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Table 5 The Organ Donation Breakthrough Collaborative Best Practices, and Conflict of Interests.

From: Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent

Category

Examples quoted from the published report[97]

Page

Job Security

Hiring, supervision, and recognition are linked to performance [rates of consent].

v, 10, 30

 

Accountability among hospital staff may be driven by hospital administration... Hold their staff accountable to performance.

v, 11-12

 

Regularly track performance, and use data systems to track results at the staff member and organizational levels. Staff are held accountable.

v. 30

Healthy Competition

Reporting data by ICU fosters a healthy competition among units.

11

 

Nurses reported that this sense of competition led to improvement in referrals and consents.

63

Call Early

Nurses automatically look at the white board to see if any patients look like potential donors.

viii, 44

 

Conduct regular rounds in high potential ICUs... They are the most likely OPO personnel to identify potential donor cases early; they raise hospital staff awareness...

44,

 

In house coordinators interacted with families as extensions of hospital nursing staff... OPO staff do not "hover" waiting for organs but do discretely monitor the patient's condition.

14, 56

 

He is already thinking about organ donation upon the arrival of certain types of patients in the emergency room.

55

Goal is "yes"

Getting to an informed "yes" is paramount.

ix, 29, 57

Bordering on coercion

Assigns only those nurses [champions] to potential donor cases.

56, 58

 

Importance of 'setting the stage' for consent well ahead of the declaration... becoming familiar with family dynamics and establishing a relationship with the key family decision-makers... bringing the family food and blankets... this type of 'surveillance' information was reported to be extremely useful in tailoring approaches to families for consent.

57, 58

 

[Use the requestor] with the strongest connection or bond with the family... and has a history of achieving families' consent to donate.

58

 

Presenting the donation request as a personal story, giving examples of transplant recipients.

61

 

Proximity to transplant recipients as an opportunity to heighten the immediacy of need for organ donation.

68

Incentives

Often given incentives to perform well: compensation, bonuses, performance reviews... Financial incentives for achieving these targets [consents per year]...

11, 23

 

Sessions at times 'when staff are hungry'... and bring more than enough food to serve all attendees.

42, 49

 

Distributes pens, notepads, and mugs.

44

 

Invites physicians, residents, and nurses to baseball games, hockey games, annual dinners and other outings to maintain buy-in, strengthen relationships, and recognize high performance.

49, 51

 

Visit high-referring ICUs with dinner... sent the physician a box of his favorite cigars.

49

Business model

Strategically recruits high profile members of business and civic community to sit on the board of governors... Strategically appoints top officials from high donor potential hospital to its board... Strategically select influential, potentially pro-donation hospital personnel to serve on their boards... they do expect them to be champions for organ donation and accessible to the OPO for immediate as well as longer-term needs for facilitating organ donation.

20, 37, 45

 

Orient operations towards outcomes rather than processes.

28

 

If you secure doctors of high stature, it will facilitate mid-level doctor support.

47

 

They serve as a 'committee of ears'...

47