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First Person Authorization Determination and Conflict Resolution (2.15)

First Person Authorization Determination and Conflict Resolution (2.15) - Policies, Clinical, UWHC Clinical, Department Specific, UW Organ and Tissue Donation

2.15


POLICY
Established Date: April 2010
Effective Date: September 2017
Title: First Person Authorization Determination
and Conflict Resolution
Policy Number: 2.15

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 1 of 6
PURPOSE

The purpose of this policy is to provide clear steps for University of Wisconsin Organ and Tissue Donation
(UW OTD) staff to follow to determine if a patient referred for organ donation has made a designation of
first person authorization (FPA) and to provide guidance on the process to follow when the patient’s legal
next of kin (LNOK) is responsible for making the donation decision or there are concerns of an FPA dispute.
Unless otherwise noted, the guidance included here pertains specifically to Wisconsin gift law.

FORMS

Wisconsin First Person Authorization for Organ Donation Disclosure Form

POLICY

First Person Authorization Determination
A. Upon initial referral of a patient for organ donation potential, a UW OTD organ procurement
coordinator (OPC) will determine if the patient has made a designation of FPA by reviewing the
applicable state donor registry, the National Donate Life America registry, or reviewing other
FPA documents.
B. The OPC will review the state donor registry of the state where the patient resides. The
following is the contact information for the applicable state registries:
1. Illinois - Call 800-358-0128.
2. Michigan - Call 800-482-4881.
3. Iowa - Call 800-831-4131.
4. Minnesota - Call 800-247-4373.
5. Wisconsin - Access
https://wamsprd.wisconsin.gov/nidp/idff/sso?id=DHSLogin&sid=0&option=credential&si
d=0&target=http://health.wisconsin.gov/donorRegistry/secure/intent.html.
i. A registration date prior to 29 March 2010 is only record of intent which is not
FPA; the LNOK will need to provide consent.
ii. A registration date on or after 29 March 2010 is a record of gift which is FPA.
6. If the patient is on the registry, the OPC will obtain a registry document.
i. The registry document will indicate the details about what the FPA consent
covers (i.e. research, training, what organs and tissues are covered, etc.).


POLICY
Established Date: April 2010
Effective Date: September 2017
Title: First Person Authorization Determination
and Conflict Resolution
Policy Number: 2.15

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 2 of 6
ii. If these details are not denoted on the registry document, the OPC will confirm
with the appropriate agency or reference the applicable state laws and will note
this information in the UW OTD patient record.
iii. In the event that the patient is on a state registry that only authorizes donation
for the purposes of transplantation (i.e. Minnesota), then the LNOK will complete
the standard authorization form if they are in favor of donation for the purpose
of research and education. On the form, “yes” would be marked for
transplantation, research, and education. This should be saved in the medical
record in addition to the patient’s executed FPA document. If the NOK declines
research and education, then the only needed documentation to pursue donation
for the purposes of transplantation is the FPA document from the state registry in
question.
C. The OPC will also review the national Donate Life America registry, even if the patient is on the
state registry.
1. If the patient is on the national registry, the OPC will obtain a registry document.
2. Documentation of FPA from the national registry will specify which organs and tissues
are consented and how they will be used (i.e. research, transplantation, education and
training).
D. If the patient documented FPA through both the state and national registries, the date of the
most recent FPA documentation will be used as consent.
E. If FPA was not documented in a state or the national registry, the OPC will review the following
other appropriate methods of FPA documentation.
1. A driver’s license or state issued identification card:
i. In Wisconsin, a donor dot alone dated after April 2008 is FPA.
ii. In Wisconsin, a signature with or without a donor dot with any date is FPA.
iii. The OPC will obtain a copy of the front and back of the license or identification
card.
2. An advance directive (i.e. healthcare power of attorney, living will, or donor card):
i. An advance directive, even those that include an “I wish” statement, is
authorization for donation for the purposes of transplantation per University of
Wisconsin Hospitals and Clinics (UWHC) legal department.
An advance directive that specifies only a general intent to make an anatomical
gift by words such as “donor,” “organ donor,” or “body donor,” or a statement of
similar meaning, is authorization for donation for the purposes of transplantation


POLICY
Established Date: April 2010
Effective Date: September 2017
Title: First Person Authorization Determination
and Conflict Resolution
Policy Number: 2.15

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 3 of 6
but not research and education. If the LNOK declines research and education,
then the only needed documentation to pursue donation for the purposes of
transplantation is the advance directive. If the LNOK is in favor of research and
education, then the LNOK will complete the standard consent form, marking
“yes” for transplantation, research and education. If the patient will be donating
via donation after circulatory death (DCD), a DCD consent form (i.e. procedural
consent form) will also be completed.
ii. The UW OTD administrator on-call (AOC) or the UWHC legal department may be
consulted to review the document to ensure it is legally valid.
ii. The OPC will obtain evidence of the most current advance directive.
F. If a minor at least 15 ½ years old has documented FPA, no additional LNOK consent will be
collected if the LNOK is in support of donation. Per UWHC legal department, the minor’s FPA is
legal authorization for donation. Unless the minor is legally emancipated, the LNOK for a minor
may still limit or revoke the minor’s decision to donate; limitations will be documented on the
standard authorization form.
G. The OPC will compare the patient’s name, and date of birth to the name and date of birth on the
FPA document, as applicable and if the information is available.
1. Two OPCs will review the FPA documentation to verify it is accurate.
2. Both OPCs will document this verification in the UW OTD patient record.
H. The OPC and Donation Support Specialist (DSS) will make an effort to obtain any amendments or
efforts to revoke the FPA.
1. The OPC will ask the patient’s family or individuals associated with the patient if they
know of any amendments to FPA during the donor risk assessment interview (DRAI)
conducted per UW OTD policy 2.03.
2. If an amendment to FPA is discovered, evidence will be provided to the OPC or DSS and
the OPC or DSS will contact the UW OTD (AOC) and the UWHC legal department.
3. Documentation that this action was completed will be recorded and maintained in the
UW OTD patient record.
I. All FPA documents will be provided to the hospital and maintained in the UW OTD patient
record.
1. FPA documentation (i.e. evidence of registry, advance directive, driver’s license, etc.) will
be provided to the hospital as soon as the documentation is identified.
J. The OPC, DSS, or other UW OTD staff will verbally communicate the patient’s FPA status to
hospital staff assisting with the patient and/or the patient’s family.


POLICY
Established Date: April 2010
Effective Date: September 2017
Title: First Person Authorization Determination
and Conflict Resolution
Policy Number: 2.15

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 4 of 6
K. Ahead of any potential end-of-life or consent conversations with families, the DSS or other UW
OTD staff will collaborate with hospital staff (including physicians) and share the patient’s FPA
status and donation eligibility.
L. For patients with a Wisconsin record of gift, the Wisconsin First Person Authorization for Organ
Donation Disclosure Form will be provided to the patient’s family.
First Person Authorization Conflict Resolution
M. If the initial response of the patient’s family to FPA is objection to proceeding with donation, the
need for a discussion with hospital staff and/or the patient’s family will be determined by UW
OTD staff and AOC on a case by case basis.
1. UW OTD staff will immediately contact the AOC and provide the following details:
i. Which patient family members are present at the hospital
ii. Which patient family members have concerns or objections and the specific
concerns/objections
iii. The brain death status of the patient (if declared brain dead or not)
iv. What organs the patient is medically eligible to donate, determined by the UW
OTD medical director on-call MOC
v. Which hospital staff have been involved and their perception of the situation (i.e.
do they object as well, etc).
2. The UW OTD staff and AOC will determine which UW OTD staff member(s) will be the
most appropriate to participate in a discussion with the patient’s family and/or hospital
staff.
3. The purpose of the discussion is early intervention to obtain a clear assessment and
provide support and information to the patient’s family and/or hospital staff.
N. To prepare for the discussion with the patient’s family, UW OTD staff, most commonly the DSS
team, will gather all information related to family dynamics and specific family concerns by
speaking with the patient’s family directly and/or by gathering information from the hospital
staff involved.
O. When facilitating the discussion, UW OTD staff will offer condolences and will ask how the
family can be supported while the patient’s FPA designation is honored.
1. UW OTD staff will offer additional information to the LNOK based on the LNOK’s interest
and understanding of the following information:
i. Understanding of the patient’s death
ii. General description of the organs, tissues, and eyes that may be donated and for
what purpose including transplantation, research and education


POLICY
Established Date: April 2010
Effective Date: September 2017
Title: First Person Authorization Determination
and Conflict Resolution
Policy Number: 2.15

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 5 of 6
iii. Estimated time requirements for the donation process
iv. Donation screening including laboratory evaluations and testing for transmittable
diseases and the recovery processes
v. Other organizations that may be involved in the recovery process including tissue
and/or eye recovery agencies
vi. The responsibility of UW OTD for donation related costs
vii. The rare opportunity donation presents and how it can help both donor families
and potential transplant recipients
viii. Any additional questions about donation.
P. If the patient’s family continues to object to proceeding with donation, the following steps will
be taken.
1. UW OTD staff will explore the reasons for the objections with sensitivity, compassion,
and respect towards the patient’s family. In a positive manner, the following resources
will be offered, as appropriate per family request or staff discretion that they may assist
the family in the supporting the patient’s decision:
i. Explanation that UW OTD proceeding with donation is based on the patient’s
legal decision and in accordance with state and federal legal requirements
ii. Option for a family conference including the extended family members who
might be able to help facilitate support
iii. The opportunity to meet with others who may be able to address family concerns
including clergy, donor advocates, transplant recipients, cultural liaisons, and
other healthcare professionals
iv. Information on the benefits of donation.
Q. If the patient’s family remains unsupportive of donation, UW OTD staff will consult with the
AOC.
R. The AOC will contact the UW OTD MOC, UW OTD executive director, and the hospital
development specialist assigned to the hospital, as appropriate and as available.
S. The AOC, MOC, and/or UW OTD executive director may contact a UWHC attorney on-call if
there are legal concerns, including potentially a question about the validity of the FPA.
T. After a review of all available information, a final determination of whether to proceed or cease
UW OTD involvement with the patient will be determined by the UW OTD executive director.
The donation decision and a UW OTD care plan will be communicated to the appropriate UW
OTD staff involved by the AOC.
U. The AOC will contact the hospital senior leader champion and/or senior leader on-call.


POLICY
Established Date: April 2010
Effective Date: September 2017
Title: First Person Authorization Determination
and Conflict Resolution
Policy Number: 2.15

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 6 of 6
1. The senior leader will be a representative of the hospital administration.
2. The current UW OTD designee for all donation related issues is the UW OTD executive
director or his/her designee.
3. The hospital’s main line or paging system will be used to contact the senior leader at the
hospital where the patient is receiving care.
4. The AOC will notify the senior leader of the situation and the donation plan.
5. If a senior leader is not available, the attempt to make contact will be documented in the
UW OTD patient record.
V. The AOC may also consider notifying the UW Health public affairs department and the public
affairs department of the hospital where the patient is receiving care if there is a concern about
potential media attention.
W. The appropriate UW OTD staff involved will communicate the donation plan to the patient’s
family and the appropriate hospital staff involved.

Documentation and Follow Up
X. Documentation of each step in the resolution process will be recorded in the UW OTD patient
record by UW OTD staff, including AOC and MOC, real-time or as soon as possible.
Y. All FPA conflicts will be reviewed in full after each instance at a UW OTD leadership team
meeting. The AOC that was involved will facilitate this review.
Z. If additional education and/or follow up is required for UW OTD staff or other stakeholders this
will be determined on a case by case basis by UW OTD leadership.

REFERENCES

UW OTD Policy 2.03