This document describes Gift of Life Donor Program's innovative training model called "Dual Advocacy" for coordinators to obtain consent from donor families. It summarizes key aspects of the model including emphasizing family-centered care, seeing themselves as advocates for both recipients and families, and helping families feel empowered to donate. It also outlines Gift of Life's extensive training program and the improved consent rates seen after implementing the new model.

1. Dual Advocacy: Innovative and Sensitive
Training Model for Coordinators In
Approaching Donor Families for Consent
Presented by:
Howard Nathan
President and CEO, Gift of Life Donor Program
Founder and President, Gift of Life Institute
Philadelphia, PA, USA

2. Gift of Life Donor Program
Philadelphia, Pennsylvania USA
• Non-Profit OPO/Tissue Recovery/Eye Bank
• Established in 1974
• Federally designated OPO (by Medicare) for
eastern PA, Southern NJ & Delaware
- 130 Acute Care Hospitals
- 15 Transplant Centers, 43 Programs
- 10.3 Million Population
Gift of Life Donor Program Office (Philadelphia, PA)
• 2011* Projected Data:
- 440 Organ Donors / 42.7 Donors/MM
- 1,236 Bone Donors and 2,551 Cornea Donors
• Over 31,000 organs for transplantation and
over 375,000 tissue allografts
• Accredited by: Association of Organ Procurement
Organizations (AOPO); American Assoc. of
Tissue Banks (AATB) & Eye Bank Assoc. of
America (EBAA); UNOS/OPTN member OPO
Team Philadelphia Transplant Recipient Athletes Competing *Source: Gift of Life data. 2011 Projection Based on YTD performance through 11/15/2011
at the 2010 U.S. Transplant Games in Madison, WI

3. U.S. Overview
• OPO‟s have variation in roles, responsibilities and process
Specialized Requestors
(family focus with minimal if any
clinical responsibility)
vs.
Transplant Coordinators w/
Full Case Responsibilities
(referral through the OR)
Approach for Authorization
(non-designated donors)
vs.
Approach for Disclosure
(designated donors)

4. Gift of Life Donor Program
Best Demonstrated Practices
• OPO Referral Trigger: „Refer all vent-dependent patients with a non-
recoverable neurological injury‟
• OPO Commitment - Immediate on-site response to evaluate every organ
donor referral
• Hospital - OPO team approach to clinical
management & family centered care
Family
• Strong OPO emphasis on
– Consistency in clinical practice
– „Timely referral‟
– „Effective requestors‟
Hospital OPO
– Family empowerment
• Routine open dialogue w/care team; reinforcing
environment of joint accountability for outcomes

5. U.S. OPO Transplant Coordinator
Background & Staffing Model
Typical Backgrounds:
• Critical Care Nurses
• Paramedics
• Respiratory Therapists
OPO Staffing Model:
• Transplant Coordinators
• Referral Coordinator
• Advanced Practice Coordinators
• Specialized Requestors
• In-House Coordinators

6. Gift Of Life Donor Program
Transplant Coordinator Responsibilities
Check DMV Family Support
Referral
&
Intake &
Communication
On-site Response
OR Scheduling
Clinical Assessment Communication
Diagnostic Testing & Prep
Donor Management
Organ Allocation &
Surgical
Collaboration with Recovery
Care Team Coordination
Team Huddles Real Time
Education Post Mortem Care
Follow-up Letters

7. Consent Philosophy and
Interactive Training Model

8. Historical Approach to Consent
(1974 – 1995)
• Process oriented (focus on clinical and recovery details)
• Script-like family conversations – Designated Requestor
‒ Death Centered to help the grieving family
‒ Requestor saw self as Donor Family Advocate
• Inconsistencies in the way staff conducted
conversations (individual vs. organizational practice)
• Minimal orientation training (often preceptor driven)
• No continuing education training on consent

9. Dual Advocacy: A Value-Positive
Approach To Obtaining Consent For
Organ and Tissue DonationSM
Goal: Inspire the family to donate by helping
them understand the power of their decision.

10. What is Dual Advocacy?
With Dual Advocacy the donation professional‟s
responsibility is to advocate for both the waiting
recipients and the potential donor family.
Donation Professionals (Family Communicators)
see themselves as:
• Proactive specialists
• Members of the family care team
• Responsible to empower families to save and improve the lives
of others through transplantation

11. Dual Advocacy-Philosophical Framework
Based on Three Underlying Beliefs
Held by Donation Professionals
Most people given an opportunity to
save a life, or help someone, will do it.
Organ / Tissue donation feels like the
right thing to do.
The key role of the donation professional is that of
a “Dual Advocate.”

12. Transplant Coordinator
Introduction to Family
“This is „Coordinator‟s First
& Last Name.‟
He is a member of our team
who specializes in
working with families like
yours who lost someone
they love.”

13. At The Heart Of Dual Advocacy Lies A
Simple Question:
Did we empower
the family and give
them something to
say yes to?

14. TEAM PHILADELPHIA 2010
109 Athletes
76 Donor Family Members
13 Living Donors
354 Total Participants
27 Gold Medals – 35 Silver Medals – 30 Bronze Medals

15. Our Training
Commitment
Increase organ and tissues available for
transplantation through the improvement of
staff competencies.
Extensive training programs, continuing education
offerings, scenario-based skills practice, field
coaching, and proficiency evaluations.

16. Leadership Models the Way
Organizational Commitment:
• Consistent messages
• Learning/Teaching culture
• Every opportunity matters
• Extensive training
• “Dual Advocacy” is both an
organizational and individual
responsibility
• 24/7 mentoring, coaching and
guidance

17. Gift of Life Institute
Celebrates Its 7th Year in Operation
• Over 200 workshops with 51 OPOs and tissue banks
participating
• More than 3,500 donation professionals trained in the
U.S. and Canada, plus hosted visitors from
Australia, Netherlands, China, Japan, Germany, Canada,
Philippines, Brazil and Spain
• National training curriculum with customized workshops
at OPOs in consent and hospital development; consulting
services including OPO evaluation, focus groups, staff
development, customized hospital assessment and
strategic planning
http://www.giftoflifeinstitute.org

18. www.giftoflifeinstitute.org
Internet based skills practice
Variety of consent scenarios
Experienced mentor providing
real-time feedback

19. Staff Development & Training
Family Communication Didactic Classes
Orientation (4 Months)
• Active Listening
• Classroom didactic • Consent Module I:
(7 - 8 weeks) Introduction to Family Communication and
the Donation Discussion: GLDP’s Dual
• Preceptors AdvocacySM Philosophy
• Consent Module II:
• Field Developing Effective Family Communication
Skills and Conversational Strategies: GLDP’s
experience Family Communication Practice and Policies
• Consent Module III:
• Independent-Study Family Communication: Learning the Art of
Averting and Overcoming Challenges and
Learning Modules Obstacles
• Foundation for Understanding the Basics of
Grief
Didactic Classes = 33
• Legal Aspects of Consent

20. Organ
Donation
Goal Setting
Monthly and
Annual
Performance
Dashboards

21. Musculoskeletal Goal Setting
Performance Dashboards

22. Gift of Life Donor Program Outcomes

23. Gift of Life Donor Program
Organ Donation Consent Rates
2000 – 2010
Pre-Training Training Post-Training
Implementation
2/1/2005
2000 2005 2010
51% 57% 66%
Organ Donors:
298 382 440*
*projected to 2011 based on data from Nov. 15, 2011

24. Gift of Life Donor Program
Organ, Bone and Cornea Donor Experience
2,400
2,300
1974 – 2010 2,364 2,382
2,200
2,100 Organ Donors
2,000
1,900 Bone Donors
1,800 1,824
Cornea Donors
1,700
1,600
*Based upon GLDP data through December 31, 2010.
1,500
1,400 1,420
1,300 1,325
1,200 1,220
1,037 1,035
1,100
1,027 1,026
1,000 882 899
900 895 863 878
885 810
800 801
757 744 698
700 623
623 631
600
520 428 470 401 439
500 469 392
421
331 354 387
434
400 298 428
210 204 208 262292
222 326 315 344 382 389
300 153 183 190 201 284
118 241256 298
200 78 82 87 92 182 235
100 23 45 62 158 149 180212
83 93 174
0 79

25. Gift of Life Donor Program
Musculoskeletal Donation
Approaches & Consent
Training
Musculoskeletal Pre- Implemented Post -
Donation Training 2/1/2005 Training
2/1/2002 2/1/2005 2/1/2008
to to to
Years 1/31/2005 1/31/2008 1/31/2011
Approaches 7,020 8,582 11,922
Yes 1,795 2,520 4,148
Consent Rate 26% 29% 35%

26. Gift of Life Donor Program
1,150 Bone Donor Experience
1,100 2000 – 2010 1,025 1,035
1,050
1,000
950
878
900
850
800
750
696
700 2004 - 2010
626 631
650 Bone Donors
600
Up 121%
550
500 470 469
420 427 434
450
400
0 1 2 3 4 5 6 7 8 9 0
2 00 2 00 2 00 2 00 2 00 2 00 2 00 2 00 2 00 2 00 2 01
Implemented Training

27. Gift of Life Donor Program
2010 Tissue Donation Summary
2,482 Tissue Donors
Tissues Donated
Cornea 2,330
Skin 777
Musculoskeletal 1,035
Heart Valves 208
Saphenous Veins 236
Other 1,008
Total Tissues Donated 5,594
Some patients may donate multiple tissues for transplantation.
Source: Based upon GLDP data through December 31, 2010

28. Gift of Life Donor Program
2000 – 2010 Outcomes
Musculoskeletal Donors = 7,111
Potential People Helped = 319,995
Organ Donors = 4,129
Transplants = 11,779

29. Focus on Family Centered Care

30. It Really Is All About the 1’s……..
1 Donor at a Time
1 Donor Family at a Time
1 Transplant Candidate at a Time !

31. GRACIAS!!!
Thank You!
Correspondence: hnathan@donors1.org