Do your staff know how to handle organ donations?
Legal issues make thorough education essential
Organ and tissue donations present an important part of the ED manager’s responsibilities, both in terms of patient/family communication and legal/risk management considerations, say emergency medicine experts.
And this issue will continue to gain importance with organ donations reaching a new record in 2004, according to the Department of Health & Human Services (HHS).
There were 27,033 procedures performed, a 10.8% increase from 2003, according to HHS. The first four months of 2005 are breaking each of the monthly records established in 2004, based on HHS records.
A federal requirement
“A lot of ED staff may not know this, but it is a federal requirement to bring the issue of donation up in all deaths,” notes Richard Nelson, MD, medical director of the ED at The Ohio State University Medical Center and professor and vice chair of the department of emergency medicine at The Ohio State University College of Medicine and Public Health, both in Columbus.
“Per our hospital policy, all deaths have to be reported and screened by a donor referral service,” he explains.
Since the issue of donation is such a sensitive one, an important consideration is determining who will approach the family. Nelson says it is preferable that it not be the treating ED physician or nurse.
“In our hospital, we have a bereavement coordinator who is especially trained to interact with the family and the patient,” he notes. “The staff might be in the room when it happens.”
There’s a certain sensitivity involved with the physician approaching the family, especially if the patient is still alive, Nelson says.
“It could always be perceived as a conflict of interest, that the physician may have an incentive to hasten the patient’s demise,” he explains. “That’s why we try to have some degree of ‘separation of powers.’”
Carolyn Ruge, RN, CPTC, director of recovery services for Life Connection of Ohio, a Maumee-based recovery agency, agrees. “If you ask for the donation of the eyes of a loved one who is still alive, the family may believe you will withhold care,” she says.
Ruge adds that hospital policy will dictate who makes the approach. “It could be a physician, a social worker, or an RN,” she notes.
Agency interface vital
Your ED staff also should know exactly who to call, and when, notes Nelson.
“Our staff are trained to call the appropriate people when death occurs or is imminent,” he says, adding that in the case of his ED, it is the nearby Lifeline of Ohio organ procurement agency.
“They would like to know ASAP when there’s a patient, for example, with a very bad head injury that does not look like it’s recoverable,” Nelson points out.
When exactly should contact be made? “Typically, the hospital should work closely with their recovery agencies and determine the clinical trigger,” Ruge continues.
“Most clinical triggers involve a neural injury and an agreed-upon Glasgow Coma Scale number of, perhaps, 5 or less,” she explains.
The manner of death also will dictate what can, in fact, be donated, says Ruge, noting that “organ donation” in her profession refers only to solid, vascular organs, while other forms of donation can include, for example, tissue and corneas.
For a patient who had a massive heart attack, the donation could involve heart valves, skin, bones, soft tissues, veins, or corneas, she says.
It’s important for your staff to be educated about what can be donated given different types of death, Ruge says. “Sometimes, the family might offer to donate everything, but you can’t because of the patient’s history,” she notes.
For example, in the previous example of a massive heart attack, if the patient had been treated for lung cancer, that person would not be able to offer tissue but could offer the corneas.
On the other hand, if a heart attack victim has not yet suffered brain death, he or she might become a solid organ donor.
Determining the suitability
The ideal situation is for suitability to be determined before the approach is made, Ruge points out.
“[The Centers for Medicare and Medicaid Services] has a regulation governing conditions of participation for a hospital, which says determination of suitability should be done by the recovering agency, and that anyone who approaches should have requester training,” she notes, adding that this type of training is a free educational piece of her agency’s hospital development program.
“When you should call the agency, what the right time is to approach the family, and who should approach them — all that should be built into your policy, so it’s seamless when the situation occurs,” Ruge continues.
“It’s not only a matter of educating your staff as to the process, but most important, they should read the hospital policy,” Nelson says.
“You’ve got to bring the right people into the process at the right time to make sure nothing is missed — that you have the maximum chance to do the right thing in the right situation at the right time,” he adds.
Sources/Resource
For more information on organ and tissue donations, contact:
- Richard Nelson, MD, Professor and Vice Chair, Department of Emergency Medicine, The Ohio State University College of Medicine and Public Health, Room 146, Means Hall, 1650 Upham Drive, Columbus, OH 43210. Phone: (614) 293-8306. E-mail: [email protected].
- Carolyn Ruge, RN, CPTC, Director of Recovery Services, Life Connection of Ohio, 3661 Briarfield Blvd., Suite 105, Maumee, OH 43537. Phone: (419) 893-1618. E-mail: [email protected].
- For more information on the Department of Health & Human Services’ organ donation program, go to the web site: newsroom.hrsa.gov/releases/2005/hhs-honors-hospitals.htm.
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