2018 Donate Life Celebration Award Nomination Form

Nomination form for the 2018 Donate Life Celebration Awards

Every year at our Donate Life Celebration Dinner (the evening portion of our Donate Life Symposium and Celebration) we present several hospital and community partners with different awards highlighting their commitment to donation, donor families and helping to make the gift of life possible for so many in need.

We rely on YOUR nominations to select the award winners and are grateful for the time that you take to fill out this quick nomination form. Below you will find the list of awards and a brief description of each. Please fill out all questions and prompts in the form to the best of your ability. If you have any questions, please do not hesitate to email skaye@cdtny.org.

PLEASE NOTE: We must receive ALL nominations by March 23rd, 2018. Nominees and winners will be notified prior to the Donate Life Symposium and Celebration (May 17th, 2018).

Thank you!

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* 1. Please state your name, title and organization:

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* 2. Please state the name, title and organization of the person you are nominating:

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* 3. Please select the award that you are nominating this person for:

Outstanding Hospital Outreach
A hospital that has gone above and beyond to support a culture of donation either in their own hospital or in the community. Examples may include exceptional flag-raisings, community events, or other hospital-wide initiatives

John Weakley Volunteer of the Year Award
A volunteer that has gone above and beyond in the work for CDT. Criteria includes:
· Has conducted themselves appropriately and respectfully in the community
· Has made a dedicated effort to raise awareness about donation, through registering donors on the registry, planning events, participating in pre-planned CDT events, sharing their story in multiple avenues, finding platforms to raise awareness in the community and/or through time spent as a CDT volunteer has made a significant impact in the community in changing lives/raising awareness about donation

Donate Life Community Partner Award
A community partner that CDT works with on a regular basis and:
· makes our jobs easier to do,
· has partnered with us on several occasions to raise awareness about donation,
· we have developed a strong, meaningful relationship with
· done exceptional work to promote donation in the community either through social or traditional media outlets, as well as other ways that they have successfully “gotten the word out” about organ and tissue donation

Donate Life Champion (Team)
A group of healthcare practitioners that go above and beyond in supporting and promoting organ and tissue donation on a regular basis in their hospital(s) and community.
Nominees can include:
• Physician Practices or Teams
• Nursing Units or Teams
• Patient Care Technician Teams
• Any staff team or unit connected to donation

Nominees may be considered if they have:
• Created, started or engaged a donor council within their hospital
• Not only participated on an organ or tissue recovery/donor case but consistently contributes to the cases in ways that are meaningful for both staff and family members
• Initiated best practices or made adjustments to current practices that have made it easier for CDT and the hospital to facilitate donation (through policy, process, EMR access, etc.)
• Gone out of their way to make support for donation a regular occurrence on their unit/in their hospital, versus just offering support when a case is ongoing
• Regularly participated in community events to support donation and encourage conversation about the NYS Donate Life Registry

Lynn LaBarre Donate Life Champion (Individual)
A healthcare practitioner that goes above and beyond in supporting, championing and promoting organ and tissue donation and/or donor families in their hospital(s) and community.
Nominees can include:

• Physicians
• Nurses
• Patient Care Technicians
• Respiratory Therapists
• Any hospital staff involved in the donation process
• Pastoral Care staff
• Administrative workers
• Social Work
• Security Staff

Nominees may be considered if they have:
•Created, started or engaged a donor council within their hospital
• Not only participated on an organ or tissue recovery/donor case but consistently contributes to the cases in ways that are meaningful for both staff and family members
• Initiated best practices or made adjustments to current practices that have made it easier for CDT and the hospital to facilitate donation (through policy, process, EMR access, etc.)
• Gone out of their way to make support for donation a regular occurrence on their unit/in their hospital, versus just offering support when a case is ongoing
• Regularly participated in community events to support donation and encourage conversation about the NYS Donate Life Registry

Center for Donation and Transplant Executive Leadership Award

A leader within a hospital that has shown significant support for donation and transplantation and has worked to make significant increases in support for donation, creating an overall culture of donation in the hospital and has gone above and beyond to make the process for facilitating donation as easy and meaningful as possible.

Donor Family Services Award

This award will be given to healthcare teams OR individuals that show a particular affinity for supporting donor families through the donation process. As this is a new award, nominees can be considered based on experiences and interactions from the past TWO years.

2018 Donate Life Celebration Award Nomination Form

Nomination form for the 2018 Donate Life Celebration Awards

Question Title

* 1. Please state your name, title and organization:

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* 2. Please state the name, title and organization of the person you are nominating:

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* 3. Please select the award that you are nominating this person for:

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* 4. Using specific examples, please explain why you are nominating this person for this award.

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* 5. Would you like the nominee to know that you nominated him/her/them?

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* 6. Please provide your most current email address:

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* 7. Any additional questions or comments? Please add them here: