Rev. Sue Wintz on the impact a chaplain can have on organ donation

Enhancing the Precious Gift of Life

April is National Donate Life Month. Donating organs, marrow, and tissue is a kind and compassionate act that can protect and enhance the precious gift of life. During National Donate Life Month, the generosity of donors is recognized and awareness is raised of the importance of donating.

Organ, tissue, and research donation is a part of end-of-life decisions and is an area in which the contributions of professional chaplaincy can be identified, measured, and replicated. In January 2007, St. Joseph’s Hospital and Medical Center in Phoenix, Arizona and the Donor Network of Arizona (DNA/SJH) launched a pilot project focusing on value-centered conversations. Value-centered conversation is based on the belief that there are core principles held by individuals and families that give meaning to and/or help to interpret events and motivate a person or group to make decisions or act concretely in a way that is consistent with those values. These core beliefs and values can often be obscured by immediate physical or emotional states, including those experienced by families facing a traumatic event.

The DNA/SJH pilot project places an emphasis on the total context and processes experienced by families during the patient’s hospital course. As one of the medical center’s professional chaplain, I serve as the lead in donation support, along with the hospital’s in-house Organ Procurement Organization (OPO) coordinator, and the OPO Family Advocates. Together we designed and are overseeing the project. Education was initiated throughout the medical center to encourage the recognition and respect of mutual critical roles from the families’ first contact with security and the unit secretary through all aspects of care and conversation, based on identifying and affirming awareness of family needs and values.

An integral goal of the project is to determine whether early assessment and involvement by professional board certified chaplains contribute as model interventions for increasing organ donation consents. A procedure was developed to ensure a spiritual care consult be initiated when a patient meets potential donor criteria. An outcome-based spiritual assessment tool was developed that includes eleven potential components to be addressed, four of which are specifically tied to collaborative efforts with the in-house OPO coordinator and its Family Advocates. Measures were also identified to evaluate family satisfaction with the experience of the donation approach and lowered anxiety and improved grief coping during the donation process.

Initial data has demonstrated the impact and effectiveness of chaplain involvement.
Since the inception of the pilot project, 100% of the potential donor families received a spiritual care consult and assessment. Our intervention in assisting families to identify values held by the patient and themselves was a key factor in over 50% of the cases; working with family history and dynamics to facilitate multidisciplinary conferences occurred in nearly 60% of cases, and assisting with family facilitation of grief in order to accept a diagnosis of brain death occurred 67% of the time. While only 11% of the families indicated that they were members of a local religious community and only 6% had their local religious leaders present to provide support during the donation process, a chaplain was requested to provide prayer, ritual, or other resource to almost 80% of the families.

The ongoing evaluation of the project is specifically aimed at chaplaincy assessment and interventions. The goal is to identify chaplaincy standards of practice that reflect the particular needs of families facing decisions regarding donation as well as contributions in the area of communication and collaboration within the multidisciplinary team and between the medical center and OPO.

The goal of the National Organ Donation Breakthrough Collaborative is 75 percent. St. Joseph’s organ donation rate rose in the first three months of 2007 from 54% to 94%, and the trend is continuing! At the recent state education mini-collaborative, the in-house coordinator, and one of the OPO family advocates and I, presented the project as a best practice. One outcome of this collaborative was a request made by another Arizona hospital to replicate the project. Plans for the beta study are now in process. The project will also be presented at an upcoming national breakthrough collaborative education event. At the state collaborative, SJH received the Overall Hospital Leadership Award and I was honored with an award for Outstanding Family Support; both indicate the importance of chaplaincy contributions.

This is one project that shows the importance of including a professional chaplain in the ongoing quality improvement process of a hospital. It is an especially important one because of the need for organ donation and the sensitivity that needs to prevail when dealing with a family that needs to make a decision about providing a gift of life in the midst of death.

 

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