U.S. Department
of Health and Human Services
Advisory Committee on Organ Transplantation
Recommendations 19–35
The Committee
(ACOT) met on November 6-7, 2003, in Washington, DC, and unanimously
agreed on the following seven recommendations:
Recommendation
29: HHS should fund necessary research initiatives, and convene
a national consensus conference, updating the criteria involved
in end of life issues related to the determination of death in the
context of organ donation and transplantation. The three specific
areas for review would be brain death, cardiac death, and imminent
death.
Brain death
and cardiac death involve two different but equally appropriate
definitions of death, yet there is widespread confusion and uncertainty
regarding their application, and some inconsistency in protocols
employed in the determination of death. (Interestingly, while the
public appears to have a clearer understanding of the concept of
brain death, only about 1% of deaths declared are by brain death
criteria.) The questions raised here are not unique to the issues
of organ donation and transplantation, but have been highlighted
by the advances in those fields, and the concomitant necessity to
more clearly define the related concept of imminent death.
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Brain
Death: ACOT recommends that a Uniform Declaration of
Death Protocol should be established and research initiatives
essential to accomplishing this goal should be funded. The Department
of Health and Human Services should encourage the American Academy
of Neurology and other interested medical specialty organizations
(e.g., American Academy of Pediatrics, Society for Critical
Care Medicine [SCCM], Child Neurology Society, American Association
of Neurological Surgeons, Congress of Neurological Surgeons,
American Neurological Association, and so forth) to participate
in the consensus conference and to assist in updating the practice
guideline for brain death determination. Both the American Academy
of Neurology’s Practice Parameter for Brain Death Determination
and the American College of Critical Care Medicine’s Intensive
Care Guidelines and Consensus could serve as a basis for preliminary
discussion.
HHS and other participating associations should work together
with hospitals, organ procurement organizations, the American
Hospital Association, and other interested groups to develop
tools for the documentation of brain death determination and
to promote consistent practices among hospitals.
-
Cardiac
Death: ACOT recommends that a Uniform Declaration of
Death Protocol should be established and research initiatives
essential to accomplishing this goal should be funded. It is
extremely important for families and all others involved in
donation after cardiac death (DCD) to understand that DCD occurs
only after the patient or family has decided to withdraw life-sustaining
therapies, for reasons entirely apart from any potential for
organ donation. Therefore, a certain amount of modeling or walk-through
of what is involved will be essential at institutions contemplating
the institution of a DCD protocol. A standard template for DCD
needs to be developed, and the consensus conference should generate
a white paper that could be used for professional and public
education. With regard to DCD, the key problems for the conference
to consider would include: (a) why the clear definition of legal
and ethical responsibilities spelled out in the IOM reports
and the SCCM guidelines have not achieved widespread acknowledgement
or integration into clearly accepted procedural protocols; and
(b) the lack of professional and public education and understanding
associated with DCD.
The two extensive DCD reports by the Institute of Medicine need
to be reviewed and the impediments to the implementation of
the recommendations within those reports must be identified
and analyzed. In this regard, it should be noted that ACOT specifically
endorses the current efforts of the HHS Breakthrough Collaborative
toward DCD identification and referral.
ACOT believes that it is time for a requirement that all Class
A hospitals at least begin the necessary ethical conversation
about DCD, involving both ICU professionals and ancillary caregivers.
The parties involved should indeed include hospital leadership,
ICU health care team members; transplantation surgeons, anesthesiologists,
OR nurses and staff, Pastoral Caregivers, local community and
church leaders, as well as OPO staff, public health officials,
and families who have or have not been offered the opportunity
to participate in DCD. Each such hospital should be required
to actively and seriously consider the development, public promulgation,
and implementation of protocols for transplantation from deceased
donors after cardiac death. These protocols should focus on
management in the ICU.
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Imminent
Death: ACOT recommends that HHS take the steps necessary
to ensure that all potential organ donors are referred to OPOs
in a timely fashion, including defining when a referral should
be made to an OPO and establishing an appropriate enforcement
mechanism to assure compliance. Two existing impediments to
timely referrals have been identified. First, OPOs are not consistently
notified before the withdrawal of all life sustaining therapies;
there should be a requirement that the OPO be notified prior
to such life sustaining therapies being withdrawn from any patient.
Second, the lack of a clear definition of imminent death hinders
the timely referral of potential donors; there need to be clear
parameters concerning imminent death. Some physicians may be
reluctant to adopt certain clinical triggers for a declaration
of imminent death; this is why a consensus conference is needed
to bring all relevant parties together for purposeful discussion.
The pathway must be clearly defined so that OPOs may be involved
at the appropriate time, and these standards should be enforced
by an appropriate designated entity.
ACOT discussions suggest that the appropriate trigger could
be the progression from aggressive care to palliative care.
We need to figure out that exact desirable point in the process
for OPO notification so that we can clearly specify it. This
point is one of delicate balance in that it establishes a time
before which the OPO should not be involved, while at the same
time providing that there is accountability for assuring that
the OPO is indeed contacted when it is appropriate to do so.
It is thus essential to establish in resulting protocols precisely
who on hospital staff is required to contact the OPO. Commitments
to action and safeguards against potential conflict of interest
must be put in place to (1) ensure that medical decisions are
isolated from any decisions related to donation; (2) maintain
complete separation between the transplant team and the patient
care team; and (3) make certain that no discussion of donation
with the family occurs prior to a decision to withdraw support.
ACOT calls specific attention here to the following two questions
and answers currently promulgated by the Centers
for Medicare and Medicaid Services (CMS) Web site which
have attempted to address the issue of imminent death. We do
feel, however, that it is time to go beyond the below recommended
discussion between OPOs and hospitals, and time now for a consensus
conference that brings all relevant parties to the table in
order to resolve this important issue. Moreover, upon reaching
this consensus, it will be imperative for each of the groups
involved to assure that their respective memberships are thoroughly
educated on the matter.
-
Q.
11 What does "imminent death" mean? Does it mean
the hospital has to call if a patient is expected to die,
but the patient is not on a ventilator?
A. 11 Based on suggestions from
both the OPO and physician communities (including the Association
of Organ Procurement Organizations and the Council on Scientific
Affairs of the American Medical Association), we have developed
the following guidelines for hospitals and OPOs to use in
developing a mutually agreed upon definition of "imminent
death." Although neither the statute nor CMS’s
regulations define "imminent death," the definition
might include:
Discussion: In our September 1999 response
to this question, we declined to define "imminent death."
We said that such a definition involves a medical judgment
that should be left up to hospitals and OPOs. We urged OPOs
and hospitals to work together to develop a definition and
a protocol for referral of imminent deaths. The only guidance
we provided was that a definition for "imminent death"
would likely include a brain dead or severely brain-injured
individual on a ventilator.
However, we have found that some hospitals have not developed
protocols for imminent death and are not notifying their
OPOs about imminent deaths. We believe this may be due to
hospitals' confusion about what "imminent death"
means. Therefore, we are providing guidance that OPOs and
hospitals can use to develop a definition that includes
specific triggers for notifying the OPO about an imminent
death.
In determining the appropriate threshold for the GCS, it
is important to remember that if the threshold is too low,
there may be too many "premature" deaths or situations
where there is loss of organ viability. The Association
of Organ Procurement Organizations suggests a GCS of <
5. However, some OPOs and hospitals use a GCS < 4 or
< 3.
Note that a patient with a "severe, acute brain injury"
is not always a trauma patient. For example, post myocardial
infarction resuscitation may result in a heart beating patient
with no brain activity.
The definition agreed to by the hospital and the OPO may
include all of the elements listed above or just some of
the elements. The definition should be tailored to fit the
particular circumstances in each hospital. Whatever definition
is used, the most important considerations are:
Contacting the OPO early enough so that organ viability
can be preserved. The OPO must assess the potential donor's
medical suitability, discuss donation with the family, obtain
consent, and arrange for placement and recovery of the organs.
The OPO must begin this process early enough so that there
is a strong likelihood the potential donor's organs will
remain viable until recovery and transplantation can take
place (assuming there is no disease process the OPO identifies
that would cause the organs to be unsuitable);
Collaborating to develop a definition of "imminent
death" acceptable to both the OPO and hospital. In
some hospitals, there is disagreement between the OPO and
hospital staffs regarding the appropriate time for the OPO
to begin assessment of the potential donor. From the OPO's
perspective, early referral and assessment of the donor
is crucial. However, physicians and nurses who are caring
for the potential donor may regard the arrival of the OPO
as a signal that they are expected to abandon their roles
as care givers and "give up" on the patient. Unfortunately,
the tensions caused by these disagreements are hampering
donation in some hospitals. We urge OPOs and hospitals to
work together to develop a definition for "imminent
death" that strikes a balance between the needs of
the OPO and the needs of the hospital's care givers to continue
treatment of a patient until brain death is declared or
the patient's family has made the decision to withdraw supportive
measures. Collaboration between OPOs and hospitals will
create a partnership that furthers donation, while respecting
the perspective of the hospital staff.
-
Q.
12 What does it mean for a hospital to notify the OPO about
a death or imminent death in a "timely manner?"
A. 12 In our September 1999 response
to this question we stated, "Timely notification means
that a hospital must contact the OPO by telephone as soon
as possible after an individual has died, has been placed
on a ventilator due to a severe brain injury, or who has
been declared brain dead. That is, a hospital must notify
the OPO while a brain dead or severely brain-injured, ventilator-dependent
individual is still attached to the ventilator and as soon
as possible after the death of any other individual, including
a potential non-heart-beating donor. Even if the hospital
does not consider an individual who is not on a ventilator
to be a potential donor, the hospital must call the OPO
as soon as possible after the death of that individual has
occurred."
We have found that some hospitals are not notifying their
OPOs about deaths and imminent deaths in a timely manner.
This is of particular concern in the event of an imminent
death if a hospital contacts the OPO after a patient is
removed from the ventilator or contacts the OPO so late
in the process that the patient's organs have started to
deteriorate. Therefore, we are adding the following clarification.
Hospitals should follow this or a similar protocol to ensure
that the OPO can arrive at the hospital with sufficient
time to assess the patient's donor potential while organs
are still viable. We believe that referral by a hospital
to the OPO is timely if it is made:
As soon as it is anticipated a patient will meet the criteria
for imminent death agreed to by the OPO and hospital or
as soon as possible after a patient meets the criteria for
imminent death agreed to by the OPO and the hospital (ideally
within one hour); AND
Prior to the withdrawal of any life sustaining therapies
(i.e., medical or pharmacological support).
Whenever possible, referral should be made early enough
to allow the OPO to assess the patient's suitability for
organ donation before brain death is declared and before
the option of organ donation is presented to the family
of the potential donor. Timely assessment of the patient's
suitability for organ donation increases the likelihood
that the patient's organs will be viable for transplantation
(assuming there is no disease process identified by the
OPO that would cause the organs to be unsuitable), assures
that the family is approached only if the patient is medically
suitable for organ donation, and assures that an OPO representative
is available to collaborate with the hospital staff in discussing
donation with the family.
Recommendation
30: HHS should review the results of the research conducted
and national consensus conference convened in response to Recommendation
29 and seek to resolve the many reimbursement issues related to
the determination of death in the context of organ donation and
transplantation. These deal with determination of brain death, cardiac
death, and imminent death, particularly with regard to ECD organs.
CMS and other appropriate HHS agencies should also review their
procedures with regard to living donors to ensure that living donors
are fully reimbursed, and further that living donors are not disadvantaged
with respect to their other insurance needs.
ACOT is recommending
that HHS re-examine government reimbursement mechanisms, and further
encourage private payers to re-examine their guidelines for the
coverage of costs associated with procurement and transplantation,
to ensure that reimbursement rules do not discourage the procurement
of organs from any deceased donor whose organs are suitable for
transplantation. The present reimbursement system was formulated
at a time when the transplant community was doing something very
different from what it is doing now. The consensus conference proposed
in Recommendation 29 will examine the system in light of how the
transplant system works today. The goal of Recommendation 30 is
therefore to similarly assure that the reimbursement system accurately
reflects current practice.
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ECD.
Several flaws in current reimbursement methodology have been
identified. The current Centers for Medicare and Medicaid Services
(CMS) reimbursement for the transplant experience, for example,
creates undesirable disincentives to using Expanded Criteria
Donor (ECD) organs, whether obtained from brain death donors
or cardiac death donors. Although the long-term outcomes of
using ECD organs appears good, and such usage is desirable in
the context of ongoing organ shortages, it is clear and understandable
that the patients in whom these organs are placed experience
more complications post-operatively, and thus have a more expensive
hospital course. At present, if an OPO aggressively pursues
the transplantation of expanded criteria donors, as, for example,
in transplanting two kidneys into a single patient, the OPO
is effectively punished financially by having to pay back Medicare
rather than rewarded for utilizing an additional organ. Moreover,
to determine suitability of organs for transplantation, certain
diagnostic tests must be performed and additional costs are
thereby incurred; such costs should be covered, whether or not
the organs ultimately prove suitable for transplantation. Therefore,
CMS must develop a plan of action related to revising the current
unitary transplantation Diagnostic Related Group (DRG) reimbursement
structure, along with a review of the Medicare Cost Report.
One possibility might be to come up with a sub-DRG to define
a high-risk donor, and the OPTN and/or SRTR could provide the
necessary data to CMS to demonstrate that the present DRG is
presently very under-weighted.
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DCD.
Similarly, the current CMS reimbursement scheme for transplants
creates undesirable disincentives to using Donation after Cardiac
Death (DCD) organs. There should be coverage/reimbursement of
additional costs occasioned by approved DCD protocols. Presently,
donor hospitals are not supposed to get reimbursed for costs
prior to brain death; families or their insurers bear those
costs. Thus, CMS does not reimburse the OPO for any costs until
after declaration of brain death; this criterion, however, is
irrelevant to DCD because the brain death criterion does not
apply to cases involving cardiac death. For DCD, where should
the break point occur-when the decision is made to transition
to comfort care, when life support is withdrawn, or at some
other point? It seems appropriate to facilitate actions (e.g.,
instrumentation, obtaining consent for catheter placement) that
meet the donor's wishes to donate organs. With DCD donors in
particular, if the family decides to withdraw life support,
OPOs are under an obligation to determine whether the patient
might be a suitable donor. Tests to answer this question are
therefore often performed early in the process. This common
practice is described in the "Cost of Altruism" paper.
Practices are changing because referrals are occurring earlier
in the death process. OPOs must make decisions about donor suitability
before approaching the family. Changes are necessary in order
to preserve a designated donor's right to donate and/or the
family's right to consent to donation. If a detailed protocol
were in place, as is envisioned with respect to Recommendation
29, we would have a better idea as to where to apply these recommendations
and how to suggest specific changes in the reimbursement structure.
This dilemma is arising because the practice of donation is
changing; practices are in turn changing because referrals are
occurring earlier in the death process. In the past, OPOs did
not get a call until both brain death exams were done; later,
they would get a call after the first exam; still later, they
would get a call when it appeared that death was imminent. Yet,
present reimbursement rules do not reflect this reality. The
OPO is being called in earlier than ever in order to determine
whether the patient might be a donor. Since, in such instances,
the OPO is only providing an option for families, it would appear
logical that it be reimbursed for its efforts.
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Living
Donors. With respect to living donors, a category that
represents an increasing percentage of donor organs available
for transplantation, ACOT recommends that living organ donors
be fully reimbursed for any and all direct and indirect costs
occasioned by the donation. Furthermore, ACOT recommends that
a needs assessment be undertaken to determine whether, and to
what extent, living donors experience difficulties obtaining
or maintaining health, life and disability insurance. (A specific
question should be raised about mental health coverage because
a lack of parity between mental and other medical coverage remains
a concern.) Government and private payer policies here too need
to be re-examined to ensure that all appropriate costs associated
with living organ donation are fully reimbursed.
In sum, DCD
and brain death acquisition costs, particularly for ECD organs,
as well as all living donor travel and lodging expenses, should
be reimbursed and CMS needs to revise its rules to assure that such
reimbursement occurs. ACOT further recommends that, in order to
fully assure that policies and practices in this regard are kept
up to date, HHS direct the OPTN and the SRTR to provide annual reports
summarizing significant financial and insurance data on relevant
socio-economic groupings.
Recommendation
31: The OPTN should continue its efforts at developing
a national standardized transplant quality of life (QOL) tool that
could be made available to all transplant centers for assessing
transplant end points in addition to mortality. In this context,
transplant centers should be encouraged to establish and implement
back to work programs for transplant recipients and living organ
donors because of their proven ability in improving post-transplant
quality of life, and the OPTN should consider including such programs
in their criteria for transplant centers.
Measures of
transplant outcomes are very limited presently: graft loss, patient
survival, hospitalization. For real human beings, there are many
stages in between. It behooves us to study what the appropriate
tools would be to assess the economic and quality of life (QOL)
status of patients post-transplant. Moreover, since we need to know,
if only in terms of allocation, whether we are doing a service or
disservice by transplanting some patients, we need to assess QOL
at various time points before and after transplant.
One significant
QOL measure is work. ACOT believes that all transplant centers should
develop, in conjunction with their state's vocational rehabilitation
department, a back to work program (sometimes referred to as a return
to work program) for transplant recipients, and, where applicable,
for living donors. The back to work referral should begin prior
to transplantation. It may even be useful to begin vocational evaluation
while patients are still on dialysis, especially since many dialysis
patients have been out of work for many years.
Vanderbilt University's
back to work program demonstrates the interrelationship of such
a vocational effort and QOL. The patient satisfaction survey that
Vanderbilt has conducted demonstrates that optimal employment following
liver transplantation is associated with a higher quality of life.
Conversely, lower QOL is associated with sub-optimal employment
and unemployment. A report on this program received by ACOT indicates
that unemployment nationally among transplant patients is 62%. Post-transplant
Social Security Disability costs run about $10,800 per patient annually.
The median return-to-work time is 3.5 years. Each 100 patients served
by vocational services can therefore save more than $1 million if
we can get them back to work a year earlier. The following non-financial
aspects should also be noted:
The human costs
of post-transplant unemployment include:
Vocational specialists
can help patients tap into such resources as:
-
State vocational
rehabilitation
-
Ticket-to-work
programs
-
Social Security
disability employment supports
-
The Health
Insurance Portability and Accountability Act of 1996 (HIPAA),
which prohibits discrimination in employer health insurance
because of disability or preexisting condition
-
American
with Disabilities Act (ADA) technical assistance.
Recommendation
32: HHS should fund or conduct a review of all underlying
issues related to recipient selection criteria.
The proposed
study should include an unbiased review of the literature that examines
and comments upon the legal, ethical, and medical bases for some
clinical and all non-clinical transplant recipient selection criteria,
as well as related issues. ACOT recommends that the Secretary employ
whatever means are deemed appropriate to conduct such a review,
whether it should involve the commissioning of a study (perhaps
by the Institute of Medicine) to explore and frame the underlying
issues and/or the convening of a consensus conference to discuss
attempts to resolve competing viewpoints.
It is apparent
that public dissatisfaction and sometimes expressed cynicism with
elements of the donation and transplantation system relate to concerns
about the propriety and appropriateness of present recipient selection
criteria. While these and many related issues have not generally
been discussed openly within the donation and transplant communities,
everyone is aware that the public frequently raises these and many
related concerns, as indeed do many health professionals.
Some of the
issues involved may reflect broader health and equity concerns than
are involved in transplantation alone, while others may exist only
because of the supply shortages that uniquely affect our field of
concern. Many physicians feel that widely accepted ethical principles
provide sufficient guidance or that their reading of the Hippocratic
Oath settles all individual patient selection issues. Nevertheless,
the goals of a nationwide patient selection system are not necessarily
resolved in a similar way, and, indeed, may call for differential
criteria to be employed. Note well that ACOT is not by this Recommendation
stating a preferred end result for the review it is requesting,
only that such an impartial and thorough review be conducted and
reported openly.
Recommendation
33: So as to identify more kidneys, and more appropriate
kidneys, that can be used for transplantation, HHS should fund a
clinical multi-center trial to determine whether, and under what
circumstances, pre-transplant kidney biopsies are a predictor of
post-transplant kidney function.
Some transplant
physicians use biopsies to determine if a kidney can be used and
to predict post-transplant function. One small study has been published,
and a second, Italian, paper suggests as well that such biopsy results
are not valid predictors. However, there are at present no comprehensive
data correlating post-transplant function with biopsy outcomes.
The experiences of transplant physicians and surgeons serving on
ACOT indicate that some kidneys with unfavorable biopsies function
well after transplant. Retrospective data analyses, followed by
prospective multi-center clinical trials, should be undertaken to
better define the predictive value of pre-transplant biopsies for
the purpose of increasing the number of kidneys available for transplantation.
Recommendation
34: HHS should review and report on factors affecting multicultural
donation, and present data on transplantation by race, ethnicity,
sex, and region.
ACOT Recommendation
9 was "That research be conducted into the causes of existing
disparities in organ transplant rates and outcomes, with the goal
of eliminating those disparities." ACOT is pleased that the
Secretary supported this Recommendation and that HHS has announced
initiatives in this area. Recommendation 34 is for some specific
follow-ups to these activities, to include as well the donation
side of issues affecting multicultural populations:
-
HHS should
review and report the results of funded grants that have examined
factors affecting multicultural organ donation, as well as identify
and explore any programs that have been successful in enhancing
minority donation. Programs in existence within the procurement
community and those identified through the Division of Transplantation
(DOT) grant program should both be highlighted. DOT has funded
numerous grants focusing on multicultural organ donation. The
final reports for these grants should be reviewed in a timely
manner and factors identified to distinguish successful from
unsuccessful programs. Results should be reported to the procurement
and transplant community and should be examined closely for
transferability because a program that works in one location
may not work in another.
-
The SRTR
(and any other relevant regulatory body with information regarding
this issue, including the Centers for Medicare and Medicaid
Services) should coordinate the collection of data and develop
an annual report that examines referrals for transplantation,
transplant rates, waiting times, and outcome by race, ethnicity,
economic status, sex, and region. The results should as well
be reported to the procurement and transplant community. This
reporting should be mandatory so that the data can be monitored
on a prospective or concurrent basis so as to illuminate disparities.
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The NIH
research agenda that the Secretary has established should focus
on these issues with a view to suggesting biomedical solutions
beyond epidemiological studies. This should include research
as to whether there might be significant genetic differences
in biological responses to allografts.
Recommendation
35: HHS should conduct an evaluation of materials presently
used by various centers and organizations across the nation to educate
potential transplant recipients; the purpose of this review would
be to develop improved patient information and education as part
of the informed consent process. HHS should also ensure that appropriate
hospital personnel undergo annual training in the organ donation
process; such training would include OPO reporting requirements.
ACOT has previously
made several Recommendations urging additional education and information
for both patients (ACOT Recommendations 1, 3, 4, and 8) and transplant
professionals (ACOT Recommendation 11). Recommendation 35 is designed
to build upon those Recommendations in specific ways for both patients
and professionals.
-
Patients:
At present, too many patients report that, prior to receiving
their transplants, they had not been adequately informed about
what to expect post-transplant. HHS should conduct or fund a
research project or grant designed to review existing pre-transplant
information packages and evaluate the perception of recipients
post-transplant assessing the value of the educational efforts
to which they were subject. As a result of the information gleaned
from such a project or grant, a template or set of guidelines
should be developed regarding the kind and quality of patient
information/education which should be incorporated into the
informed consent process, possibly as a part of the ongoing
HHS Best Practices Initiative.
Potential organ
recipients and their families also need to be aware of and understand
any complications that might occur after the patient undergoes a
transplant. Transplantation teams need to help patients and their
families in the advance care planning process. They need to discuss
the possibilities of life-sustaining interventions and the potential
need for intensive care, as well as the possibility that the patient
could die or have an unacceptably poor outcome after transplantation.
Patients and their families in turn should be encouraged to describe
in detail their wishes or goals for care. Kidney patients should
also be informed about the possibility of having to go back on dialysis
for a time during the post-transplant course. Educational materials
should describe the range of outcomes, from very good to very poor,
including death. Patients have a need to know about the spectrum
of possibilities that can occur post-transplant. Neurological complications
from immunosuppressive therapy, mood changes, and complications
concerning pregnancy all need to be more fully described in patient
education materials. It might also be desirable to develop an educational
video, which could be widely distributed by HHS, including interviews
with a range of patients, to more fully explain what should be expected
post-transplant.
As ACOT noted
with respect to its Recommendation 8, we could also do far more
education about the transplant experience while people are on dialysis
awaiting transplant. The key importance of fully educating patients
beforehand is not only to provide a knowing consent to procedures,
but also to encourage patients to become their own best advocates
and empower them to be more involved in their own care.
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Transplant
Professionals: Training on the organ donation process
(including OPO reporting requirements) should be one of the
yearly mandatory updates that hospital personnel are required
to take, just as they presently undertake annual training, for
example, in CPR. Yet, even most hospital personnel are unaware
of the fact that more lives are saved annually through organ
donation than through CPR. The training updates proposed here
should be tailored to meet the needs of the area where the employee
works, but virtually all hospital personnel should comply with
such a training requirement since the public tends to ask relevant
questions of almost all hospital employees. The training should
vary according to need; i.e., ICU, ER and OR physicians and
staff — who are more likely to actively participate
in organ donation — should receive full updates, whereas
other staff should be trained primarily on where questions should
be referred.
For most hospitals,
training is presently available from the local OPO, but it is offered
sporadically. ACOT is here recommending that the process of OPOs
disseminating appropriate education to relevant personnel in the
hospital become more regularized.
Go to: Consensus
Recommendations 1-18 (November 2002)
Go to: Consensus
Recommendations 19-28 (May 2003)
Go to: Consensus
Recommendations 36-41 (November 2004)
Go to: Consensus
Recommendation 42 (May 2005)
Back
to: ACOT Recommendations
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