Welcome back! In part one of this series you learned about how to designate yourself as an organ and tissue donor and how to ensure your wishes are honored. Now for Part 2 – The Referral we will explore the first step in a donation case – the referral call. Before we jump in, we’ll back up just a bit and explain who we are at The Living Legacy Foundation of Maryland.
Who is The LLF?
The Living Legacy Foundation of Maryland is the Organ Procurement Organization (OPO) covering all of Maryland with the exception of Montgomery, Charles, and Prince George’s counties. We are the non-profit health organization who saves and enhances lives through organ and tissue donation and transplantation. We also provide family support and educate hospitals and the public about donation. Check out our website to learn more about our mission and our team!
Every hospital in our service area is legally obligated to report all deaths to The LLF, based on state and federal laws and guidelines. A referral call is made to The LLF when a patient at the hospital** either has a cardiac time of death (their heart has stopped beating and they have been declared dead) OR when they have a score of five or less on the Glasgow Coma Scale (GCS). The GCS is a well-known system used by doctors and nurses for assessing the level of neurological functions of a patient after suffering an acute brain injury or some type of medical incident which blocks oxygen from reaching the brain. The scale ranges from the highest score of 15 to the lowest score of three. A score of five or less means the patient has little or no reaction to stimuli and chances of recovery are slim.
MYTHBUSTER: The biggest myth about organ and tissue donation is that hospital staff will not work as hard to save your life if they know you are registered as a donor. By now it should be easy to see that this is completely FALSE.
The OPO is only made aware of a patient who meets the criteria to be referred after every effort has been made to save their life. Additionally, the team handling a patient’s care is completely separate from the team facilitating donation. And furthermore, we care about you! The hospital work hard to SAVE all lives, not end some of them prematurely for the sake of other lives! Now we’ll jump off the soap box and move on.
Who makes the call?
Most often it is the nurse caring for the patient who makes the referral call, but a doctor or physician responsible for the patient may also call. Hospital staff are educated on making referral calls by our Hospital Service Coordinators (HSC). Our hospital service coordinators provide donation education to all 34 hospitals in our service area. They thoroughly explain when to make a referral call and why that call is so important: to save lives! All the hospitals in our services area also have donation related policies that guide their practices.
Who receives the call?
Referral calls come in to our call center at The LLF, which is staffed by dedicated Donor Service Coordinators (DSC) who take calls 24/7, 365 days a year. Along with taking calls in our service area, our Donor Service Center also serve as a call center for the DC-based OPO Washington Regional Transplant Community (WRTC) and for Cytonet, a liver research organization.
The Referral Conversation
A referral call must be made within 60 to 120 minutes of the cardiac time of death or from the point at which the hospital team has determined the patient has a GCS of five or less. The conversation can last less than a minute, or up to ten minutes, depending on if there is potential for organ or tissue donation. First the DSC collects basic information: hospital, unit, patient’s name, date of birth, date of admission to the hospital, and cause for the admission. Then they ask a very important initial question related to determining if organ donation is possible: Is the patient on a ventilator? A patient MUST be on a ventilator in order to be an organ donor. However, a patient does not have to be on a ventilator to become a tissue donor. Reasons for this will be explained in future blogs so keep following!
Every potential organ and tissue donor is evaluated on a case by case basis. The LLF team works closely with the hospital staff to learn more about the patient’s medical history to determine if donation might be possible. There are some diseases that might affect whether a patient can be a donor, but in many circumstances, donation is a possibility. If a patient meets the initial criteria for organ donation, an Organ Recovery Coordinator (ORC) will go on-site to the hospital and take next steps in gathering more medical information. If the patient is a potential tissue donor, then the DSC will continue to gather information on the phone from the hospital staff person who made the referral call.
We’ll go over the next steps of the referral, which dives deeper into how donors are evaluated for the possible gifts they may give.
**But wait! What if I don’t die at a hospital?**
We mentioned that hospitals work very closely with us to meet their responsibility to report all deaths to The LLF, but what happens if you don’t die at a hospital? If you do not die at a hospital, there is still a chance for tissue donation to occur, but we would need to know the exact time of death or the time you were last seen alive. Tissue recovery must start within 24 hours of the time of death, otherwise the tissues are no longer acceptable for donation. How do we get this information if you aren’t at a hospital? The LLF works very closely with the medical examiner, which provides the opportunity for donation for those who died and may not have gone to a hospital. Outside of that, there are situations when a person dies at home or in a hospice and the body goes directly to a funeral home and not to a hospital. In those cases, we would not receive a notification since the death did not occur in a hospital. Sometimes in these situations, the family may call our organization directly to ask about donation and we would determine if that might be possible. Although we cannot consider every case of death for donation, we still always honor and appreciate all who sign up to donate life!