Hospital administrators are in a position to save thousands of lives every yearwithout having to practice medicine.
By actively supporting the donation of organs and tissues, administrators could make possible the survival of many of the nearly 100,000 people across the U.S. who are on waiting lists. That number is growing rapidly, but only about one-fourth of those on the lists have their needs met.
Why the big shortfall?
Hollywood can be blamed for much of it. A recent survey by Purdue University found that movies and TV shows routinely portray organ donation and transplantation in a bad light, thereby discouraging the public from donating.
Then there is the occasional, unfortunate abuse that hits the headlines: A person gets a kidney that was supposed to be given to someone higher on the list. A prominent medical center refuses offers of donated organs despite the fact that it had many patients in need of them. A transplant doctor is accused of trying to hasten a patients death so he could recover the patients organs.
Such incidents make headlines only because they are so rare. The fact that some 25,000 people receive transplants every year through well-established protocols doesnt even warrant a one-paragraph story next to the classified ads. Meanwhile, many doctors and nurses in hospitals overlook or even avoid opportunities to recover organs that could save the lives of many people.
How can hospital administrators work to reverse this negative attitude? I have some suggestions, but first, for the benefit of any readers who may not be familiar with the donation process, here is a hypothetical but typical example of how it works:
A 19-year-old boy with a severe brain injury sustained in an auto accident is admitted and put on a ventilator. The attending physician determines that this patient will not survive and notifies the local organ procurement organization, or OPO. The organization then sends a person called a procurement coordinator to review the patients chart.
After the procurement coordinator confirms brain death and determines that the patient is medically suitable for donation, a huddle is called to discuss the next step. The attending physician then informs the family that their sons injuries are not survivable, and turns the case over to the OPO.
Once the patients family fully understands the situation, the organ procurement team approaches them about donation. If the family agrees to donate the sons organs, the OPO team takes charge of the case and manages it until the organs are recovered.
During this emotionally draining process the family care coordinator, a member of the OPO team, the hospitals social worker, chaplain and bedside nurse provide support to the family.
But if the family does not consent to donation, the OPO will tell them it understands their position, thank the hospital and close the case.
So what can hospital administrators do to increase the number of donations made on their premises? They might start by contacting their local OPO to say they would like to participate in the national Organ Donation Breakthrough Collaborative. That program assists hospitals in improving their donor conversion ratethe percentage of eligible donors from whom organs are recoveredto 75% or better.
Participating hospitals form Donor Councils composed of doctors, nurses, chaplains, social workersand, yes, administrators, too. Meeting monthly or at least quarterly for only an hour or so, these groups review all cases in the hospital to identify potential donors.
Often, doctors will be reluctant to participate in these sessions. An hour spent in a Donor Council meeting is, after all, an office hour lost.
And its quite understandable why organ donation isnt a paramount consideration for doctors when a patient rolls in on a gurney. They dont want to wait until someone from the local OPO comes in with a team to recover a brain-dead patients organs when they need an ICU bed immediately.
But seeing how the organs of a single donor can save as many as eight lives can cause doctors to view donation in a completely different light. Its truly a life-altering experience when relatives of donors say, as they often do, Thank you for making something good come of this.
The effectiveness of this government-backed program has been demonstrated at hospitals across the country. Within one 12-month period, the conversion rate at Providence Holy Cross Medical Center in Mission Hills, Calif., went to 75% from about 50%. At Yale-New Haven (Conn.) Hospital the rate was 53% in mid-2005; within little more than a year, it had increased to 87%. In the same time frame, the rate at St. Joseph Mercy Hospital in Ann Arbor, Mich., climbed to 88% from 54%.
Hospital administrators who back donation programs that prove successful will not only have the satisfaction of knowing they have saved many lives, but they also will be rewarded with recognition. Every year, HHS awards its Organ Donation Medal of Honor to hospitals achieving donation rates of 75% or higher in a 12-month period.
But of the thousands of hospitals across the country, only 371 are participating in the collaborative program. And just 184 have earned the Medal of Honor.
Hospital administrators who make the effort to encourage their medical staffs to endorse donation will be doing a service to them and their families to fulfill their mission of creating a stronger, healthier community.