1. A Panel Discussion The Donation and Transplantation Symposium October 15, 2013 Presenters: Amy Durrant, OneLegacy Ambassador & Donor Wife Robert Coppel, Family Care Specialist, OneLegacy Melanie Crowley, Clinical Manager Trauma Service, Northridge Hospital Medical Center Moderator: Bryan Stewart, Vice President of Communications, OneLegacy Donor Designation, Your Families and You

2. Kevin Durrant

3. Donor Designation Robert Coppel Family Care Specialist OneLegacy Working with Families in Conflict

4. Advance Health Care Directive Form “You have the right to give instructions about your own health care.”

5. (2.1) END-OF-LIFE DECISIONS: I direct my health care providers and others involved in my care to provide, withhold, or withdraw treatment in accordance with the choice I have marked below:  a) Choice Not To Prolong: I do not want my life to be prolonged if the likely risks and burdens of treatment would outweigh the expected benefits…  b) Choice To Prolong: I want my life to be prolonged as long as possible within the limits of generally accepted medical treatment standards. Upon my death (mark applicable box):  I give any needed organs, tissues, or parts

7. Melanie Crowley, RN, MSN, CEN Clinical Manager, Trauma Service Northridge Hospital Medical Center Donor Designation Protecting the Decision: A Case Study

8. Admit 12/14 @ 00:46 20yr Female admitted s/p MVA Only ID is Credit Card in pocket GCS 3 on arrival / Severe Traumatic Brain Injury Referred to OneLegacy @ 08:34 Family onsite +8hrs post ICU admit Registered Donor Day 1 Day 2: CT Scan shows herniation Day 3: EEG ordered, Na 119 Family first voices objection to donation Day 4: First BD Note written 12/17 @ 19:10 Pt too unstable for CBF/apnea test Day 2-4 Second BD Note written 12/18 @ 09:39 Family refuses to meet with OneLegacy FCS Nursing staff voices discomfort with starting case against family’s wishes 19:00 Administrator On Duty (AOD) contacted Day 5 Case Overview

9. Overarching Goal Strive to meet the needs of the What happens when these CONFLICT? Patient Family Staff

10. Law & Policy Must Guide Practice CA State Health & Safety Code Section 7150.35 (a): “…Absent an express, contrary indication by the donor, a person other than the donor is barred from making, amending or revoking an anatomical gift of a donor’s body or part if the donor made an anatomical gift…”  Anatomical gift that does not revoke before death is irrevocable  No permission from the donor’s family is warranted  The family does not have the power, right or authority to consent to, amend or revoke

11. ? Law & Policy Must Guide Practice Northridge Hospital Policy

12. Law & Policy Must Guide Practice

13. Utilize Your Resources Follow your chain of command: AOD AOD Unit Director Unit Director VP Medical Affairs VP Medical Affairs Bioethics Bioethics Legal Counsel Legal Counsel OneLegacy Hospital Liaison OneLegacy Hospital Liaison

14. Perception = Reality Address Misconceptions of Family & Staff Validate patient’s Donor Registry status (Document of Gift) Validate patient’s Donor Registry status (Document of Gift) Donor Registry Status cannot be overridden Donor Registry Status cannot be overridden Donation honors the patient’s wishes! Donation honors the patient’s wishes!

15. Next Steps 12/18 @ 24:00 (+14hrs post BD declaration) Charge RN & OneLegacy FCS meet with family in hospital lobby Additional family support provided by Social Work, Nursing Staff, OneLegacy Staff 12/19 @ 12:00 Family completes Med/Soc History Family provided with memory box, handprints, Aftercare Support Services Day 5 Post Admit

16. Case Outcome 4 Organs Recovered & Transplanted: Left Kidney – 17yr Male Right Kidney & Pancreas – 49yr Male Liver – 61yr Male Tissues Recovered for Transplant: Corneas Bone

17. A Panel Discussion The Donation and Transplantation Symposium October 15, 2013 Presenters: Amy Durrant, OneLegacy Ambassador & Donor Wife Robert Coppel, Family Care Specialist, OneLegacy Melanie Crowley, Clinical Manager Trauma Service, Northridge Hospital Medical Center Moderator: Bryan Stewart, Vice President of Communications, OneLegacy Donor Designation, Your Families and You