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U.S.
Department of Health and Human Services
Advisory Committee on Organ Transplantation
Recommendations 29–35
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.
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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.
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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.
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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:
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State
vocational rehabilitation
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Ticket-to-work
programs
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Social
Security disability employment supports
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The
Health Insurance Portability and Accountability Act of
1996 (HIPAA), which prohibits discrimination in employer
health insurance because of disability or preexisting
condition
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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:
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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.
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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.
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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.
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