1. Donation Process: Preparing for the Gift Breakout Session A Presenters: Jennifer Do, RN, Unit Director, Surgical Transplant ICU, Ronald Reagan UCLA Medical Center Beverly Jacoby, Donation Development Coordinator, OneLegacy Moderator: Marwa Kilani, MD, Providence Holy Cross Medical Center

2. Understand how to identify organ and tissue donors and the importance of timely referrals Understand the importance of preserving the opportunity for donation to maximize organs transplanted per donor Understand the importance of the partnership between hospitals and organ procurement organization (OPO) in the Effective Request Process Objectives

3. Explain the concept of timely referrals in the donation process Describe how preserving the opportunity for donation can maximize organs recovered Identify the types of partnership opportunities shared between hospitals and organ procurement organizations (OPOs) Questions to Run On

4. Hospital Clinical Triggers  Mutually agreed upon by Hospital and OPO*  GCS, ventilator-dependent, acute brain injury Hospital Policy  Identification of potential organ and tissue donors*  Medically maintain patients as potential donors* Identify Organ and Tissue Donors *CMS Regulations

5. Imminent neurologically devastated, or patients who received optimal treatment but cannot recover from injury or illness, whose death is imminent As soon as these individuals are identified, refer to OneLegacy within an hour of meeting criteria* Answer preliminary screening questions that include basic patient medical history Clinical Triggers / Timely Referrals *CMS Regulations

6. UCLA Health System Clinical Trigger ID Badges

7. If not a candidate for organ donation, hospital issued a referral number so that it can be used at the time of cardiac death If patient is deemed medically suitable for organ donation at the time of referral, OneLegacy will send a Procurement Transplant Coordinator (PTC) or Referral Process Coordinator (RPC) to conduct further evaluation of patient Timely Referrals

8. Referred when the potential donor’s organs are still viable OneLegacy PTC will evaluate patient as potential donor Meet with hospital staff (unit director, bedside RN, physician, spiritual care, social services) to gain a better understanding of what the family is going through so approach is smooth Hospital/OPO Partnership

9. Determine if patient is a registered donor Patient is declared brain death by two physicians, the second note is the legal time of death Once the second death is done, assess the timing of approach with family* Hospital/OPO Partnership *Check with Hospital Policy on time interval of notes

10. Physician’s Responsibilities Brain Death Determination  Brain death documentation by 2 licensed physicians not associated with transplantation  Note should state “Patient is Brain Dead”  Sign, date & time notes Test(s) performed to determine brain death:  Clinical exam is required in the State of California  EEG or CBF is not mandatory and may not be conclusive in newborn  Discretion of the physician for confirmatory tests  Hospital Policy and Procedure

11. Registered Donors (First Person Authorization) have documented their decision to become a donor on the Donate Life California Registry website or through DMV Similar to Advanced Directive and legally binding Family is provided this information Registered Donors

12. Some families will ask “What’s next?” Some families will mention “What about organ donation?” Difficult situation for hospital staff Refer patient to OneLegacy, and they will send a representative on-site What if the Family Mentions Donation?

13. Continue to optimize patient outcome according to standard medical practice Maximize the gift for the family and honoring the patient’s decision Hospital Policy CMS Regulations Preserving the Opportunity of Donation

14. Patient has suffered an irreversible neurological injury Does not meet brain death criteria Discussion for withdrawal of ventilator or vasopressor support are initiated by family or physician Patient may be a suitable candidate for Donation after Cardiac Death (DCD); OneLegacy evaluates each case Potential DCD and Withdrawal of Support

15. Brain Death vs. Donation after Cardiac Death For both organ donation opportunities, patient suffered a severe brain injury and is ventilator dependent Trauma: GSW, BHT, MVA Cerebral Vascular Accident: ICH, ICB Anoxia: MI, Drowning, Hanging

16. Interdisciplinary discussion between OL and key hospital staff (MD, RN, SW, etc.) regarding a potential donor case Opportunity to get everyone “on the same page” regarding family care, medical preservation of the donation option and testing plan Plan the optimal first discussion of donation for each family of each potential donor patient Effective Request and “Team Huddle”

17. Identify, protect, and preserve the donation opportunity for patients and their families when donation may be a viable end of life option Provide excellent end of life care for optimum healing of the family Effective Request and “Team Huddle”

18. Timing is critical Assessment of family dynamics Quiet setting away from bedside Physician provides finality of death OneLegacy approaches family collaboratively with hospital staff Authorization Approach

19. Explain the concept of timely referrals in the donation process Describe how preserving the opportunity for donation can maximize organs recovered Identify the types of partnership opportunities shared between hospitals and organ procurement organizations (OPOs) Questions to Run On