent Philosophy andInteractive Training Model
8. Historical Approach to Consent (1974 – 1995)• Process oriented (focus on clinical and recovery details)• Script-like family conversations – Designated Requestor ‒ Death Centered to help the grieving family ‒ Requestor saw self as Donor Family Advocate• Inconsistencies in the way staff conducted conversations (individual vs. organizational practice)• Minimal orientation training (often preceptor driven)• No continuing education training on consent
9. Dual Advocacy: A Value-Positive Approach To Obtaining Consent For Organ and Tissue DonationSMGoal: Inspire the family to donate by helpingthem understand the power of their decision.
10. What is Dual Advocacy? With Dual Advocacy the donation professional‟s responsibility is to advocate for both the waiting recipients and the potential donor family. Donation Professionals (Family Communicators) see themselves as: • Proactive specialists • Members of the family care team• Responsible to empower families to save and improve the lives of others through transplantation
11. Dual Advocacy-Philosophical Framework Based on Three Underlying Beliefs Held by Donation Professionals Most people given an opportunity to save a life, or help someone, will do it. Organ / Tissue donation feels like the right thing to do.The key role of the donation professional is that of a “Dual Advocate.”
12. Transplant Coordinator Introduction to Family“This is „Coordinator‟s First & Last Name.‟He is a member of our team who specializes in working with families like yours who lost someone they love.”
13. At The Heart Of Dual Advocacy Lies A Simple Question: Did we empower the family and give them something to say yes to?
14. TEAM PHILADELPHIA 2010 109 Athletes 76 Donor Family Members 13 Living Donors 354 Total Participants27 Gold Medals – 35 Silver Medals – 30 Bronze Medals
15. Our Training Commitment Increase organ and tissues available for transplantation through the improvement of staff competencies.Extensive training programs, continuing education offerings, scenario-based skills practice, field coaching, and proficiency evaluations.
16. Leadership Models the WayOrganizational Commitment: • Consistent messages • Learning/Teaching culture • Every opportunity matters • Extensive training • “Dual Advocacy” is both an organizational and individual responsibility • 24/7 mentoring, coaching and guidance
17. Gift of Life Institute Celebrates Its 7th Year in Operation• Over 200 workshops with 51 OPOs and tissue banks participating• More than 3,500 donation professionals trained in the U.S. and Canada, plus hosted visitors from Australia, Netherlands, China, Japan, Germany, Canada, Philippines, Brazil and Spain• National training curriculum with customized workshops at OPOs in consent and hospital development; consulting services including OPO evaluation, focus groups, staff development, customized hospital assessment and strategic planning http://www.giftoflifeinstitute.org
18. www.giftoflifeinstitute.org Internet based skills practice Variety of consent scenarios Experienced mentor providing real-time feedback
19. Staff Development & Training Family Communication Didactic ClassesOrientation (4 Months) • Active Listening• Classroom didactic • Consent Module I: (7 - 8 weeks) Introduction to Family Communication and the Donation Discussion: GLDP’s Dual• Preceptors AdvocacySM Philosophy • Consent Module II:• Field Developing Effective Family Communication Skills and Conversational Strategies: GLDP’s experience Family Communication Practice and Policies • Consent Module III:• Independent-Study Family Communication: Learning the Art of Averting and Overcoming Challenges and Learning Modules Obstacles • Foundation for Understanding the Basics of Grief Didactic Classes = 33 • Legal Aspects of Consent
20. Organ DonationGoal SettingMonthly and AnnualPerformanceDashboards
23. Gift of Life Donor Program Organ Donation Consent Rates 2000 – 2010 Pre-Training Training Post-Training Implementation 2/1/2005 2000 2005 2010 51% 57% 66%Organ Donors: 298 382 440**projected to 2011 based on data from Nov. 15, 2011
24. Gift of Life Donor Program Organ, Bone and Cornea Donor Experience2,4002,300 1974 – 2010 2,364 2,3822,2002,100 Organ Donors2,0001,900 Bone Donors1,800 1,824 Cornea Donors1,7001,600 *Based upon GLDP data through December 31, 2010.1,5001,400 1,4201,300 1,3251,200 1,220 1,037 1,0351,100 1,027 1,0261,000 882 899 900 895 863 878 885 810 800 801 757 744 698 700 623 623 631 600 520 428 470 401 439 500 469 392 421 331 354 387 434 400 298 428 210 204 208 262292 222 326 315 344 382 389 300 153 183 190 201 284 118 241256 298 200 78 82 87 92 182 235 100 23 45 62 158 149 180212 83 93 174 0 79
25. Gift of Life Donor Program Musculoskeletal Donation Approaches & Consent Training Musculoskeletal Pre- Implemented Post - Donation Training 2/1/2005 Training 2/1/2002 2/1/2005 2/1/2008 to to toYears 1/31/2005 1/31/2008 1/31/2011Approaches 7,020 8,582 11,922Yes 1,795 2,520 4,148Consent Rate 26% 29% 35%
27. Gift of Life Donor Program 2010 Tissue Donation Summary 2,482 Tissue Donors Tissues Donated Cornea 2,330 Skin 777 Musculoskeletal 1,035 Heart Valves 208 Saphenous Veins 236 Other 1,008 Total Tissues Donated 5,594Some patients may donate multiple tissues for transplantation. Source: Based upon GLDP data through December 31, 2010
28. Gift of Life Donor Program 2000 – 2010 Outcomes Musculoskeletal Donors = 7,111Potential People Helped = 319,995 Organ Donors = 4,129 Transplants = 11,779
29. Focus on Family Centered Care
30. It Really Is All About the 1’s…….. 1 Donor at a Time 1 Donor Family at a Time 1 Transplant Candidate at a Time !