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You are Here: Home Page > Quality Improvement in Living Liver Donation > VIII. Discharge Planning  

VIII. Discharge Planning

The Committee recommended a comprehensive survey of all donors in New York State to more completely understand issues surrounding donation and, in particular, to help identify ways to improve the discharge planning process and the posthospital experience. The surveys were mailed by each transplant center in October 2002. Donors were provided with business reply envelopes addressed to the New York State Department of Health where a confidential analysis is underway. (See Appendix IV for a copy of the survey.) Results of the survey will be used to further refine the Committee’s recommendations.

A. Predonation

1. Discharge planning should be viewed as a comprehensive process beginning with the decision to donate.
2. The independent donor advocate team should be available to provide support to the donor from preadmission to postdischarge, as outlined in this report.
3. The potential donor should be referred to others who have donated in the past. Consideration should be given to encouraging the creation of a voluntary statewide or national live adult liver donor consumer organization to provide support for potential donors and their families, as well as for those who have gone through the surgery.

B. Discharge

1. A detailed written discharge plan should be developed, given to the donor, and provided to all health care professionals involved in the donor’s care including the donor’s primary care physician.
2. This plan should be reviewed with the donor by a health care professional designated by the program, such as the primary care nurse, social worker, or transplant coordinator.
3. Instructions should include:
   1. restrictions on activities (no heavy lifting for one month, no driving for four weeks, etc.);
   2. activities permitted (showering, walking, other activities as tolerated);
   3. diet (in most cases will be regular);
   4. medication for pain;
   5. wound care;
   6. a 24-hour contact number that donors can call with questions, concerns, and/or problems; this contact person should be available when needed and be knowledgeable about live adult liver donation;
   7. name, address, and telephone number of the surgeon and instructions for the follow-up visit; and
   8. instructions for family members or caregivers.

C. Postdischarge

1. Medical follow-up should be appropriate for someone who has undergone a major liver resection procedure. This follow-up should include:
   1. postoperative visits with the donor’s surgeon(s);
   2. follow-up coordinated with the donor’s primary care physician to assess wound healing, monitor for signs/symptoms of infections, and monitor liver function;
   3. serum liver chemistry tests at discharge or at six weeks (whichever is sooner) and six months and annually for the first five years; three dimensional liver scan with volume assessment at one year should be performed on all donors of full right or full left lobes;
   4. written summary of the donor’s condition which should be provided to the donor and his or her primary care physician upon the donor’s discharge from the hospital; this will ensure continued appropriate medical care.
2. Follow-up social/psychological supports which may include measures such as:
   1. visits with a social worker;
   2. visits with a psychologist or psychiatrist;
   3. participation in a professionally run support group, similar to support groups for cadaveric donor families;
   4. participation in a center-sponsored computer donor listserve or bulletin board to share patient concerns;
   5. invitation to a donor recognition event, such as an annual recognition ceremony or presentation of a donor medal.
3. There should be follow-up on financial/insurance concerns, possibly by the transplant center’s financial coordinator.

Adult liver donors should be followed for the donor’s lifetime to determine if there are any longterm health issues associated with the donation. A data collection system should be established to track and analyze the long-term (lifelong) outcomes of live adult liver donation in New York State. Centers should be required to report data on an ongoing basis, and verify accuracy of data for report generation to New York State and the New York Center for Liver Transplantation on a quarterly basis. The data system should be available to the New York State Department of Health. (See Appendix II.)