Review quality regularly to measure improvement
- Review compliant referral rate monthly
- Review conversion rate monthly
- Review effective request rate after each request
- Review organs transplanted per donor after each organ donor
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Donor Designation and the Law
Families are usually relieved to find out that their loved one has already declared their wishes with regards to donation, and that the decision has already been made. (In Washington state, for example, more than 75% of licensed drivers have already registered their wish to be a donor.) Families often feel an ethical duty to honor the expressed wishes of their loved one—since giving the gift of life to others, whatever their values or motive, may have been very important to the donor.
If a patient is not a registered donor the donation decision falls to their Legal Next of Kin (LNOK). There is a LNOK decision making hierarchy in every state. Please Click here for frequently asked questions regarding donation and the law, as well as the hierarchies for the states that we serve. LCNW and the hospital will always follow the hierarchy outlined by the state where the hospital is located.
In some cases families may question their loved one’s designation, and at that point state laws must be followed so that neither LifeCenter Northwest (LCNW) nor your hospital can be held legally responsible for not honoring the patient’s designated wishes.
Below are some of the relevant regulations, but contact our Hospital Development team if you want more information on the legal issues surrounding donation. In general, we have found that in many cases when families question their loved one’s wishes, they just needed better timing or more information. For example:
- Donation was raised too early with the family. Giving the family time will usually help them understand.
- Someone has set an expectation with the family that authorizing donation is a decision they need to make. Avoid language that indicates they have a decision to make.
- Families may have misconceptions about donation. Be thorough and respectful in addressing the family’s concerns.
- Family is surprised that their loved one didn’t tell them. Help the family understand that it is not unusual for individuals to not discuss death with their family.
Donor designation is a documented, legally binding commitment by an individual to make an anatomical gift—and just like a will or testament, it can only be revoked by that individual. Below you can find links to the Uniform Anatomical Gift Act (UAGA) for states in our region:
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Click here to watch Alexandra Glazier, JD, MPH Vice President and General Counsel, New England Organ Bank, discuss Why Gift Law Matters: The Law and Ethics of Donor Designation at the UNOS Region 6 Forum in Seattle, WA
Conditions of Participation for Organ and Tissue Donation
What are the Conditions of Participation (COP)?
COP is a Centers for Medicare & Medicaid Services (CMS) regulation that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries. The COP that covers organ and tissue donation is intended to increase organ donation and save lives.
All hospitals that receive Medicare reimbursement must identify and refer all deaths and imminent deaths to the Donor Referral Line (for LifeCenter Northwest, 888-543-3287).
The COP requires hospitals to:
- Notify the designated Donor Referral Line of all individuals who have died or whose death is imminent. “Imminent death” is defined as a severely neurologically injured ventilator dependent patient with either a Glasgow Coma Score </=5 or with discussion about withdrawal of support
- Ensure the family of each potential donor is informed of their option to donate by a donation agency coordinator or trained designated requestor
- Continue to apply discretion and sensitivity with respect to circumstances, views, and beliefs of the families of potential donors
- Have an agreement with the designated organ procurement organization and at least one tissue and eye bank
- Maintain a cooperative working relationship with the donation agencies for:
- education of staff on donation issues
- review of death records to improve identification of potential donors
- maintaining potential donors
Does this mean every family will be approached with the option of donation?
Not necessarily. All referral calls are to be placed to the Donor Referral Line prior to approaching the family to evaluate medical suitability. This process ensures that families will only be approached with the appropriate options. For example, if the patient is unable to donate, there is no need to approach the next-of-kin. If donation is an option, the donation agency will facilitate approaching the family. The referral call and outcome must be documented in the patient chart.
Does this mean that all patient deaths must be reported to the Donor Referral Line, despite age?
Yes. All deaths and imminent deaths must be referred to the Donor Referral Line despite age and medical/social history. Calls are to be placed on all ventilated patients prior to withdrawal of support to preserve the option of organ donation.
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