Progress Notes, Number 11, Fall 1997
Yet, we recognize that "one size fits all" solutions cannot successfully address the variety of issues and needs facing hospitals and OPOs. Key to the success of this approach is its flexibility. Different hospitals are taking this framework, responding to local realities and figuring out how to make it work for them. For example, facing the challenge of training a large, diverse nursing staff in the new protocol, Oregon Health Sciences University developed concise, to-the-point 15-minute presentations, scheduled when nurses are available and videotaped so that per-diem nurses and other part-time staff could learn about the protocol at their own convenience. The University of Maryland Medical System created a new position for a remarkable trauma nurse, allowing her to take families step-by-step through the process from grave prognosis to donation to bereavement resource information, always making sure the family's needs are her top priority. Her success is reflected in both increased family satisfaction and rising donation consent rates. At the University of Iowa Hospitals and Clinics, a Family Support Person team, comprising social workers and clergy, was created to ensure consistent application of the donation protocol and that a trained staff person is always available to support the family and the health care professionals.
Early data on donation and consent rates from the University HealthSystem Consortium (UHC) project are promising, and give credence to the old adage, "practice makes perfect." Part of the value of this program is that each experience between families and staff is carefully examined, so that if difficulties arise, as they commonly do when trying something new, the causes can be identified quickly and the process at each hospital can be fixed.
The foundation of The Partnership's hospital-based solutions is solid research. Our recently-published study of donor and non-donor families quantified what donation professionals have long suspected families have the vocabulary, but not the meaning of brain death. Yet their understanding of brain death directly affects their willingness to consent to organ donation. Fortunately, many hospitals and organizations are developing brochures and visual aids to assist staff in explaining brain death to families.
Pictured in this issue of Progress Notes, our Critical Care and Transplant Advisory Boards deserve special thanks. Since the inception of The Partnership's work, we have benefited from the contributions of a wide range of professionals who have shaped our projects and research, bringing their own clinical and research experience to bear on the work we do. Our work is much stronger as a result of their generous advice.
As we begin to see success and increased donation rates in hospitals
across the U.S. and Canada, we know this would not be possible without
the corporations, hospitals, OPOs, government agencies and individuals
who have supported our work financially. As a private, non-profit organization,
we depend on this support to continue our work. By joining our efforts
and resources, we are helping to save and improve lives through transplantation
by making sure that the organ donation process is appropriate and sensitive
for those families who give the gift of life.
Michael J. Evanisko President
Carol L. Beasley Managing Director
The following articles are contained in this issue of Progress Notes:
Protocols have been enacted at Oregon Health Sciences University, University of Iowa Hospitals and Clinics, Virginia Commonwealth University's Medical College of Virginia Hospitals, Ohio State University Medical Center, and Medical College Hospitals of Ohio. Most of the recent donation requests at these hospitals have included two or three of the factors necessary for an optimum request to the family: decoupling of the declaration of brain death from the request; quiet, appropriate setting; and both hospital and OPO staff involved in the request. OPOs participating in the project include: LifeNet (VA), Iowa Statewide Organ Procurement Organization, Pacific Northwest Transplant Bank, Transplantation Society of Michigan, Lifeline of Ohio Organ Procurement Agency, and Life Connection of Ohio.
The six-month collaborative intervention in each hospital involves developing and implementing a framework for a more optimal donation process, comprising a formalized donation protocol, a designated team within the hospital with primary responsibility for carrying out the donation protocol, and a system for ongoing monitoring. The intervention is followed by a six-month monitoring period to ensure that long-term changes are successfully institutionalized.
One unexpected finding is the large number of cases in which the families themselves first bring up organ donation. In past Partnership work, 13 percent of the cases were family initiated. In this group, 28 percent have been family initiated, with a consent rate of 69 percent. "It's a bit early to understand what's going on," says Carol Beasley, Partnership managing director. "It may be that one byproduct of better family communication is that more families feel comfortable bringing the issue of donation up themselves. Obviously, we'll be watching this."
A closer look at two key elements of the collaboration in two participating hospitals' professional education at Oregon Health Sciences University (OHSU) and the Family Support Person team at the University of Iowa Hospitals and Clinics (UIHC) provides a window into the project.
Professional education
Throughout the critical care units at OHSU, it's hard to miss the neon
pink laminated cards with "OHSU ORGAN DONATION PROTOCOL" on one side and
"YOUR ROLE" on the other. The card outlines, both in words and by a flow-chart
diagram, the role of MDs, RNs, In-House Coordinators and all staff who
come in contact with potential organ donor families.
"Our intent is that the families receive adequate communication and the option of choice," says Retty Grimwood, R.N., director, Neurosurgical/ Medical ICU. "Our commitment is to provide families with a better experience and if donation comes out of it, that's for the better."
The first step was to educate all hospital staff who have contact with these families. Karen Ellmers, R.N., C.C.R.N., nurse educator; Susan Yoder, R.N., nurse administrator and in-house coordinator; and Trudy Robinson, R.N., transplant coordinator, Pacific Northwest Transplant Bank, developed a 15-minute presentation "crisp, to the point and action oriented," which highlights the changes in the protocol and what each staff member is being asked to do. Their goal was to reach all 400 nurses both regular staff and the large part-time resource staff in targeted critical care areas: neo-natal ICU, coronary care unit, neurosurgical/medical ICU, surgical trauma, cardiac recovery, pediatric ICU, pediatric transport team, emergency room and the critical care float pool.
"One of the educational challenges in a university setting is that we have many different programs with an educational thrust," says Ellmers. "When you get down to the staff nurse level, every week they are bombarded with a new piece of equipment or a research project they have to learn about. But we're very committed to organ donation and transplantation."
The presentations were made at staff meetings, before and after shift reports, or any time that was convenient for the busy staff. The presentation was also taped and made available to nurses who couldn't attend in person. The pink cards outlining the protocol and staff roles were distributed as a quick reference guide.
"We didn't have to do any selling about organ donation," says Ellmers. "One of our goals was increasing a more sensitive family approach. I think that really appeals to nurses."
Concurrently, a similar effort was made to residents and staff physicians at their required weekly lectures and grand rounds. Information was also presented to chaplains, social workers and medical interpreters, "because they all have a place in the request process," says Ellmers. "We're seeing this as a one-time education that we want everyone to receive."
Family support
Family Support Person (FSP) teams are an option for hospitals aiming
to improve family support while bringing greater consistency and quality
to their handling of organ donation. Such teams can play an active role
in the implementation of quality improvement efforts in organ donation.
At UIHC, a multi-disciplinary Donation Committee, comprising physicians, nurses, social workers, hospital administrators and members of other departments, developed a protocol for organ donation. "The system we had was not user friendly. The Partnership has helped us find this new system," says John Sum-Ping, M.D., Medical Director, Surgical ICU. "Eventually we would have solved this problem ourselves, but it would have taken a long time because it wasn't a top priority for us."
They designed the FSP team to ensure consistent application of the protocol and that a trained staff person was always available to support the family and the health care professionals.
It seemed a logical step to utilize social workers. According to Greg Jensen, director of the Department of Social Service and head of the FSP team, "Social workers have been providing psycho-social services to patients and family members at the UIHC for 76 years. Not only was the FSP role consistent with what the social workers were providing, but the accessibility issue was already solved." UIHC has an on-call program in which social workers are available throughout the institution 24 hours a day.
Responsibilities of the FSP include:
Referrals to the FSP team have been averaging one a week. The first few times, the FSP was called late in the process; once, donation had already been discussed with the family. "We went back to the physician and nurses and reviewed the protocol. In most instances, it took practice and experience to fully integrate the protocol to see the benefit to both family members and UIHC staff," says Sue Witte, M.S.W., coordinator of the donation protocol. "Physicians and nurses who have had hands-on experience in these cases have been very complimentary."
Although the families' response to the FSP team has not been evaluated formally yet, the feedback about having someone available to them has been positive.
"My primary job is to be the support person to the family, not to acquire organs. I'm there to provide information as the process unfolds so the family can make an informed decision," says Jensen. "When the patient is ultimately declared brain dead, the family has the right to have access to information regarding donation. I think it's an injustice to families not to deal with that issue."
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As in every other country where transplants are performed, Canada is facing a severe shortage of organs for transplantation. In 1996, there were 435 donors and a waiting list for transplants numbering in the thousands and continuing to grow. Of the industrialized countries, Canada has a relatively low rate of organ donation, with 15 donors per million population, compared to 21 donors per million in the U.S. and 27 donors per million in Spain, the top performing country.
Medical Record Review (MRR) was conducted in the 13 participating hospitals, located in Edmonton, Calgary, Vancouver and Toronto. This systematic examination of all deaths that occur in a hospital tracks key information that provides an understanding of how the donation process is working, illustrates patterns among potential organ and tissue donors, and identifies areas for improvement.
The review found 186 potential donors in 1995, of which 76 (41 percent) became actual donors. Potential donors were lost in 28 percent of the cases because they were not identified as such by hospital staff or their families were not asked to donate. Another 23 percent of families were asked but refused to give consent.
In comparison, a review of 456 charts in five Donor Action hospitals in Spain, The Netherlands and the United Kingdom revealed a 32 percent donation rate. Of the 268 potential donors, 52 percent of their families were not asked to donate, while consent was denied in 26 percent of the cases. The Donor Action program, developed by The Partnership, Eurotransplant in The Netherlands and Organizaci—n Nacional de Trasplantes in Spain, is designed to help hospitals diagnose and improve their organ donation procedures.
Following the Medical Record Review in Canada, a survey of 1,235 staff members in nine hospitals revealed a high level of support for organ and tissue donation. More than 92 percent support donation, 96 percent believe organ donation saves lives, and 73 percent believe it helps families cope with grief. However, most staff members underestimated public support for organ donation. In fact, more than 76 percent of Canadians support organ donation.
Comfort levels of the staff with the tasks surrounding donation were somewhat lower: 66 percent are comfortable explaining brain death, 61 percent are comfortable introducing organ donation and 52 percent are comfortable making the request. Sixty-six percent said they wanted training in at least one of the areas around donation.
Opportunities for improvement exist in identification of potential organ and tissue donors, consensus regarding approach processes, and clarification of staff roles. "It appears that organ donation in Canada faces many of the same challenges we have been addressing in the U.S.," says Carol Beasley, Partnership managing director.
Hospitals participating in the diagnosis include: Edmonton Royal Alexandra Hospital, University of Alberta Hospital; Calgary and vicinity Foothills Provincial Hospital, Children's Health Centre of Northern Alberta, Rockyview Geriatric Hospital, Bow Valley Hospital, Lethbridge Regional Hospital, Medicine Hat Regional Hospital, Red Deer Regional Hospital; Vancouver St. Paul's Hospital, Vancouver Hospital; Toronto St. Michael's Hospital, The Toronto Hospital.
At least one hospital has seen major improvements in donation following the diagnosis. "The process of looking at organ donation performance has enabled us to reach higher levels of performance," says Prudence E. Taylor, program manager, Transplant Services, for the Hope Program at the University of Alberta Hospitals. "But enthusiasm alone can't sustain higher donation rates. Now we'll be able to put an infrastructure in place to ensure that improvements are maintained."
In Edmonton, a working group was formed to look into this information and make improvements to the donation process so that it works better for both hospital staff and families of potential donors. The group's recommendations include: continue to perform MRR; consider a donation protocol with clearly defined roles and responsibilities; respond to staff request for education; increase visibility and awareness of the Hope Program; and explore opportunities to support hospital staff and improve their comfort and readiness in handling organ and tissue donation processes.
In a follow-up project, four hospitals will be selected for full implementation of the Donor Action program. This will include a formalized donation protocol that incorporates best demonstrated practices; a designated team within the hospital with primary responsibility for carrying out the donation protocol; and a system for ongoing quality monitoring to ensure that the protocol is followed consistently over time.
The project is a collaborative funding model, with major funding provided by Novartis Canada and a portion of costs contributed by participating sites.
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"While evaluative approaches are being incorporated into many areas of the U.S. health care system, this is not yet the case for the nation's organ procurement system," says principal author Patrick McNamara, Ph.D., Partnership manager of research and evaluation. He points to Medical Record Review (MRR)Ña systematic audit of hospital deaths to collect specific data about each potential organ donor caseÑas currently the best available method for evaluating donation performance.
"MRR yields accurate estimates of donor potential for an individual hospital," he says. "It also provides information on unrealized donor potential so that hospital practices can be adjusted appropriately."
Although 20,260 transplants were performed nationwide last year, 10 or more people died every day while waiting for an organ and more than 50,000 people were on the transplant waiting list by year's end. The nation's procurement system recovered organs from 5,411 cadaveric donors, estimated to be only a fraction of the potential donors. A previous study by The Partnership, in collaboration with the Harvard School of Public Health, found that only one-third of medically suitable potential donors become actual donors, and estimated a pool of 13,700 medically suitable donors per year.
"These figures offer little guidance to individual hospitals or OPOs attempting to assess their own effectiveness," says Carol Beasley, Partnership managing director. "Yet we know that hospitals can increase their donation rates once they know what the problems are and start to address them."
For example, in a previously reported two-year intervention implemented by The Partnership in 50 hospitals within the service areas of three OPOs, the overall donation rate increased significantly, from 33 percent to 43 percent following MRR and staff education about donation. Recent Partnership interventions have led to donation rates above 60 percent, using MRR to assess baseline performance and to track donation improvements.
The fact that organ procurement rates vary substantially over a wide range of hospital types and sizes indicates that some hospitals are doing a better job than others. "In line with standard approaches to quality improvement, high-performing hospitals should be examined closely to identify superior practices, those practices should be validated, and strategies should be developed to facilitate their adoption in less effective hospitals," says Beasley.
This is where Medical Record Review becomes useful. MRR involves conducting an initial screen of hospital deaths; collecting data on those patients who meet brain death criteria and are medically suitable to donate organs; and then assigning each case an outcome classification.
"Periodic MRR can measure the effectiveness of the hospital organ procurement system, including rates of identifying suitable donors, rates of asking families to donate, rates of consent among those families asked, and rates of cardiac arrest or medical examiner refusal," says McNamara. "These indicators establish donation potential, reveal where and how potential is being lost, and yield information on long term trends, opportunities and systemic problems."
A compatible effort was recently initiated by the Association of Organ Procurement Organizations (AOPO). "The whole idea behind the AOPO project is really to take a look at what is true donor potential," says Lori E. Brigham, M.B.A., executive director of the Washington Regional Transplant Consortium and co-chair of AOPO's Performance Standards Task Force. Performance standards for OPOs have always been based on donors per million, which Brigham says "is going to vary, depending on the OPO, their potential, the demographics of that particular area, whether you're in a regional program, whether you're hospital based. In taking a look at what OPO performance is all about, it has to be based on what your potential is."
Examining initial data from 29 OPOs, the AOPO project found 1,229 potential donors from July through December, 1996. There were 338 actual donors (28 percent donation rate); 239 potential donors were not referred to the OPO. Assuming a 28 percent donation rate, AOPO estimates that 67 of these would have become donors if they had been referred, and 201 transplantable organs would have been recovered. Since the 338 donors are 6.2 percent of the actual donors nationwide during this six-month period, AOPO concludes that more than 3,000 organs were missed in the U.S.
"It really drives home the point that every single donor counts," says Brigham. "Overall, people are not shocked or surprised at the data. Everybody has an intuitive sense that we are missing some donors. Data just confirm that is the case. There's still a large percentage of hospitals that are not identifying medically suitable potential cases for organ and tissue donation."
The project is ongoing and will be collecting data for all of 1997. "The OPO community realizes that reviewing medical records is an important way to measure performance," says Beasley. "Hospitals are beginning to embrace this."
For a copy of "Medical Record Review as a Measure of the Effectiveness of Organ Procurement Practices in the Hospital," contact The Partnership Communications Department. For more information about Medical Record Review, call The Partnership at (617) 482-5746; Lori Brigham at (703) 641-0100; or Suzanne Lane Conrad at (319) 337-7515.
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Tyree Nutter, R.N., M.A., a former trauma nurse and patient care coordinator, was appointed to that position to work with the families of potential organ donors from the beginning of the protocol, when they are presented with the grave prognosis, through the declaration of brain death and the consent process. Her role grew out of The Partnership's first-of-its-kind collaboration among leading and "competing" health care providers in Baltimore to address the increasing need for transplantable organs and tissues throughout the state. New donation protocols were developed and implemented recently at both Johns Hopkins Hospital and University of Maryland, in collaboration with The Transplant Resource Center of Maryland.
Nutter spends from four to 16 hours with each family she assists. Judging by the responses of these families, as well as the burgeoning consent rates, she is doing her job well. Of the first 21 families she worked with at Maryland's University and Shock Trauma Hospitals, 10 consented to donation, a 48 percent consent rate, compared to seven consents out of 44 requests (16 percent) at University Hospital in a 20-month period prior to the implementation of the new protocol. (Baseline data was not collected at Shock Trauma Hospital.)
"We're not just looking at whether the donors increase, but how the family feels about how they've been treated at the University of Maryland," says Nutter. Families have been very appreciative of this support, and one family even donated money towards the University's traumatic brain injury research.
She makes sure family members understand all the information the physician has communicated, the status or condition of their loved one, and the testing procedures and results. Each case has been different. About half have been African-American families. "All families are in crisis," says Nutter. "The need for that support and constant reinforcement in explaining things is definitely the same. I am there to support them whatever their decision is."
Only one family said no outright. Some families discussed the donation option but declined because there was no family consensus; some felt they could not make a decision because they had not had a prior discussion with their loved one.
"I don't offer the option of donation. I introduce the family to The Transplant Resource Center," she says. This follows Partnership research that shows that consent rates increase when both hospital and OPO staff are involved in the request. "The family is able to discuss donation more fully because they're approached at a time when they're emotionally ready to hear and understand what their donation options are."
Two to four weeks after the death, Nutter follows up by telephone with the family to see how they're doing and if there's any other way she can help. She is developing a bereavement care packet that will include information on brain death, funeral arrangements and support resources.
Hospital staff have been very receptive to Nutter's work, especially
the strong element of family support. "We believe that a coordinated effort
to provide the appropriate information and support will lead to increased
donations," says Jane Hooker, associate director of patient care services.
"Ultimately our goal is to ensure that the family's needs are met and they
are given the opportunity to donate."
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Organ donation professionals have long believed that a family's understanding of brain death influences their decision about donating their loved one's organs. Now there is solid research evidence, based on 164 extensive interviews with both donor and non-donor families, that shows just how pivotal the understanding of brain death is. Addressing this issue can lead the way to better care of families and higher consent rates.
"Families have the vocabulary, but not the meaning," say Holly G. Franz, B.S.N., C.P.T.C., of The Partnership and William DeJong, Ph.D., of the Harvard School of Public Health, who report their findings in the March 1997 issue of the Journal of Transplant Coordination. In telephone interviews conducted four to six months after the death of their family member, the immediate next of kin of medically suitable organ donor candidates were asked about their donation decision and the events leading up to it.
Nearly all donor (95 percent) and non-donor (97 percent) respondents stated that their relative was brain dead. However, when respondents were asked a series of questions to investigate their understanding in more detail, it became clear that brain death was confusing to many, with the majority (52 percent) of non-donor families believing that a brain dead person could recover. Only 61 percent of the donor families and 53 percent of the non-donor families said they had received an explanation of brain death from a physician or other health care worker.
Few respondents reported that the hospital or organ procurement organization staff used visual aids to clarify or reinforce the information they were given. "Brain death needs to be a primary focus," says Franz. "The Partnership is actively putting its energies into developing tools and standards for explaining brain death to families. You can teach hospital professionals to be skillful in this."
The Partnership is piloting a new Brain Death Comprehension Assessment Tool (BD-CAT). A checklist of questions about brain death with responses that can be put on a scale, this tool is designed to measure family understanding and acceptance of brain death. It can be filled out in one minute by a clinician who is working with the family of a brain dead patient.
The BD-CAT is being reviewed and revised by experts in critical care and neurology. It will then be piloted in hospitals in which The Partnership is working to increase donation. Other hospitals also may apply to pilot this tool. "Once the tool is validated, clinicians will be able to use something more than their own intuition to gauge where the family is with respect to understanding and acceptance of brain death," says Franz.
To ensure that the subject of brain death is properly handled, Franz and DeJong recommend that health care teams develop and be trained on a clear protocol for communicating with the families of potential organ donors from the initial communication of grave prognosis to the pronouncement of brain death and the organ donation request itself.
"How the explanation of brain death is given, how the family's understanding of their loved one's death is assessed, and how the family's questions are answered will spell the difference between good and substandard care," concludes Franz. "It may also spell the difference between higher and lower rates of consent to organ donation."
This is the first paper published by The Partnership using data from
the donor/non-donor survey. Others are in progress. For a copy of "Explaining
brain death: a critical feature of the donation process," contact The Partnership.
Hospital and OPO professionals are also invited to call or e-mail ideas
on how to communicate brain death to families effectively.
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A number of visual aids and hand-outs have been developed over the last two years to help families understand this difficult concept. In 1996, the National Donor Family Council of the National Kidney Foundation produced a pamphlet, based on the experiences of donor families, which defines and explains brain death. Since then, pamphlets on brain death have been developed at Medical College of Virginia Hospitals (MCV) in Richmond, VA, and other hospitals in the United States.
"Participating in The Partnership/University HealthSystem Consortium program to increase donation was definitely an impetus for this brain death pamphlet," says Susan Kuthy, Clinician IV, who developed MCV's pamphlet with partial funding from LifeNet Organ Procurement Agency. Organized in a question-and-answer format in simple, direct language, the pamphlet clarifies and reinforces that brain death is death and that there is no hope of recovery for a brain dead person.
"We needed something to give families after talking to them about brain death and organ donation," Kuthy says. She emphasizes that this pamphlet is no substitute for staff support and explanation of brain death; rather, it is a resource for families whose relative has experienced brain death.
The central message of all of these pamphlets is that brain death is death. They explain why the heart is still beating and assure the reader that the patient feels no pain. They are intended to be material that the families can look at "after the fact" so that they can be reassured that their loved one was truly dead.
However, each pamphlet is tailored to the particular needs of the intended audience. MCV's pamphlet is very short, designed to be handed to the family at the time of the brain death explanation. The National Donor Family Council's pamphlet is a more detailed explanation aimed at families whose loved one may have died a long time ago, but who have lingering questions about brain death.
Another UHC hospital is in the process of developing a pamphlet as an outgrowth of the project. Other hospitals across the nation, such as Saint Vincent Hospital & Health Center in Billings, MT, have also developed their own pamphlets.
"Support of families dealing with brain death is crucial both during
and after the crisis, and the number of hospitals who use or are developing
these materials is encouraging," says Holly Franz, Partnership manager
of site education. "The proliferation of these materials signals increased
hospital commitment to an overall organ donation system focusing on family
needs."
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CBS News' 60 Minutes aired a story on non-heartbeating donation that caused concern within the donation community and confusion among the general public. Excerpts (highlighted in bold) from The Partnership's response were read on the program's April 27 broadcast:
We deeply hope that this story does not adversely impact organ donation nationwide. We urge you to devote coverage to this important issue in a more balanced way in order to clarify the issues, and reassure families facing the death of a loved one that their relative is being properly cared for."
The successes of organ donation during the past 10 years, as well as challenges for the future, were discussed in "After A Decade of Progress, A Need to Re-energize the Organ Donation Movement," by Carol Beasley, in the February 1997 issue of Nephrology News & Issues. "After a decade of progress we still do not have a well-integrated system for organ donation in hospitalsÑone that ensures that all donation opportunities are addressed with best-demonstrated practices and that all participants in the process are accountable," she wrote.
In response to an economic viewpoint in Business Week by Nobel laureate Gary S. Becker proposing a market solution for the organ donor shortage, Susan L. Ettner, Health Care Policy Department of Harvard Medical School, and Carol Beasley wrote a letter that appeared in the February 10, 1997, issue. They called Becker's idea of a futures market for organs "simple in concept, but probably prohibitively expensive" and pointed to new research that "shows that hospital practiceÑnot public reluctanceÑis the big barrier to donation."
For more information about these articles, contact The Partnership Communications
Department.
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The Partnership's work is described by Carol Beasley and Jessica D. Blaustein in the chapter they co-authored, "The Partnership for Organ Donation: a strategic approach to solving the organ donor shortage," in the recently published book, Organ and Tissue Donation for Transplantation (Arnold, 1997). "This book brings together detailed analysis of the problems surrounding organ and tissue donation," says Celia Wight SRN HV Cert, who edited the book with Jeremy R. Chapman MD (Camb) FRACP FRCP and Mark Deierhoi MD. "We hope that it will be a useful source of reference for the intensive care and transplant communities, and a source of information for the public as well as those in government."
Published in the March 1997 issue of the Journal of Transplant Coordination, "The impact of a comprehensive, hospitalÐfocused intervention to increase organ donation," by Carol L. Beasley MPPM, Carie Lynn Capossela, Lori E. Brigham MBA, Susan Gunderson MHA, Phyllis Weber RN and Steven L. Gortmaker PhD, details the results of a two-year intervention project conducted in 50 hospitals in the service areas of three organ procurement organizations (OPOs). Results showed rapid improvement in identification, referral and asking rates, and laid the framework for The Partnership's current model of implementing best practices in hospitals in collaboration with their OPOs.
So far in 1997, the following abstracts have been presented at scientific meetings:
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"This group adds value by pressure-testing our ideas and approaches, expanding our grasp of key issues, providing practical and creative advice, and linking The Partnership to the broader community," says Michael Evanisko, Partnership president and founder. "We are truly a 'partnership,' with a multi-disciplinary approach to our work."
The day-long meeting focused on The Partnership's on-site projects, particularly the University HealthSystem Consortium collaboration; international activities, including Donor Action and project work in Canada; communications strategies; and research and evaluation. Also discussed were the possible impact of changes in the health care environment on donation, including the effect of mergers, advance directives and incentives.
"The Partnership's work has remained outcomes-oriented, strategic, hands-on and data-driven," says Evanisko. "Our focus is to ensure that donation is offered in a timely and sensitive way. The input of these experts will help us to fulfill our mission of saving and improving lives by closing the gap between the number of organ transplants that are possible and the number of organ donations that actually occur."
Guests included liaisons from the collaborative project with the University HealthSystem Consortium, researchers and funders: Retty Grimwood, R.N., B.S.N., Oregon Health Sciences University; John Sum-Ping, M.D., University of Iowa Hospitals and Clinics; Ed Guadagnoli, Ph.D., Harvard Medical School; John Maddox, Novartis; and Kevin O'Neill, Wyeth-Ayerst.
Advisory board members attending included:
Gabriel Danovitch, M.D., Director of Renal Transplantation, University
of California Los Angeles
Nicholas Feduska, M.D., Director, Multi-Organ Transplant Program &
Kidney Transplant Program, Ochsner Clinic, New Orleans
Ake Grenvik, M.D., Ph.D., Director, Critical Care Medicine Training
Program, University of Pittsburgh School of Medicine
Steven Johnson, M.D., Department of Surgery, University Medical Center,
Tucson
Jimmy A. Light, M.D., F.A.C.S., Director of Transplantation, Washington
Hospital Center
Bruce A. Lucas, M.D., President, Board of Directors, Kentucky Organ
Donor Affiliates
Thomas Luerssen, M.D., Director, Pediatric Neurosurgery, University
of Indiana
Margaret Miles, R.N., Ph.D., Professor, School of Nursing, University
of North Carolina, Chapel Hill
William O. Ritchie, Ph.D., Director, Office of Decedent Affairs, Washington
Hospital Center
Steven Rosner, Founding Member, The Partnership for Organ Donation
Eduardo Santiago-Delpin, Director, Transplant Program, Auxilio Mutuo
Hospital, Hato Rey, Puerto Rico
