Case Studies
Case studies showcase real-world applications of policies and innovations, offering insights into improving outcomes and efficiency. They enhance problem-solving skills, highlight best practices, and engage through storytelling for education and transparency.
Interest(s): , Checklists & Forms, Cultural Perspectives, Donation after Circulatory Death (DCD), Donor Designation / First-Person Authorization (FPA), Ethics, Family Care, Hospital Donation Process & Education, Legal and Regulatory,
Organ(s): Eye, Heart, Intestine, Islet Cells, Kidney, Liver, Lung, Pancreas, Small Bowel, Tissue, Vascularized Composite Allograft (VCA)
Patient Group(s): Adult
Share
Bridging the Gap: Empowering Conversations for First-Person Authorization Success at Indiana Donor Network
Jamie
Rivas
, Director of Donor and Family Services
, Indiana Donor Network
The Challenge
The case involved a 54-year-old African American woman whose family strongly resisted the brain death determination and organ donation process. The team faced significant challenges, including hospital hesitation, religious objections, legal involvement, and emotional outbursts from the family. Several issues arose during this case. First, the hospital’s reluctance to initiate brain death testing delayed the start of donation conversations. Second, the family’s grief, anger, and religious objections heightened resistance, while their legal consultation increased the hospital’s anxiety. Third, escalating emotional outbursts led to security removing the family from the hospital, further straining relationships. Fourth, the family presented out-of-state power of attorney (POA) documents in an attempt to override the donor’s FPA, creating a legal dispute. Finally, both the family and hospital staff felt that the situation was emotionally traumatic, threatening trust and future collaboration.
The Approach
To address these challenges, the Indiana Donor Network relocated the donor to their facility, creating a fresh environment that helped de-escalate tensions. They re-invited the family to participate in the process despite earlier security concerns, emphasizing inclusion over exclusion. Multiple staff members, including leadership, engaged directly with the family so they could hear from different voices within the organization. Rather than avoiding the attorney involvement, the team welcomed it, which ultimately led one sibling to help the rest of the family understand and accept the legality of FPA. The team also assisted in verifying the POA documents, which surprisingly confirmed that donation authority remained intact. Throughout the process, they applied a grief-centered approach, recognizing that resistance often softens over time, and avoided rushing toward recovery to allow space for processing. Finally, they debriefed the hospital after the case to provide closure and strengthen future collaboration.
The Results
The actions taken led to a remarkable turnaround. The family moved from anger and objection to acceptance of donation just before the organ recovery. The donor’s mother became engaged in meaningful memory-making at the facility, choosing music, sharing stories, and experiencing a more peaceful goodbye. The final moments took place over the Thanksgiving holiday, where the mother shared a meal with staff and expressed deep gratitude, calling the coordinators’ work “a ministry.” Hospital partners gained better clarity on FPA processes, and the organization implemented key policy changes. These changes included proceeding without requiring signed family paperwork when legal FPA exists and establishing structured methods for safely re-inviting families to participate in donation at the organ facility.
Insights & Lessons Learned
This case provided several important insights. Resistance in donation cases is not always permanent—families can shift toward acceptance if given empathy, time, and a supportive environment. Transparency builds trust, as demonstrated by openly engaging with attorneys and assisting families with legal document review. Changing the environment by moving a donor to a neutral facility can help reset dynamics. Maintaining hospital relationships requires post-case follow-up to resolve any lingering tensions. While consistent staffing is often beneficial, rotating team members and involving leadership can make families feel heard and supported. First person authorization and donation after circulatory death (DCD) require ongoing education for both OPO and hospital staff due to turnover and evolving best practices. Most importantly, viewing resistance through a grief-centered lens allows for more compassionate decision-making, ultimately leading to better outcomes for both families and staff.