Mind and Life Institute

Transplant centers hold the key to accelerating organ use and transplanting more patients more efficiently. However, not all transplant procedures are alike, as organ complexity and patient comorbidities can dramatically increase the risk of the procedures, demanding unique skills and more extensive resources to achieve good outcomes. What if transplant centers could emulate aspects of the trauma center model to ensure that necessary capabilities are consistently applied and uniformly available for all levels of organ risk and patient health? The proposed model recognizes that some transplant centers would have the capacity and aligned resources to care for the most complex patients and different types of organ transplants. Other transplant centers would leverage their available resources for less complex patients and organs. Importantly, this model also provides a template for regular stakeholder review of transplant program performance and episodic certification of transplant center resources. By moving to a tiered trauma center-like certification model, transplant centers, organ allocation policy, and patients could be triaged to the center most capable of providing them timely, effective care.

Introduction In 2018, this U.S. OPO, located in the mid-Atlantic region with 2.7 million population serving 43 hospitals, had an authorization rate of only 42%, resulting in 54 donors with 133 organs transplanted. A decision was made to seek help to redesign their donor referral responses, authorization practices, and implement a standardized bi-weekly post donor case review. The OPO reached out to an international training center (ITC), affiliated with the U.S.’ leading OPO in organ donations and transplants for the past 15 years. Methods The OPO and ITC examined current practices and challenges. The ITC made recommendations for 1) authorization standards of practice 2) training on referral response goals, expanded identification of donor potential, and 3) strategies to create and preserve BD and DCD organ donation opportunities. Between 2018 and 2022, the ITC facilitated 6 team trainings. The team trainings were supplemented with 44 individual scenario-based family donation conversation (FDC) simulations and 45 enrollments in eLearning modules. Initial focus was on FDC fundamentals and maximizing donation potential of each referral. As staff skill and confidence improved, training transitioned to managing more challenging, complex situations. In 2021, the ITC clinical leader began facilitating bi-weekly case debriefs. Staff were engaged in new ways, including practices to examine referral response, identification of donor potential, and creation and preservation of BD and DCD opportunities. The forum created a distinct shift in the group’s critical thinking and problem-solving capabilities. Staff became open to receiving/ providing constructive critique and increasingly took initiative to report using new strategies to successfully overcome donation challenges. This forum has proven to be pivotal in continued improvement and in 2022 OPO leadership assumed facilitation of the debriefs. Results Over 5 years, the OPO increased family approaches by 36% and authorization rates increased by 33%. Overall, organ donors increased by 102% (54 to 109) with brain dead donors increasing by 110% and DCD donors by 82%, resulting in 105% (133 to 273) increase in organs transplanted. Conclusion In 5 years, with consultation from ITC, this OPO realized a 102% increase in organ donors, resulting in a 105% increase in organs transplanted. Having this OPO’s leadership commit to improving clinical practices by standardizing the response to donor referrals, recognizing expanded donor potential, improving FDC practices, and adopting strategies to create and preserve BD and DCD donation opportunities led to sustainable, improved donor and transplant outcomes.

BACKGROUND Latinx populations are severely underrepresented among organ donors compared with the non-Hispanic White population. The <i>Promotoras de Donación</i> e-learning module was developed to train Latinx lay health educators (ie, promotoras) to discuss deceased organ donation and promote donor designation within their communities. OBJECTIVE This paper described the results of 2 studies designed to assess the direct and indirect effects of the module on promotoras’ and mature Latinas’ organ donation and donor designation knowledge, attitudes, and behaviors. METHODS In partnership with 4 community-based promotoras organizations, we designed 2 nonrandomized, quasiexperimental pragmatic studies to evaluate the <i>Promotoras de Donación</i> e-learning module, with participating promotoras and mature Latinas serving as their own controls. Brief surveys were administered to participating promotoras before and after module completion to assess changes in organ donation knowledge and support and communication confidence (study 1). Promotoras participating in the first study were asked to hold at least 2 group conversations about organ donation and donor designation with mature Latinas (study 2); paper-pencil surveys were completed by all participants before and after the group conversations. Descriptive statistics, means and SDs, and counts and percentages were used as appropriate to categorize the samples. Paired sample 2-tailed <i>t</i> test was used to assess changes in knowledge of and support for organ donation and confidence in discussing donation and promoting donor designation from pre- to posttest. RESULTS Overall, 40 promotoras completed this module (study 1). Increases in organ donation knowledge (mean 6.0, SD 1.9 to mean 6.2, SD 2.9) and support (mean 3.4, SD 0.9 to mean 3.6, SD 0.9) were observed from pre- to posttest; however, these changes did not reach statistical significance. A statistically significant increase in communication confidence was found (mean 692.1, SD 232.4 to mean 852.3, SD 139.7; <i>P</i>=.01). The module was well received, with most participants deeming it well organized, presenting new information, and providing realistic and helpful portrayals of donation conversations. A total of 52 group discussions with 375 attendees were led by 25 promotoras (study 2). The trained promotora-led group discussions about organ donation resulted in increased support for organ donation in promotoras and mature Latinas from pre- to posttest. Knowledge of the steps to become an organ donor and belief that the process is easy to perform increased in mature Latinas from pre- to posttest by 30.7% and 15.2%, respectively. In total, 5.6% (21/375) of attendees submitted completed organ donation registration forms. CONCLUSIONS This evaluation provides preliminary support for the module’s direct and indirect effects on organ donation knowledge, attitudes, and behaviors. The need for additional modifications to and future evaluations of the module are discussed.

Background: In this organ procurement organization (OPO), organ donation rates are closely related to: 1) timely notification rates (number of potential organ donors referred to OPO by hospital prior to starting brain death exams, prior to discussing withdrawal of life-sustaining therapy with the family and in time for the OPO coordinator to arrive to the hospital as a percentage of the total number of potential organ donors), and 2) planned family approach rates (the number of family requests initiated by the OPO coordinator or family, and not by hospital staff as a percentage of all approached). Most referrals are made by acute care and emergency department (ED) nurses. Methods: This OPO developed an interactive eLearning module focusing on the organ donation referral, family support and family approach processes. The training is designed to reinforce the in-person training already provided by the OPO. In one high-performing, 9-campus hospital system, 2031 care team members, including 892 acute care and ED nurses, completed the training over one year. Process variables and donation outcomes were analyzed before and after the training was provided. Results: Comparing the year after the eLearning module was rolled out to the prior year, the timely notification rate of 88% was sustained; the planned family approach rate increased by 4%; and the combined rates of timely notification and planned approach increased by 6%. Despite a 5% decrease in the number of potential organ donors, actual organ donors increased by 21% (28 to 34) with an 18% increase in donation rate (67% to 85%).Conclusion: Keeping the hospital care team proficient at basic organ donation processes is paramount to achieving high organ donation rates. At this hospital, providing the process-focused eLearning module added value in sustaining the timely notification rate and improving the planned family approach rate, resulting in improved organ donation outcomes. Although there are other factors that may have influenced these results, this OPO continues to provide this eLearning module to its hospitals. To date, 50 hospitals within this OPO’s donor service area have adopted this training with more interest in sight.

IntroductionSince 2004, an international training institute has educated more than 8,000 organ and tissue donation professionals in traditional classroom settings. In 2014, institute launched a Virtual Classroom Training (VCT) initiative using combination of eLearning modules, instructor-led webinar

Background In an effort to provide just-in-time training of “Conducting the Donor Physical Assessment,” an international training institute for donation professionals developed a comprehensive eLearning series. Consisting of four distinct modules (approximately 20 minutes each), the online series provides a step-by-step overview of how to perform the hands-on exam, the rationale for performance standards, the importance of correlating all findings, and the role communication and documentation play in ensuring the safe transplantation of all organs and tissues. Aim Recognizing that its training audience is increasingly digital-native, the institute offers eLearning—a tool that provides anywhere, anytime instruction over the web—to augment traditional “Conducting the Donor Physical Assessment” classroom-based models. Materials and Method To maximize learner engagement, instruction is provided through text, audio, and video. Knowledge checks and a final assessment are used to gauge comprehension, with results documented in a learning management system. Results In 2015-2016, a US-based, mid-western Organ Procurement Organization (OPO) began implementing the eLearning series. In total, there were 62 learners. To date, 61 learners completed the program; all passed their assessments; and all received 1.25 CEU (AATB)/1.0 (ABTC) credits. Conclusion In addition to the inherent benefits of providing on-demand training and the ability for learners to revisit training topics on an ongoing, as-needed basis, the “Conducting the Donor Physical Assessment Interview” eLearning series offers problem-solving opportunities in a multi-media environment to help learners retain content and produce results.

There is a growing need to develop and deliver programs in educational settings that support the social, emotional, and prosocial development of teachers and students. In recent years, researchers, educators, and contemplatives have worked to develop and adapt mindfulness- and compassion-based interventions for use in school settings. This chapter provides a theoretical overview of three such programs—Mindfulness-Based Stress Reduction (MBSR), Cognitively Based Compassion Training (CBCT), and Sustainable Compassion Training (SCT)—which have been implemented in educational contexts. It also provides a brief overview of the development and status of these programs to date as well as suggestions for further research and application.