“Losing a loved one is tragic. Losing the opportunity to turn that around is even more tragic.”

Perhaps no one is more qualified to make those statements than Admiral Kenneth Moritsugu, M.D. As Deputy Surgeon General in the Department of Health and Human Services, Admiral Moritsugu knows the laws surrounding transplantation and the rationale behind them.

As a physician who lost both his wife and daughter in separate motor vehicle accidents within five years, he also has a broad perspective of the issues surrounding donation. When his wife died, he consented to donate organs and tissues. He did so again when he lost his daughter.

At a July workshop co-sponsored by the Health Care Finance Administration (HCFA), Admiral Moritsugu spoke of his personal tragedies in the context of Medicare’s Conditions of Participation (COP) relative to organ, tissue and eye procurement. The COP’s importance was never clearer to him, he noted.

Implemented by HCFA in 1998, COP, also known as the “Donation Rule,” sets forth donation standards and documentation requirements. The rule also promises a penalty for non-compliance – revocation of Medicare reimbursement to hospitals.

That shouldn’t be the only incentive to adhere to the rule, Admiral Moritsugu told workshop attendees. “You can look at it as an opportunity to be compliant with the law or as an opportunity to make a difference in the lives of others…the difference between life and death. It is the law, but as professionals, we also know that it is the right thing to do.”

The admiral’s compelling presentation and the workshop that followed explored factors that improve donation:

• quality care,
• cooperation between programs and
• targeted training for designated requestors.

Need for discussion
HCFA held the workshop in response to hospital requests for guidance, and to further enhance the rule’s impact. Participants who discussed issues and challenges surrounding its implementation included representatives from the Joint Commission for Accreditation of Healthcare Organizations, the American Hospital Association, medical examiners and coroners, healthcare professionals, and donation agencies.

The purpose of the event was to define the best practices that are increasing donation throughout the country. It spotlighted successful donation programs and focused on collaborative and cooperative relationships between healthcare professionals, medical examiners/coroners and donation agencies. The experiences of several donation programs indicate that organizations that work together to serve potential donor families have higher donation rates.

Quality care matters
Families that choose to donate are more often satisfied with the overall hospital care of their loved ones than those families that decline the option. How a family responds to the approach for donation is linked to many aspects of care, not only to the donation discussion.

As research suggests, there is a correlation between family members’ satisfaction with the quality of care their loved ones received and their subsequent willingness to donate organs and tissues.

In fact, a study by DeJong, Franz and Wolfe (American Journal of Critical Care, Jan. 1998) discovered that non-donor families were more likely than donor families to report inadequate or insensitive care and poorly handled donation requests. A coordinated effort between donation agencies and hospital staff can improve the quality of care and communication to bereaved families. Such coordination will ensure that the families have an opportunity to make an informed donation decision.

Increasing effectiveness
One of the most positive outcomes of the workshop was HCFA’s indication that it is now allowing donation agencies and hospitals some flexibility in their implementation of the Donation Rule, taking into consideration the competencies and training needs of hospital staff.

After all, approaching a grieving family about donation and end-of-life issues is not easy. It requires knowledge, compassion, timing and coordination of the donation process. The needs of the family should mediate the entire donation process.

So, HCFA encouraged hospitals and donation agencies to establish donation programs with common goals to ensure effectiveness and provide focus for customized training. Based on studies, the expectation is that as the number of key staffers who receive training about donation increases, so will the hospital’s donation rates.

What does a hospital need to do to have a successful donation program?

• Call on all patient deaths, imminent and declared.
• Refer severely brain injured, ventilator dependent patients prior to withdrawal of mechanical and/or pharmacological support.
• Place referral calls prior to family approach to evaluate patient eligibility to donate.
• Work with the donation agency when offering donation options to bereaved families.
• Insure the individual who approaches family for tissue and eye donation is a trained designated requestor or donation agency coordinator.

What can the Northwest Tissue Services do to assist with compliance?

• Provide specialized training for trained designated requestors for tissue and cornea donation.
• Provide hospital-specific referral outcome reports on a monthly or quarterly basis, so the hospital can monitor its own compliance with the requirement to place a referral call on all deaths.
• Assist hospitals with development and implementation of an effective donation program.
• Review compliance data and partner with hospitals to target training to achieve optimal referral compliance and increase donation rates.

The two key provisions of the Donation Rule (COP):

• Hospitals must contact their donation agencies in a timely manner concerning individuals whose death is imminent or who die in the hospital.
• Only donation agency staff or trained hospital staff – referred to as designated requestors — may approach families about donation options.

Northwest Tissue Services has worked collaboratively with the Northwest Lions Eye Bank and LifeCenter Northwest to provide designated requestor training to more than 1500 professionals in hospitals in Washington, Montana and northern Idaho.

For more information regarding the implementation of the Donation Rule (COP) and Trained Designated Requestor Workshops, contact the Northwest Tissue Services at (206) 292-1879 or 800-858-2282.