I've been a critical care nurse for 6 years, I'm employed at a Southern California hospital that mandates all nurses taking care of poor prognosis patients to report them to one organ donation company. If a nurse fails to comply or report it to that "none profit" organization, even if the family does not want to donate organs, we are written up. Essentially, we are forced to call them regardless and this organization sends a nurse to persuade the next of kin in their vulnerable state. I mean within hours of being declared brain dead.
If the deceased did not make their wishes known about organ donation, nurses should not force another third party to come in and try to sales pitch them. I asked one of the family's what they said, and they said all the good things that come from it, i.e. a tragedy. I think the organ donation organization plays on their vulnerability.
I've done research on this particular organ donation company and the CEO makes well above $500,000. I've seen invoices from other hospitals the amount of money that goes into harvesting an organ and clearly have been disenchanted by the thought of donation. Additionally, this organization threw a thank you party for our unit because we had 6 organ "harvesting" in a month.
I feel there are HIPAA violations of reporting something to a third party without the family's knowledge and mandating it by the hospital. Note, we do not get permission from the family to divulging information about the decease.
I have not been an icu nurse for six years. I did not say that. Yes, I have seen autopsy and procurement. Saying you are misinformed is not questioning your intelligence, it's saying you don't quite understand the process or are misinterpreting what is going on. Not at any point did I say you were stupid or dumb.
Again, another thread, another wow. I don't care if you are for or against donation. That is a personal choice. I have never seen what the OP is claiming. The organ team have much more years of training and experience in approaching families than I do and I'm glad I have nothing to do with it. I'm glad I don't.
I have always seen them treat the families with the utmost respect. Always.
Just as people are free to agree with you OP, people can disagree. And nobody slung any names at you, while you have managed to sling them at others and look unprofessional. You can disagree professionally.
I never said you were an ICU nurse. I even stated, let me give you another example. The topic was, people questioning my knowledge. Another poster asked that question. I gave you examples of what users were saying, questioning my knowledge. Although, it may not have been explicitly said, I interpreted that way. There's many ways to call someone dumb without even saying the word.
I never said I was against organ donations. I'm for organ donation, I've said it numerous times. You can be for something and questioning certain practices. But, clearly, it's all or nothing, to you. Clearly, you have not been reading my posts.
I have contacted my state rep and let me tell you, the squeaky wheel gets the grease. So, if you do decide to go that route, just keep trying to contact them as long as you are able, so that you can finally get them to listen.
What did you contact your state rep about and what became of it?
The OP brings a curious point to light in that communicating PHI to this third party organ-procurement organization (Univ. of Miami Tissue Bank or Lifelink here in my locale) there may be HIPAA violations.
If I am ordered to request medical records from another facility, a patient or their representative must sign a release of information form.
Why is this not true when I share information with these organ procurement-related third parties, as I have done so many times in the past? I have never once stopped to think that I am sharing PHI without the knowledge of the patient or their representative, but now it seems I have done so quite a few times.
Anyone?
I was curious about this myself, so I read into policies of HIPAA and everything.
Like ambulance companies and what have you, they are designated to be allowed to read these types of information by law. I read into after I posted this already. Again, I'm from California. So, maybe HIPAA laws are different in your state.
Being written up for not reporting poor prognosis patients is violating (to me) the following :
1 - Family's right to choose;without being forced into making a choice at a time when they are under stress
(poor prognosis reporting = the organ procurement company can; and, probably does; send in a representative to talk to family and "convince" them to donate)
2 - It is a violation of your rights as a nurse for being ethical (HIPPA).
3 - Reporting poor prognosis patients is just plain wrong.
Most states have their own laws regarding this. If I was put in this position I would be reporting this to the state medical board; nurses union (if allowed in your state); and, any applicable agencies.
"During the 50-year period of protection, the Privacy Rule generally protects a decedent's health information to the same extent the Rule protects the health information of living individuals but does include a number of special disclosure provisions relevant to deceased individuals. These include provisions that permit a covered entity to disclose a decedent's health information: (1) to alert law enforcement to the death of the individual, when there is a suspicion that death resulted from criminal conduct (§ 164.512(f)(4)); (2) to coroners or medical examiners and funeral directors (§ 164.512(g)); (3) for research that is solely on the protected health information of decedents (§ 164.512(i)(1)(iii)); and (4) to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for the purpose of facilitating organ, eye, or tissue donation and transplantation (§ 164.512(h))."
Also, I have never seen an organ procurement agency come to see a family of a patient with a poor prognosis. They really only come to see the family when the patient is brain dead, on a vent, if they sound like they are a good candidate for donation based on the medical info that the nurse provides. Otherwise they will call a family to discuss eye/tissue donation if cardiac death has already occurred. If the patient is still a full code and we are still "doing everything" then they will call for daily updates and daily lab values, but will not speak to the family at all, or even let them know that they are following the case. There is literally zero pressure on the family. They only get the family involved when a) the patient has zero prognosis for recovery- i.e. two physicians have performed brain death/apnea testing, or b) cardiac death has already occurred. There are zero ethical violations here. Also, it took me a 2 second google search to find that HIPAA info, fyi.
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
What did you contact your state rep about and what became of it?
My son is autistic and we want rules to change about Amber alerts so that when autistic children wander, we can get a silver (vulnerable adult) or amber alert for them. It's something we are still fighting. My former congressman (I moved to a different part of the state) kept sending me form letters. So far, no change.
I did have a close friend whose son was killed in a hazing incident get legislation passed regarding hazing and schools disclosing that information. She and her husband were relentless and it took just over a year for it to pass. She was relentless though. It can be done but you have to be persistent and relentless. Don't give up, especially if it's something you are concerned about (and after reading more, I completely understand where you are coming from. ) I have been lucky that my experiences have not been like yours. I would like to apologize for my misunderstanding.
I guess i don't understand what it so horrible that the actual organ network has to actually talk to the family and can't just "take your word for it"
I had to call the donor network when i was withdrawing care on a HIV, multi-system organ failure pt. I told them this and i KNEW she wouldn't be a candidate but they still had to look over her chart and not just take my word for it.
My understanding is, if a family said no, no means no. I think autonomy is very important when caring for patient's and their family. But, again, in the end the greater good comes into play, like someone else mentioned, feelings v. lives, and then, you'll find your answer.
But, bringing in someone else to ask the question, again, does make it questionable to say the least. I see it as, hoping that no changes to a yes, whether it being being more informed. And, that's grey area.
My son is autistic and we want rules to change about Amber alerts so that when autistic children wander, we can get a silver (vulnerable adult) or amber alert for them. It's something we are still fighting. My former congressman (I moved to a different part of the state) kept sending me form letters. So far, no change.
I did have a close friend whose son was killed in a hazing incident get legislation passed regarding hazing and schools disclosing that information. She and her husband were relentless and it took just over a year for it to pass. She was relentless though. It can be done but you have to be persistent and relentless. Don't give up, especially if it's something you are concerned about (and after reading more, I completely understand where you are coming from. ) I have been lucky that my experiences have not been like yours. I would like to apologize for my misunderstanding.
California is an odd state. LOL!! I think it's really nice to hear when congressmen actually send letters back to people who've sent them very thoughtful letters. Gives me hope.
I'm sorry too. This topic is really sensitive. And, in the end, we all want to do good as nurses. Reading, feelings v. lives that someone posted, gave a perspective that I didn't have before.
Specializes in Complex pedi to LTC/SA & now a manager.
I was curious about this myself, so I read into policies of HIPAA and everything.
Like ambulance companies and what have you, they are designated to be allowed to read these types of information by law. I read into after I posted this already. Again, I'm from California. So, maybe HIPAA laws are different in your state.
HIPAA is national. This is absolutely permitted communication no patient or next of kin consent required.
I will admit your original post and first responses seemed anti-organ donation. However your clarification revealed a concerning issue whether it's their corporate policy or they keep hiring overzealous representatives. If a family seems on the fence and it's likely the deceased may have consented to donation and is a reasonable candidate then a second inquiry is not harassment. The scenario posted by Spidey's Mom was over the top. Hospice patients know they are terminal, the question of donation hopefully came up at some point in the consents and ultimate preparation for the inevitable. A patient who died with multiple organ failure, necrotic ulcers and mode is don. I don't care if their fingernails can save a new born. No means no.
This isn't about the ethics of organ donation. This is about the ethics of aggressive, heartless unreasonable donor company representatives hell bent on harassing grieving families that weren't waivering, no indication patient was a donor, grieving, said no and they don't take no for an answer as if their monthly bonus depends on getting as many parts donated as possible.
The title implies this is a debate over organ donation and couldn't be further from the truth. This is about aggressive body recruiters with questionable ethics. Im glad to say most of my interactions have been the polar opposite.
HIPAA is national. This is absolutely permitted communication no patient or next of kin consent required.
I will admit your original post and first responses seemed anti-organ donation. However your clarification revealed a concerning issue whether it's their corporate policy or they keep hiring overzealous representatives. If a family seems on the fence and it's likely the deceased may have consented to donation and is a reasonable candidate then a second inquiry is not harassment. The scenario posted by Spidey's Mom was over the top. Hospice patients know they are terminal, the question of donation hopefully came up at some point in the consents and ultimate preparation for the inevitable. A patient who died with multiple organ failure, necrotic ulcers and mode is don. I don't care if their fingernails can save a new born. No means no.
This isn't about the ethics of organ donation. This is about the ethics of aggressive, heartless unreasonable donor company representatives hell bent on harassing grieving families that weren't waivering, no indication patient was a donor, grieving, said no and they don't take no for an answer as if their monthly bonus depends on getting as many parts donated as possible.
The title implies this is a debate over organ donation and couldn't be further from the truth. This is about aggressive body recruiters with questionable ethics. Im glad to say most of my interactions have been the polar opposite.
Boo hoo.
Who cares about someone's feelings when LIVES are on the line? The pursuit of organ donation should be aggressive and persistent. We owe that much to those who are dying and to the families to know what their feelings may cost.
Organ donation is serious and should be treated as such, their tears will dry but dead is forever. Maybe their loved one's death will mean that others may live.
"Who cares about someone's feelings when LIVES are on the line? The pursuit of organ donation should be aggressive and persistent. We owe that much to those who are dying and to the families to know what their feelings may cost."
Absolutely wrong. Each person has rights, and your rights/your family member's rights DO NOT take precedence over mine! I know you will disagree, but too bad. What if I wanted your car because it was prettier than mine? Do I have the right to just take it? What if I NEED rent money, and you have more money than you need? Can I come take it just because? What if I am having difficulty feeding my child, can I come in your house and raid your refrigerator even though you say no? Where does it end?
OP, I'm not questioning your intelligence, experience, or anything else, but it sounds to me like you have an issue with organ donation. I've been an RN for a long time. I've had experience with organ donation professionally and personally. When my youngest brother died (AVM rupture), seven people got the best Christmas gift ever. His being an organ donor helped me to make sense of his death. Just last Sunday, my niece received a pancreas and kidney. She had been on dialysis for a year and it was taking its toll on her. Immediately after surgery, her kidney was functioning properly, her blood pressure and blood sugar were within normal limits for the first time in years. The donor and his family have blessed her, her husband, and their four year old son beyond measure.
What I'm trying to say is, it's OK to question policies and procedures. Just don't do it within earshot of families who are watching a loved one who is actively dying. Your attitude toward organ donation may be the difference between a selfless, lifesaving decision or the death of, not just one, but multiple, patients.
Do you mean there are zero HIPAA violations here? I wouldn't say there are zero ethical violations. A rep approaching family members repeatedly is coercive and is an ethical concern for the deceased's family members.
dangerous1
50 Posts
I never said you were an ICU nurse. I even stated, let me give you another example. The topic was, people questioning my knowledge. Another poster asked that question. I gave you examples of what users were saying, questioning my knowledge. Although, it may not have been explicitly said, I interpreted that way. There's many ways to call someone dumb without even saying the word.
I never said I was against organ donations. I'm for organ donation, I've said it numerous times. You can be for something and questioning certain practices. But, clearly, it's all or nothing, to you. Clearly, you have not been reading my posts.