The increased use of transplantation is not the only factor widening this tremendous gap. The public’s misconceptions about organ donation have exacerbated the problem. For those who have never personally encountered a recipient or donor family, organ donation and transplantation can be a frightening, even alien, concept. But with over 78,000 names on the national transplant waiting list—and another name added every 14 minutes—chances are that we all know someone leading an ordinary life that will take an extraordinary turn because of organ transplantation.

While medical researchers look for ways to combat illnesses that make transplantation necessary, as a healthcare executive you and the organization you serve can join the crusade from a critical vantage point. Because they work closely with people who need transplants and those who can be donors, healthcare organizations can play an important part in increasing donations. “Hospitals have a crucial responsibility in this effort because they can facilitate a respectful dialogue on the subject of donation,” says James Caldas, FACHE, executive vice president and chief operating officer of Christiana Care in Newark, Del. “If people really understood what donating an organ can mean for those who would otherwise die, I truly believe we would have incredible support for the concept.” To gain such support and increase awareness, several healthcare organizations have found success by implementing the following strategies.

Work with Your Local Organ Procurement Organization Organ procurement organizations are nonprofit agencies that are overseen by the federal government, and each OPO is assigned to a specific territory. When an organ becomes available in the OPO’s geographic area, OPO staff recover the organ and coordinate its allocation to a qualified patient. In addition to handling the clinical and financial functions in organ recovery, OPOs promote donor awareness in their communities.

Despite being a vital link in the transplantation process, the OPO’s role is not always clear to hospital staff. According to the Joint Commission on Accreditation of Healthcare Organizations, many healthcare organizations experience problems during JCAHO surveys because staff are unsure about organ procurement guidelines, such as the time frame in which the OPO needs to be notified about an “imminent death.” Because organs must be recovered quickly in order to be transplanted successfully in another patient, the OPO must be involved in a timely fashion or the organ may no longer be useful. “Hospitals need specific procedures and policies for working with OPOs,” says Patrick J. Giordano, CHE, chief executive officer of the Texas Organ Sharing Alliance in San Antonio. “Such policies should address the importance of early referral of potential organ donors, standardize the organization’s brain death declaration protocols, and provide a coordinated approach for working with the family to gain consent for donation.”

While the OPO actually manages the patient and the case once it is clear that donor organs can be recovered, the cooperation of healthcare organizations is key to the process, especially in working with the donor family. “Hospitals are blessed with caring staff,” Christiana Care’s Caldas says. “But because the average physician or nurse may not routinely encounter such a situation, they are not going to be as expert in dealing with donor families as an individual from an OPO who is dedicated to this specific pursuit.” A study published in the July 4, 2001, issue of JAMA found that the time spent with an OPO coordinator was a strong factor associated with a family’s decision to donate. The authors of the study concluded that the role of hospital staff should be limited to involving OPO staff early in the process and working under their direction to optimize the donation request.

OPOs can also provide a wealth of information—including materials that debunk the prevailing myths about organ donation—and offer regular educational programming to the staff of healthcare organizations in their region. “If your organization wants to begin an organ donation awareness campaign, your OPO can develop an educational process for everyone, starting with the CEO and the board,” says Michael D. Means, FACHE, president and chief executive officer of Health First, a health system headquartered in Melbourne, Fla. “Your OPO can help you and your staff understand the law and how the organ donation process works in your state and in your region.”

Educate Employees Even if hospital staff are not directly requesting donations from patients’ families, their support will shape the organization’s culture. “If staff have a negative attitude about donation, patients and their families will be able to sense that,” says Mary Gainey, R.N., administrative supervisor, Patient Care Services, who has been instrumental in Health First’s highly successful donor awareness program. When Health First decided to embark on an in-house initiative, the organization surveyed staff to assess their understanding of and attitudes toward the process and found that many misconceptions about donation and transplantation prevailed—even in the healthcare setting. “The results were used to determine the content of frequent in-services to increase employee awareness,” Gainey says. Within one month of instituting the in-services, donation rates doubled. And over a four-year period, Health First has seen a 500 percent increase, proving that staff who are educated about organ donation can positively influence potential donors and their families. In addition to in-services, Health First distributes a monthly newsletter to all staff, featuring the latest donor statistics and facts about organ and tissue donation. Annually, the organization offers staff a two-day organ/tissue donation seminar called “Life: Keep It Going,” which features speakers on donation issues as well as panel discussions with recipients and donor families.

While all staff should be included in the educational process, focused training must be directed at those closest to potential donor situations, particularly staff in trauma and emergency units and social services. “We educated the emergency center and ICU staff and our chaplain to make sure that they had access to the right information should the opportunity for a donation arise,” says Jennifer Malatek, chief operating officer with McKenna Memorial Hospital in New Braunfels, Texas. “With the help of the Texas Organ Sharing Alliance, we now place a green sticker that lists the donor referral line number on every single patient chart. This will help our nurses respond in a timely fashion should a situation arise where we have a potential organ donation.”

Form Hospital-Based Educational and Promotional Groups With organizationwide support behind them, both McKenna Memorial Hospital and Health First formed multidisciplinary groups of employees charged with increasing awareness about organ donation within their organizations as well as their communities. McKenna created the “G.O.L.D. (Gift of Life Donor) Team,” composed of volunteers from all departments in the hospital, including physicians. As the group’s profile has grown, people from the community have been attending meetings as well. G.O.L.D. Team members have promoted organ donation by sponsoring poster campaigns at local schools, through speaking events, organ donation fairs, and hospital receptions, as well as a best practices training session for staff with the help of the Texas Organ Sharing Alliance. “Our G.O.L.D. Team is passionate about overcoming the cultural, social, and religious myths associated with organ donation,” McKenna’s chaplain Forrest Anderson says. “There is a moment of ‘enlightenment’ that sweeps over people once they learn the facts. Human nature, I believe, is generous. You really can get people on board with just a little education.”

Similar to McKenna Memorial Hospital’s efforts, Health First formed the “Tiger Team,” so named because the group strategizes ways to “attack” the shortage of donor organs. In the four years since its inception, the Tiger Team has enjoyed incredible success through an array of awareness-building projects. “We have an 83 percent consent rate in our communities, which is almost more than double the national hospital average,” Health First’s Means says.

The team meets monthly to discuss issues related to organ and tissue donation and to plan projects that will involve both the hospital staff and the community in the cause. “We sponsored a donor awareness essay contest in the local schools to promote awareness among young people,” Health First’s Gainey says. “The winning essay was published in the hospital newsletter, on our Web site, and in the newsletters of several organ and tissue procurement agencies. We’ve also sent letters to more than 100 local businesses, asking them to distribute donor cards with their paychecks, which resulted in the distribution of over 20,000 donor cards.”

And that’s not all the group has accomplished. Because of the Tiger Team’s efforts, more than 100 bumper stickers promoting organ donation were placed on the vehicles of local police, sheriff, and fire depart- ments. From the donor awareness art contest the group sponsored for school children, several billboards displaying the winning entries were put up throughout the county. This year, the team also published a calendar featuring many of the art contest entrants. Further demonstrating the organization’s commitment, the Tiger Team sponsored a local 12-year-old kidney recipient at the 2000 U.S. Transplant Games. A postcard featuring the young recipient’s amazing story was then distributed to area high school students to stimulate family discussion about organ and tissue donation. “In addition to all of these projects, members of our group speak at local Lions and Rotary clubs meetings, church groups, paramedic and nursing classes, hospital orientations, and driver’s education classes—basically we’ll talk to anyone who will listen,” Gainey says.

Gainey believes that the Tiger Team’s success can—and should—be replicated at healthcare organizations around the country. To that end, she recommends the following guidelines:

• Find a “champion” to be the group facilitator. Usually the ideal champion is an ICU nurse who has cared for potential donors or recipients.
  
  
• Invite members of local organ, tissue, and cornea procurement agencies to participate.
  
  
• Enlist the aid of your administration, asking at least one executive to become a member of the team.
  
  
• Allow open membership. Invite any staff with an interest in the topic to join. Encourage each nursing unit to have at least one representative on the team.
  
  
• Conduct a survey before the first meeting to determine what the learning needs are. Use this information to plan ways to educate the team and, in turn, to help team members share information with other staff.
  
  
• Set up monthly meetings at a convenient time to encourage participation from both night and day shift employees. Breakfast meetings work well.
  
  
• Post monthly informational flyers or newsletters to keep the issue fresh in people’s minds. Include current donor statistics or FAQs about various religious responses to organ donation to help staff interact with patients of different faiths.
  
  
• Tout your successes.

With a solid program in place both inside of your organization and in the community it serves, promoting organ donation becomes the expectation, rather than the exception. “We respect a family’s right to say no, but we offer the opportunity to every appropriate situation and patient,” Gainey says.

Promote Early Discussion One critical element of organ donation that must be emphasized to all of your constituents—staff and community members alike—is the importance of expressed consent. Very little public education about organ donation has explained this process—information that could prepare individuals for a time when they may face the issue themselves. “For the average person, the question of organ donation doesn’t really arise except at the time of a very tragic circumstance, and that’s one of the big obstacles,” Christiana Care’s Caldas says. “People need to express their intent to their families in advance.” A signed donor card or driver’s license is a legal document; however, family or next-of-kin consent must be obtained for organ and tissue donation. Because there is no national donor registry, individual donors must share their decision with their families.

Increasing organ donation awareness is a major initiative for the U.S. Department of Health and Human Services. Their Web site, www.organdonor.gov, provides valuable information and resources that your organization and your community can use to promote donor awareness—and to help share the gift of life.

To find out which OPO serves your area, visit www.organdonor.gov.

Ellen G. Lanser is a senior editor for Healthcare Executive.