Organ Procurement Organizations and Telehealth: The New Shift to Increase Organ Donation Authorizations

Natasha Ansari

PhD Student, College of Nursing

June 3rd, 2021

The Past and Present

    Organ Procurement Organizations (OPOs) currently reach potential donor families by in-person contact, and when this method is unattainable, then telephone conversations are the next method of choice. A real-life example looks like this: a patient is in the intensive care unit of a hospital and the nurse is charting in the patient’s electronic medical record (EMR). The neurological section shows a table of 5 clinical triggers:

1. Patient has a Glasgow Coma Score less than 5 without sedation or paralytics

2. Clinician discussion of brain death testing

3. Loss of any 3 cranial nerves on patient’s neurological examination

4. Clinician discussion of brain death testing

5. Patient’s family is mentioning organ donation

If the nurse selects “Yes” to any of these 5 options, the EMR is set up to either send an automatic page to the call center or prompt the nurse with the phone number to the call center. A conversation then takes place between the bedside nurse and the call center staff member – where patient information is exchanged. The call center then pages the on-call organ procurement coordinator to call the bedside nurse.

    The coordinator asks the nurse more in-depth questions regarding neurological examination, medications, and family perceptions. The coordinator obtains the family contact information and, depending on urgency of the case, will either make a phone call or try to be at the bedside to talk to the family in-person regarding organ donation. This approach, either in-person or via telephone, is called the initial approach. Bedside nurses are not allowed to discuss organ donation due to the sensitive nature of the topic – organ procurement coordinators are licensed social workers with additional training in regards to approaching families for the purposes of organ donation authorization.

Issues with the Current Method

The main issues of the current operating procedure that have been discussed amongst DonorConnect, Utah’s local OPO, are:

• Travel time of the coordinator to the hospital is 20 minutes to 3 hours long

• Family members impatient to wait for the coordinator

• Delayed withdraw of life-support for the patient

• With COVID-19, family was not at the hospital and/or coordinators are not allowed in the hospital

• Phone calls are impersonal and unstructured

With the rise of telehealth encounters amongst the COVID-19 pandemic, DonorConnect is interested in addressing these issues and changing the “norm” for the OPO coordinator’s initial family approach. You can find DonorConnect’s website by clicking on this image.

The Future - Knowns and Unknowns

Telehealth is now being introduced to DonorConnect as a more efficient and personal method of communication instead of telephone calls. An in-person initial approach will be the preferred contact method, however, when this is not possible or time is limited, then telehealth is a better approach compared to phone calls to the family. 

Barriers to this new shift include establishing software and hardware at each of the hospital locations, getting hospital administration and other stakeholders on board, teaching bedside nurses, teaching coordinators and empowering them to adopt this new approach, as well as empowering and teaching family members how to download the HIPAA-compliant software on their own devices. 

Currently, a pilot study is being conducted with DonorConnect to adopt telehealth as the second-line of approach for the coordinators receiving referrals in their affiliated hospitals – especially focusing on the rural hospitals which require more travel time. 

Consequences that one can foresee with this paradigm shift are technology issues, family members unable to connect due to not owning a device capable of downloading applications, and bedside clinician scheduling conflicts.

As for the potential impact of this shift: OPOs and society have the opportunity to achieve more organ donation authorizations. The impact on the coordinators is achieving a more personal connection then a phone call can provide. The same goes for the family members - feeling heard, empowered, and valued over a telehealth connection instead of phone call – also the ability to include many other family members on the call.

Unanswered questions for this shift include the real impacts – satisfaction scores of clinicians, coordinators, and family members utilizing this approach versus telephone and how they compare. That is the objective of the pilot study that is being conducted at this point in time. 

Telehealth is here to stay and its potential has only just begun. This telehealth and OPO relationship is the perfect example of how one can visualize technology assisting humans and the possibility of making a huge impact on organ donation and saving thousands of lives.

This photo is used with the permission of Dr. Safdar Ansari – shown here in the top left corner (4/13/2021)

If you would like more information regarding OPOs and hospital collaboration – click on this image