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): , Brain Death / Death by Neurologic Criteria, Donor Designation / First-Person Authorization (FPA), Donor Management, Ethics, Family Care, Hospital Donation Process & Education, Legal and Regulatory, Tissue Donation
Organ(s): Eye, Heart, Intestine, Kidney, Liver, Lung, Pancreas, Small Bowel, Tissue
Patient Group(s): Adult
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Upholding First Person Authorization Amidst Family Resistance at LifeGift
Alfred
Sanders
, Manager of Donation Systems
, LifeGift
The Challenge
A 45-year-old patient was admitted to a community hospital with head trauma caused by a gunshot wound to the head and was declared dead by neurological criteria. Upon notification of the death, the patient’s family was informed by LifeGift’s Family Engagement Specialist that the patient was a registered organ donor and had made the decision to save lives through donation. Despite the patient’s legal First Person Authorization (FPA), the family opposed the patient’s, expressed strong resistance, sought legal counsel, and issued threats to the healthcare team in an attempt to prevent the donation from proceeding. LifeGift, in accordance with both legal and ethical standards, proceeded with starting the organ donation process while continuing to offer support to the grieving family and maintaining open communication with hospital staff.
The case presented several challenges, including the family’s resistance to FPA, safety concerns due to their threats, involvement of legal counsel, unfamiliarity with the FPA with family resistance processes by new hospital leadership, and donor medical instability which prevented transfer to the local dedicated Donor Care Suite.
The Approach
LifeGift and the hospital followed their established policies and protocols for First Person Authorization. Key LifeGift internal stakeholders were notified, including administrators on call, clinical staff, family engagement, donation systems, vice presidents for relevant departments, the CNO, and the legal team. The escalation protocol was activated to ensure appropriate oversight. The Donation Systems Specialist assigned to the hospital engaged with key hospital leadership—including the ICU nurse manager, director, operating room director, COO, and CNO—to assess their understanding of the process and secure their support for honoring FPA. Hospital security was also involved to address safety concerns due to threats made by the family. Although the donor’s medical instability prevented transfer to the dedicated Donor Care Suite, LifeGift continued the donation process in place, prioritized safety, and upheld the integrity of the donor’s legally documented decision in close collaboration with hospital leadership.
The Results
As a result, First Person Authorization was successfully upheld, and three lives were saved through the gift of the donor’s liver and kidneys. This outcome was made possible by strong communication within LifeGift, coordinated engagement with hospital leadership, and adherence to established policies and protocols. The case highlights the importance of structured escalation procedures, collaborative leadership, and a steadfast commitment to honoring donor decisions even in the face of resistance.
Insights & Lessons Learned
The Critical Role of Hospital Development
From an OPO perspective, this case underscores the importance of strong, proactive relationships with hospital partners. The ability to engage hospital leadership and clinical teams early on—through consistent hospital development proved vital in navigating a high-conflict, emotionally charged situation. These established relationships created a foundation of trust and collaboration, allowing LifeGift and the hospital to move forward together in honoring First Person Authorization.
The Power of Organ Donation in the Community
From a community perspective, this case highlights that even in moments of profound tragedy, hope and healing can emerge. Organ donation has life-changing outcomes for recipients, but many in the broader public remain unaware of it’s true impact. This reinforces the need for ongoing community education that uplifts stories of generosity and shows how donation brings purpose to loss and transforms lives.
Building Hospital Trust Through Shared Purpose
From a hospital perspective, this situation was a test of both legal and ethical resolve. Upholding First Person Authorization, despite family opposition and safety concerns, required courage and conviction. The hospital’s choice to support the donor’s legally documented wishes helped reinforce the integrity of the donation process and strengthened the hospital’s relationship with LifeGift. It also deepened mutual trust, clarified the hospital’s understanding of its role, and aligned all parties more closely with the shared mission of saving lives through organ donation.