FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM
Our Lady of the Lake Regional Medical Center has significantly increased the number of organ donors on its campus through a series of changes it put in place in key clinical units beginning about two years ago.
The changes in large part involved transforming the way Our Lady of the Lake clinicians view efforts to secure consents for organ donations from the families of imminently dying patients, according to Alice Battista, divisional director of mission services for the Baton Rouge, La., medical center. She is the medical center's "clinical champion" and liaison with the Louisiana Organ Procurement Agency, a nonprofit agency that helps transplant teams recover organs from deceased patients and that supports the donors' families and caregivers before, during and after the organ donation.
"There was a culture change around our organization," Battista said, explaining that in the past, some of the medical center's clinicians saw representatives of the organ recovery agency "as vultures. They didn't want them involved. (Clinicians) felt they had failed their patients" if the patients were considered as candidates for organ donation. Of course, this perception was neither true nor openly trumpeted. It took an investigation to discover the reasons behind the clinicians' resistance to overtures from representatives of the organ procurement agency.
Once the cards were on the table, the hospital moved to improve communications and relationships between staff and the organ procurement agency and build front-of-mind awareness of the lifesaving and selfless nature of the gift.
"Now, they see organ donation as a way to make good out of a sad situation and save lives," Battista said of hospital clinicians.
Conversion rate
Our Lady of the Lake's efforts to rethink its facilitative role in organ procurement began in mid-2010, when staff connected with the organ donation program grew concerned that their conversion rate was 55 percent, as compared to the 75 percent benchmark goal established by the U.S. Department of Health and Human Services. The conversion rate is the number of potential organ donors who actually become donors.
"We felt an obligation to improve . . . for the 110,000-plus individuals who are awaiting a lifesaving organ," said Battista. (Transplant surgery is not performed at Our Lady of the Lake.)
Normally, only a small subset of imminently dying patients is eligible to donate organs post mortem: people with brain death from an injury or aneurysm and patients who die within one hour of cardiac arrest after the removal of life support. Whether or not such patients have declared — with consent indicated on their driver's license or in a registry maintained by the state — that they wish to be an organ donor, family consent is necessary to implement those instructions.
To figure out why Our Lady of the Lake seemed to be missing opportunities to provide organs for transplant, a small team that included Battista talked with clinicians. The team determined that there was unspoken tension between patients' clinical team members at Our Lady of the Lake and the representatives from the Louisiana Organ Procurement Agency — these Family Advocates talk to a dying patient's next of kin about organ donation, handle the consents and provide emotional support to the families. If families consent, the representatives coordinate the logistics of the organ recovery. The process requires the cooperation of medical center staff, something that is happening more fluidly now.
Finessing the conversation
Conversations revealed that some hospital staff felt that endorsing organ donation was akin to "giving up" on their patient; and some felt that the organ procurement agency representatives were overly concerned with obtaining organs, although that was not the case, according to Battista.
The team focused on addressing the low conversion rates at the hospital fostered conversations about the concerns among clinicians, the agency representatives, patients and a member of the hospital's sponsoring congregation, the Franciscan Missionaries of Our Lady. Battista said the discussions helped clinical staff to refocus on the potential lifesaving value of organ donation in order to counter their sense of disappointment and loss when a patient's life cannot be saved. And increased familiarity with the work and approach of the organ recovery organization caused some staff to see the value of having an organ procurement agency representative support and comfort the donor's family, and ease the process for the family.
During these group discussions, staff members acknowledged that their personal feelings of having "failed" a dying patient had often interfered with their receptivity to the organ donation representatives. Once they were able to talk through those feelings, they became more amenable to working with the organ recovery organization. With that opening, the team was able to begin rolling out best practices in organ recovery, using recommendations from the Joint Commission.
Clinicians now help ensure the organ procurement agency representatives can reach out to families of potential donors early in the process, so the families will not be blindsided with a difficult decision at the last moment. Organ donation can be mentioned any time after a patient meets the clinical criteria, but organ donation is never mentioned until brain death has been declared or the family has decided to withdraw life support. The representatives gauge a family's emotional readiness prior to initiating the discussion.
Our Lady of the Lake clinicians also hold "huddles" of a patient's care team and the agency representatives to discuss the status of the donation discussions and how to support the family. They also welcome the agency representatives for daily rounding in intensive care and step-down units to improve communications with Our Lady of the Lake team members, according to materials from the hospital.
"In the past, clinicians would hide from the LOPA representative, now they seek her out and are truly engaged," Battista said.
Our Lady of the Lake clinicians now see themselves as working in tandem with the organ procurement representatives to support emotion-laden families making decisions on behalf of their dying loved ones. In line with the hospital's mission, physicians, nurses, social workers, child life team members and chaplains all can help provide emotional and spiritual care to families.
Displays of reverence
Additionally, now, Our Lady of the Lake staff shows honor and reverence for an organ donor and support for the family by holding a prayer service and blessing a "donate life" flag at the bedside. The flag is hoisted near the main hospital entrance. A representative from the donor's family also is welcome to be in the operating room during a prayer before life support is discontinued. When the organ recovery procedure is complete, the flag is presented to the patient's family. With the family's approval, a photo and a short biography of the organ donor are featured for a time on a donor wall of honor. Our Lady of the Lake holds an annual prayer service to commemorate organ donors.
Each donor has the potential to donate nine organs, and so each donor's "gift" can benefit multiple people. Families have the option to limit their donations to specific organs.
With the culture change, the medical center's conversion rate increased to 91 percent, or 30 patients, for 2011. These 30 patients saved 107 lives, said Battista.
Copyright © 2012 by the Catholic Health Association of the United States
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