Amanda Wilde (Host): April is Organ Donation Month. And in this episode, our guests will be sharing how the organ donation process works and their hospital's dedicated efforts toward organ donation. Colleen Okyere is Regional Manager, Hospital Partnerships, and Cory Murphy is Nurse Manager of the Intensive Care Unit at Palmdale Regional Medical Center.

This is Palmdale Regional Radio, a podcast from Palmdale Regional Medical Center. I'm Amanda Wilde. Colleen and Cory, thank you so much for being here to discuss organ donation. Colleen, I'm going to start with you. Just to start, can you share the significance of organ donation and its impact on saving lives?

Colleen Okyere: So, in the United States nationally, we have approximately 103,000 people waiting for a life-saving transplant today. I work with OneLegacy. We're the organ procurement organization that facilitates organ and tissue donation in California, in Southern California specifically. And our mission is to save and heal lives through donation. And we think about 103,000 people nationally in need of a life-saving transplant. That's a significant number of people.

Every 10 minutes, on average, about one person is added to that waitlist. And approximately 17 people die each day waiting for a life-saving transplant. So, it's an urgent issue and it's especially urgent in California. Approximately 20,000 people are waiting here in California alone. So even though the waitlist is 100,000 people, we have 20% in our state. So when we're talking about organ donation, we are talking about people in our communities, hyperlocal, that are in need of this life-saving gift.

Host: Colleen, who are the donors? And after you answer that, can you sketch out how the whole organ donation process works?

Colleen Okyere: Sure. So, who are the donors is such a big question. Really, there's different criteria for who can be an organ donor, but these range from everything, all races, ethnicities, religions, genders, ages. There's so much potential to save and heal lives through donation. But the donors, essentially, they're going to be in your hospitals. They're in our hospitals, they're critically ill patients, they're patients heading toward end-of-life. And the hospitals then notify the organ procurement organization or the OPO that they have a patient.

So, the organ procurement organizations basically work with the hospitals like Palmdale and the transplant centers where they have potential recipients and we act as the liaison between the two. So, organ procurement organizations I think are sort of this mysterious third party that most people don't know anything about unless you either work in a hospital or you are unfortunately in a situation where you know somebody who could potentially be an organ donor. So, as an OPO, we are working with the transplant centers, we're working with the hospitals on potential organ donation. We also have this whole other aspect of what we do, which is community outreach, like we're doing today, and also working with donor families. So, OneLegacy has a whole separate section of our organization that just supports families as they go through the grief journey, as they lose a loved one, and then for years and years afterwards. So, it's a very odd thing OPOs do. We kind of do a little bit of everything, but a really important and rewarding area to be in.

Host: And it's really interesting to hear that you put so much into supporting families in an ongoing way as part of the process.

Colleen Okyere: Yeah. It's a huge part of what we do. It's one of my favorite parts of the job. To be entirely honest, we have what we call an ambassador's program. So, if a donor family has a loved one that passed and they said yes to donation, then they can sign up for our ambassador's program and they go back to hospitals. They go out in the community and they tell their story of donation. They talk about their loved one. They keep their memory alive. Most of our ambassadors that I've gotten to know say they don't ever want their loved one to be a forgotten. And I just think that's so wonderful. And we also have recipients that are ambassadors as well, and they go out to hospitals and thank nursing staff and say, "I wouldn't be here if it wasn't for you." So, it's a really, really cool part of the job, and I love our ambassadors.

Host: Well, Cory, now that Colleen has demystified OPOs, tell us a little bit about the hospital role in the process. How do staff support organ donation in the hospital?

Cory Murphy: So, on a nursing side of it, we really don't participate much in the organ donation side of it. What we do is we see certain criteria that the patient might meet that has been established between the doctor and the nurse and the assessment. And then, that leads us to call the OneLegacy. There are certain criteria that guide us to call them. And once we call them, they are able to then look up the patient, find out if the patient's already a registered donor or if they're not. And then, from there, they might just follow and keep an eye out for this patient because not every patient passes away. Some of them will get better. Everything changes with the patient. And so, they just kind of follow, and the nurses will give them updates as they call.

Host: So, you were just talking about the situation if somebody is not signed up as a donor. But if someone already is signed up as a donor, do you already have this information?

Cory Murphy: On the nursing end, we do not. Unless the family tells us, we would never know that information. That's through the OneLegacy registry. They would be the only ones to know.

Host: So, the hospital does not have access to the registry. So Colleen, how do you verify someone's registry status?

Colleen Okyere: Yeah. So once we get that really important call from the frontline staff, and it honestly is usually like the bedside nurse that's recognizing that criteria, calling OneLegacy, we basically just look up that patient's name. The registry is actually owned by the state of California, it's Donate Life California. And they do that really intentionally so that everyone who registers can feel comfortable that their care is not different in the hospital. OneLegacy can't do anything with their registry. Basically, we have a one-way access into the California State Registry. We put in a name or a birth date or whatever information we have about that person. And then, we see if there are any matches. And then, even beyond that, when we talk to the family, if it comes to that point of where we're approaching for the opportunity for donation, we verify that information, because two people could have the same name. So, you have to go back and say, "Is this your loved one? Is this their birth date? Is this their address?" To verify that registry. So, I think there's a common misconception that registering to be a donor might affect medical care, but the hospital can't even see it.

Host: That's reassuring to know that personal information is highly protected. Colleen, when a patient is at end-of-life, what is the procedure to proceed with organ procurement?

Colleen Okyere: Yeah. I think Cory made a really good point when she was talking about sort of the criteria for referring or calling into OneLegacy. It's something that happens actually, I think, a little bit earlier in the process than most people realize. Now, making that initial referral to OneLegacy does not affect patient care at that point in time. But we have to find kind of a perfect moment to present the opportunity for a donation to the family. And what that means is that prior to withdrawal of a ventilator, prior to actual what we call cardiac time of death, we need to engage with the family. Once a patient's removed from a ventilator, they've lost the potential to become an organ donor. So, we are working with the nursing staff and the physicians kind of early and talking and the nursing staff, the social workers, the case managers, the chaplains, the doctors, the palliative care physicians, all these different people are telling us this is where the family's at. They're now talking about maybe wanting to move toward end-of-life care, withdrawal of life-sustaining therapies, withdrawal of the ventilator. And then, we kind of try and time it so that we are in that conversation, in what I call that window of contemplation with that family, so we can say, "I know you're thinking about end-of-life care." This is another option for end-of-life care. And I think there's a very common misconception that you call us after the patient dies. And that's far past the window of opportunity. And the reason it's so important to engage with the care team and the family early is that the procurement process, that donor workup process actually takes several days.

So once a family says yes to donation or we're able to confirm that this patient is a registered donor and they're moving toward end-of-life care, we then start a very complicated donor workup process where we're working with an outside organization called UNOS, the United Network for Organ Sharing, and trying to find potential recipients to match those organs. So, it can go faster. We can speed up the process, but it gets a little hectic. But then, if we take it the full length of time, it can be a couple days. And we're really coordinating with the transplant centers with their recipients getting testing, when their transplant surgeons can come out and do that organ recovery process. So, the timing is something that I think is a little bit longer than people are used to thinking about.

Host: But it sounds like it does happen fairly quickly anyway, and I imagine in a situation where someone's an organ donor and an unexpected death occurs, then you have to move fairly quickly too.

Colleen Okyere: I mean, yes, we can move fairly quickly. Most of the time, the patients that are on a ventilator, as they're moving toward end-of-life, we kind of keep them stabilized on the ventilator. Many patients might already be declared brain dead, and so you do have a little bit more space, a little window. But yes, it's not something that can go on for like weeks and weeks or anything like Your window's a couple of days.

Host: It's an efficient process, I guess is what I'm saying, which is interesting to know. Cory, how does the hospital as a whole support donation in the community at large?

Cory Murphy: Well, I think supporting donation is just by us trying to do the early calling to OneLegacy and helping. We definitely try and hold back from talking about it to our patients, because it's not appropriate, it's not reassuring to them. And we've been trained. We have OneLegacy representatives will come to our staff meetings and just educate us as well, that it's never for us to discuss with the family. It's for them to discuss with the family. So, we kind of take a backseat until anything has been mentioned.

Once it does get mentioned and let's say the patient does or the family does decide to accept to donate their loved one's organs, they become a one to one. The nurses, along with the patient and the family, the whole time, stays with them until the end. It is very busy at the beginning. You are running a lot of tests. You're taking them for a lot of exams. Because now, you're trying to find that perfect match for this patient. And we start answering to the OneLegacy representatives that are guiding us in which direction to go and where we go next. And the family is there the entire time. And our energy is directed towards the family, you know, and just helping them to make this not such a devastating memory for them, but more of a positive gift that, one, they're spending a little bit more time with their loved one. And we're celebrating the gift that they've given, and they're more of our focus than the patient is.

The nurses alone, we do little things for them. In the hospital I'm working in, my nurses, they create these little glass jars and they put the heart rhythm in it for them so that they can have their last heart rhythm. They've made Build-A-Bears where we're able to get the audio of their heartbeat and we're able to put it into a Build-A-Bear if there's children. There's a lot of different things that we do just to make this more of a better experience for the families. It's not supposed to be something negative or scary or a bad memory. It's, you know, just losing a loved one is a bad memory for everybody or a bad experience. So, we try and see the positive in it for them and just kind of help them through it.

Host: And know that they're, or again, is giving life to another person. That's got to be so rewarding. Colleen, do you know how many people are registered, the statistics regarding involvement from the general public?

Colleen Okyere: So yeah, I do have some statistics on that. We use a lot of data from UNOS, which is the United Network for Organ Sharing. So right now in California, we have approximately 19 million people registered as donors. So, it's a little bit of an interesting dynamic. When you talk to people in the public, when you ask people, "Would you accept an organ? Do you think organ donation is a good thing?" Ninety percent of adults say, "Oh my gosh, yes. This is something that I would do. This is something that I think is great." However, only 60% of adults nationally are registered donors. So, there's certainly a little bit of a discrepancy there. And California, despite our high need, actually lags behind the nation in our percentage of registered donors, registered adults. Not by much, but we definitely do have a lower registry rate. So, it's something that we, as community hospitals and organ procurement organizations, want to focus on in California is helping people understand donation, helping bring that understanding to the community. And I want to give credit to Palmdale Regional Medical Center for doing so much to raise that awareness in their community.

So, as you mentioned at the beginning, April's Donate Life Month and hospitals partner with OneLegacy to do Donate Life Month activities throughout the month of April to raise awareness in their facilities with their staff about the process of organ donation, but also in their communities about the life-saving gift of donation that has come from their hospitals, that has been given to their communities.

Palmdale Regional Medical Center actually has a flag raising event on April 1st where they have a beautiful ceremony. Our ambassadors come and speak, the nurses come out, and they raise that Donate Life flag, they raise that OneLegacy flag above the hospital for the whole month of April. In the last year alone, from Palmdale in 2023, they had seven lives saved through organ donation, over 1,300 lives healed through tissue donation, and restored the gift of sight to 24 individuals just from Palmdale. So, when you're talking about a hospital that is committed to the cause, I think you guys have done such a beautiful job.

Host: How do you register to be a donor? If someone's hearing this right now and is on board, what's the first thing they should do?

Colleen Okyere: So, there's two ways you can register. You can register at your California DMV. You check that box. And that's an easy, fast way to register to be a donor. Once you check that box, you don't have to go back and do it every time. You can remove yourself, but that's a one-time, "Yes, I want to be a donor." However, I always think people should go to donatelifecalifornia.org. That is the online registry. And I think it provides more information, more insight, and it also allows people to make more detailed designations about their gift. When we go and talk to families about organ donation, when I can show them, "Your loved one went online and this is exactly what they wanted," it helps families really understand their loved one's wishes.

Host: Colleen, you've mentioned some myths about organ donation or some misconceptions. What's the most important message you would like to give regarding organ donation? And Cory, I'll ask you the same question. But, Colleen?

Colleen Okyere: Sure. I think, for me, the most important thing is just for everyone to educate themselves about it. It's a really personal decision, and it's a decision that nobody wants to have to deal with. Nobody talks about death and dying. Nobody wants to think about end-of-life. But unfortunately, people find themselves in these situations. And what I think is the hardest for families is not knowing what their loved one would have wanted. So if you choose to be a donor and you register, tell your family about it so that they know that, yes, you made this choice and you won it, or whatever your decision is. It doesn't matter what it is. It's a personal decision, but just talk to your family about it. Because our team, we spend so much time with these families and supporting these families, and the shock of just trying to make that decision without knowing is so hard. And I would love for everybody to just feel confident and comfortable as possible in that situation.

Host: Cory, do you have anything to add?

Cory Murphy: She said it beautifully, and it really is, it's just about talking to your family about what you want. Because too often we see where even when the patient is a registered donor, and we're just sitting in the background hearing these conversations that are going on as the nurses, but there's so many people that have registered as a donor, but the family does not know that. They had no idea, and they might have said no, and it becomes more of a struggle for the family to deal with it, because they didn't know that their loved one would have wanted this.

Host: And we really want to avoid that happening during such a difficult time.

Cory Murphy: Right. There's other decisions that need to be made.

Host: So, as with so many situations, and particularly medical ones, communication is key. Any last thoughts you'd like to leave us with?

Cory Murphy: Yeah, I would like to let everybody know about the Honor Walk that we do to also show tribute to the family for making this decision, as well as the patient that is donating their organs in the hospital. We announce it overhead, and everybody that is available that works in the hospital is lined up in the hallways, and we do an honor walk as the patient is brought to the OR. And it is the most beautiful thing to watch. And I think families really feel touched by it and see that their loved one is being honored.

And I do know that for years, in the Rose Parade, in the Pasadena Rose Parade, there is a OneLegacy float. And anybody who has said yes, it doesn't matter if their loved one was able to donate or not, but if they have said yes to donation, they are given a rose in honor of their loved one in that decision, and it goes on to the Rose Parade float, on to the actual OneLegacy float. And it is actually really beautiful to watch. I, myself, am a parent of somebody who said yes to a donation for my son. And I remember sitting and watching the Rose Parade to see my son's rose on the float. So, it is a very beautiful thing for families.

Host: That's just one of many ways, acknowledging the ways in which organ donation is transformative. Well, Colleen, Cory, thank you both for your efforts toward organ donation. I know it's not just part of a job, but a heartfelt commitment to saving lives. And thanks for talking today.

Colleen Okyere: Thank you.

Cory Murphy: Thank you.

Host: That was Colleen Okyere, Regional Manager, Hospital Partnerships, and Cory Murphy, Nurse Manager of the Intensive Care Unit at Palmdale Regional Medical Center. And that concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. Please visit our website at palmdaleregional.com for more information and to get connected with one of our providers. For more health tips and updates, be sure to check out all the other interesting podcasts in our library.

Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Palmdale Regional Radio, a podcast from Palmdale Regional Medical Center.