Call to organ donation center post pt death

[LogCabinMom]

Hi there -

I'm questioning a policy my hospital has and am wondering what other hospitals do. I have not encountered this at other hospitals mainly because they've been larger, and have had "death coordinators" to do this, so I wasn't directly involved.

At this hospital, though, it is required that we call the organ bank within 1 hr of all deaths and go through a very time-intensive question and answer process about the pt and their diagnosis, how they died, etc, sometimes involving the MD. The last 2 I've been involved in have taken about 45min, after which they have denied the pt. We call for ALL patients, not just those with an organ donation card. In fact, our policy even states:

"The opportunity for organ, eye and/or tissue donation should not be discussed with next of kin without NEOB involvement. NEOB must screen a patient for medical suitability prior to next of kin being offered the option for donation."

I find this really weird. First question is, where is HIPAA in this? Next, if I think as a patient's family, what if I am totally against organ donation and yet the nurse is giving all this personal information to the organ bank about my loved one - what if the organ bank says, yes, they would like this person's organs/tissue? Am I, as the RN, supposed to go into that deceased patient's room and try to convince the family that they should donate?

What do other facilities do?

Thanks!

[Altra, BSN, RN]

A federal law, the Organ Donation Recovery Improvement Act (2004) requires hospitals to notify their regional organ procurement organization of all deaths for screening for suitability for organ donation. Representatives from the OPO approach the decedent's family, if appropriate -- medical staff who have been involved in the care of the patient NEVER do this.

It does not violate HIPAA. I have made these calls countless times. In my experience, call takes no more than 7-8 minutes provided that you have the appropriate information gathered before calling: patient demographics (including SS#), past medical history, and a timeline of the interventions leading to up to the patient's death.

[netglow, ASN, RN]

LogCabinMom, I agree, it is very weird. I know for a fact that at some OPOs, reps are on a quota system, they are in essence sales people and must meet metrics to stay employed. So it's a numbers game, for them. You can bet some of those families are gonna be pressured in a big way into consent if one of those reps is a little under his/her numbers at the time of the call. Think about this type of job. Not a normal sales job since there is no way of priming the client by visiting and selling over time. You get a call from the hospital, and you got to get that consent any way you can. Lots of psych games to get that consent if the family is not able to handle such thoughts at the worst time of their lives. I think of traumatic brain deaths, and say it's your kid, and you just can't stomach the idea of organ harvesting... but the person from the OPO's numbers are a little low that month and they need to keep their job. That poor family is going to have to endure more pain in that phone call with intense pressure to consent so the rep can have a "win". This is what I don't like. Don't like it at all.

Things need to be changed... it's a big money business. And all the marketing is so lovey dovey, hmmm. Where the heck does the money go?

Organ donation is a great thing. But no one should ever be pressured in the process.

[s0ad]

I work on an oncology floor with many deaths and have made many phone calls regarding possible organ donation. I've only had one "maybe" (for eyes) which was later a no. None of my patients have ever qualified (mostly due to age, sometimes disease). I did have a nurse have a pt. that was a potential and apparently the family had to be asked some pretty uncomfortable questions (sexual habits, etc).

Usually these phone calls are short for me (less than 10 minutes). If anybody ever did qualify for donation, it should not be the responsibility of the nurse to "convince" the family. We are there to provide care to the dying patient and emotional support to the family and when you begin asking to harvest the patient's organs, it kind of breaks that bond. If they have a question, and you know the answer, then I think its ok to answer, but it should not be brought up by the nurse caring for the pt. The liaison who deals with organ donations needs to step in and talk with the family. Our county has one for the few hospitals in the area.

[KelKelKel]

In my State we are not to discuss organ donation with the family. We call in repsonse to certain triggers, GCS 5 or less, mention of terminal wean, mention of donation, etc. In my most recent Organ donation case, the OPO was on site, but did not actually approach the family until almost 10 hours after any mention of terminating care, and that was after they did extensive research about whether he was eligible or not (the process had actually started the day before, so they had already been working on it for 24 hours) I was heavily involved in this process, and I can say they were very professional and compassionate and never once did I feel they were putting pressure on the family to donate. They were very supportive of the family during such a hard time.

[MunoRN, RN]

The initial call is usually not more than 10 minutes in experience as long as you have the information ready. If they're interested then there will be more calls although those are also usually pretty short.

Not a HIPAA violation, next of kin become the designated decision makers when the patient is unable to make decisions, which means they have a right to the information needed to make those decisions, obviously death counts as incapacitated when it comes to decision making.

It's not your job to convince the family to donate, although I've been involved in situations where donation is pursued I haven't found it to be lacking in compassion, actually quite the opposite. Everyone patient I've had who's turned into an organ source has been young and their death was unexpected, the opportunity to improve the lives of others is usually the one bright spot we have to offer families of someone who's brain dead, and at least in my experience families have appreciated having something positive to focus on.

On a side note, "death coordinator"; best job title ever. I'd have business cards made up immediately and pass them out at parties, (which is probably why I should never had that job).

[nrsang97, BSN, RN]

Never mention donation to the family. That the agency will do. No it is not a hipaa violation.

[netglow, ASN, RN]

Seriously though, the coordinator is informed in no uncertain terms of "expectations" during the face to face interview. Coordinators are heavily trained, lots of scripting. If the family is all for donation, it's a breeze and there is no pressuring anybody. It's a real bear of a job if they don't lay down easily, and the turnover is extremely high due to not meeting quota and when it dawns on the coordinator what their job really is, hard to ignore that if you have feelings and values. Hence, some OPOs have stopped hiring healthcare professionals... it's a 'can you live with yourself when you suddenly realized what you are doing for a living' problem, and healthcare folks realize "it" right away. Once consent is won, then another group entirely handles the family afterwards. Lots of heavy interaction and counseling in the form of debriefing and moulding of impression of what all just went down. Families more often than not will latch on to what the OPO after event counselors impart as how to think about what the hell just happened, it's easier than going nuts. BTW, I have interviewed at an OPO in the past, and saw all behind the curtain, so to speak.

[mappers]

We are required to notify the organ donation agency in our state for every death. I've done it a few times, it never took 45 minutes though. We do not discuss it with the family. If the deceased qualifies, the agency will discuss it with the family. I witnessed a cornea harvest once. It was interesting.

[Altra, BSN, RN]

We are required to notify the organ donation agency in our state for every death.

This is a federal requirement, uniform in all states.

(H.R. 3926)

http://www.gpo.gov/fdsys/pkg/PLAW-108publ216/html/PLAW-108publ216.htm

[Laurie52]

Seriously though the coordinator is informed in no uncertain terms of "expectations" during the face to face interview. Coordinators are heavily trained, lots of scripting. If the family is all for donation, it's a breeze and there is no pressuring anybody. It's a real bear of a job if they don't lay down easily, and the turnover is extremely high due to not meeting quota and when it dawns on the coordinator what their job really is, hard to ignore that if you have feelings and values. Hence, some OPOs have stopped hiring healthcare professionals... it's a 'can you live with yourself when you suddenly realized what you are doing for a living' problem, and healthcare folks realize "it" right away. Once consent is won, then another group entirely handles the family afterwards. Lots of heavy interaction and counseling in the form of debriefing and moulding of impression of what all just went down. Families more often than not will latch on to what the OPO after event counselors impart as how to think about what the hell just happened, it's easier than going nuts. BTW, I have interviewed at an OPO in the past, and saw all behind the curtain, so to speak.[/quote']

This has certainly not been my experience. The coordinators I work with are very supportive of families regardless of the family's decision. I don't think interviewing for a job gives you inside info on how things are done.

[imintrouble, BSN, RN]

Back to the thread:)

Small hospital here too. We have to call the donor number following every death. Last call I made was VERY lengthy. I'd never had anybody ask me that many detailed questions. Lab, VS, and Xray reports.

What made me angry was that both admitting diagnoses made the deceased ineligible for donation. All donation. I found that out after about 30 minutes of detailed questions. I couldn't for the life of me figure out why we had to dance the dance, when the answer to the first question eliminated my pt as a donor. I understand completely about protocol, but yikes! Let's be reasonable.