Certified Designated Requestor (CDR)
2013 Training and Recertification
Pre-Session Worksheet
This worksheet is designed to focus your review of the training materials so that our time together in the
training and recertification sessions can be spent on practical application and skill practice. In order for you to
be fully prepared for your session, you must dedicate time before the workshop to studying the materials and
answering these questions.
Using the Study Guide and Fifth Edition Training Manual, complete this worksheet PRIOR to the scheduled
training and/or recertification session. Only those who have completed this worksheet prior to the session
will be permitted to participate in the training session.
Legislative Overview
1.
Write the definition of Donor Designation:
2. True or False. Family members ultimately make the final donation decision even if donor designation is
present.
Explain:
3.
Who is responsible for verifying a patient’s donor designation status?
4.
Would you ever proceed with a donation discussion without knowledge of the patient’s donor designation
status?
Explain:
5.
What federal organization requires hospitals to have a signed agreement with an OPO, tissue and eye
donation agency and also requires hospital staff to be trained by the OPO to discuss donation with the
family and obtain authorization:
a. The Joint Commission
b. CMS
c. Both
Benefits of Organ, Tissue and Eye Donation
6. Who do you know personally that has benefitted from donation and transplantation?
Describe the benefits to that person:
7. One organ, tissue and eye donor can give life to approximately ____ people.
8. How would you describe the benefits of the following transplants to families (tip: use your personal
experiences and healthcare knowledge in your descriptions):
a. Pancreas
b. Bone
c. Cornea
d. Kidney
e. Skin
The Donation Process
9. List the three components of an effective response for families when they mention donation:
a.
b.
c.
10. Place the following components of the donation process in order from beginning to end, with 1 being the
first component.
___ Family Outcome Huddle
___ Family mentions donation
___Family Support Huddle
___ Patient meets the trigger
___ Donation Assessment Huddle
___ Referral call to 1-800-24-SHARE
___ Family discussion
11. True or False. It is okay to discuss donation with a patient’s family before the referral call has been made.
12. True or False. It is okay to discuss donation with a patient’s family before huddling with the donation
agency.
13. Describe your hospital’s plan for notifying and utilizing CDRs for family approaches:
Where is this information located?
Brain Death and Cardiac Death
14. How do you explain brain death to a family? Write your script below:
What other resources would you use to support your explanation?
15. Compare and contrast organ donation when brain death is present and organ donation after circulatory
death (DCD):
16. Where is your hospital brain death declaration policy located:
17. Where is your hospital DCD policy located:
The Family Discussion
18. Write your introduction statement:
19. Write a description of LifeSource, i.e. how do you explain who LifeSource is to family members?
20. Convert the following sentences to value-positive statements:
a. “I’m here to talk with you about organ donation. Is that okay?”
b. “Do you know if your loved one wanted to be an organ and tissue donor?”
c. “Your loved one is brain dead and the only option for you and your family is organ donation.”
21. List two scenarios that you would like to practice during the role play session:
a.
b.
Bring your completed worksheet to your training session.
You will not be permitted to participate in the session without a completed document.