Cutting Through the Red Tape: Establishing an Organ, Tissue, Eye Donation Program in a Veterans Affairs Medical Center Shaneé D. Stewart, MPH Donation System Specialist

Background State law mandates all eligible medical facilities have an agreement with an Organ Procurement Organization (OPO). For decades the local Veterans Affairs Medical Center (VA), also a transplant center, was out of compliance. This examines the best practices put in place to overcome hurdles in establishing and maintaining an Organ, Tissue, and Eye Donation (O/T/E) Program in a VA facility

VA Organ and Tissue Handbook In April 2009, the Department of Veterans Affairs in Washington, DC published the VHA handbook concerning organ, tissue and eye donation. Under the Office of Patient Care Services The handbook was recently recertified April 2014

VA Organ and Tissue Handbook The revised regulations states that each VA medical center must have implemented written protocols that: – Incorporate an agreement with the local OPO; contacting in a timely manner and upon imminent death – Include at least one tissue and eye bank registered with the FDA – Disclosure of all pertinent health care information

Michael E. DeBakey VA Medical Center A member institution of the Texas Medical Center (TMC) since 1985 Located on a 118-acre campus and built in 1991 MEDVAMC is a state-of-the-art facility with 357 acute care beds A 40-bed Spinal Cord Injury Center A 141-bed Community Living Center 40-bed domiciliary residence for homeless Veterans Liver Transplant Center Kidney Transplant Center

Hospital Engagement by the OPO In February 2012, foundation work for the donation program began with a face to face meeting with the OPO CEO and VA Chief of Staff. The OPO Hospital Development (HD) Representative arranged monthly meetings by identifying key hospital staff, recruiting physician champions, and designating essential contacts in Quality Management. HD assisted in drafting a hospital agreement incorporating government regulations. Bi-weekly meetings were scheduled to integrate the donation process with hospital logistics.

Hospital Engagement by the OPO OPO staff was issued VA badges for access to the hospital. Education was provided weekly from HD to staff and trigger cards were given to nurses. The OPO HD continues to provide monthly feedback on hospital progress.

VA Staff Engagement VA Chief of Staff - CEO Director of Ethics/Physician Advocate Quality Management CNO Decedent Affairs Department ANOD – Administrative Nurse on Duty MAA – Medical Administrative Assistant Education Department Directors/Managers of Units and OR IT Transplant Center Representatives (if applicable)

Data Organ and Tissue Dashboard – Conversion Rates 9/12-12/122013*Q1-Q Organ Donors100% 1/10% 0/0100% 1/1 Organ Referrals100% 5/5100% 11/11 100% 6/6 Tissue Donors 40% 2/519% 3/16 10% 1/10 Timely Referrals82% 108/13194% 381/405 99% 270/284 Referral Rate90% 131/14695% 399/42099% 284/287

U.S. Air Force Veteran Ronald Chustz, the 50 th liver transplant patient at the Michael E. DeBakey VA Medical Center, poses with (from left) Dr. Christine O’Mahoney, Dr. Stacey Carter, Samirah Brown, RN, Chiquita Jones, RN, and Brenda Chustz.

From left: Chiquita Jones, RN; Army Veteran Francisco Perez, Jr.; Army Veteran Roberto Saldana; Hepatologist Khozema Hussain, M.D.; Navy Veteran Raymond Simmons; and Samirah Brown, RN.