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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:
A patient with severe, acute brain injury:
Who requires mechanical ventilation;
Is in an Intensive Care Unit or Emergency Department;
AND
Has clinical findings consistent with a Glasgow Coma Score
(GCS) that is less than or equal to a mutually-agreed-upon
threshold; or
For whom physicians are evaluating a diagnosis of brain
death; or
For whom a physician has ordered that life sustaining
therapies be withdrawn, pursuant to the family’s
decision.
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:
- 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.
- 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.
- 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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