Organ Donation from a nurse's experience

Miscellaneous and Personal Stuff I Must Share
1

There was discussion about organ donation in the Anne Heche thread and I offered to share my experiences and it was suggested that a new thread might be more appropriate.
Anne Heche: Actress, lost soul, burn victim [Update: She has passed] - Cafe Society - Straight Dope Message Board

Now, currently I work in ER, so I send pts to ICU and occasionally hear that they became donors. In the past I worked in ICU and cared for pts that had the potential to become donors but didn’t, and others that did, and, once, I accompanied a pt I’d taken care of for a couple of days into OR and watched the procedure. I never specialized in donor care, and it’s been a while since I worked there, so I’m going from memory and older protocols, anyone is welcome to fight my ignorance.

Since there are a lot of variations, I thought I’d stick to the questions that came up in the other thread, at least for a start. I also have some ‘interesting’ stories regarding children for this topic which I can spoiler or just leave out depending on interest.

So, regarding time of death, we were always encouraged to state, died, in the past tense, whether a pt still has a pulse or not, when brain death is involved. Sometimes we would keep the machines going for an afternoon or a day to allow closure for families, or several days to make organ donation arrangements, but it’s easy for people to imagine hope where there is none, so we tried to be clear. Various news sources have used different times in this case, but I don’t know if that’s just casual research or they have editorial requirements for them. A pt has to be dead to donate, and it takes some time from getting the green light to donate and arrangements being complete.

When we had a potential candidate, we would contact a donor facilitation group and they would dispatch a nurse to our hospital. We always knew when they were in the house, and I believe that was intentional, because they always brought snacks and they always brought the same stuff. You’d walk into the breakroom and know what was in play out on the floor, and I was grateful for that. At first, they’d be in the wings, getting some information and monitoring the situation with little direct input, this can last for several days.

Once they got a green light, a flurry of activity would ensue. Primary responsibility would be transferred from the ICU doc to the transplant doc. We would draw labs to test for various diseases, HIV, Hepatitis, I’m not sure what else, and they run the histocompatibility markers, and send the results out to find the recipients. They’d have to confirm the recipients were still eligible and get them into their own hospitals. There may be 3 or 4 recipients getting the major organs and they could all be in different places and need different prep times, all while trying to minimize the time the organ is out of a body and not being perfused.

Unlike a gunshot wound or baseball bat where there is localized trauma, an anoxic brain injury (such as drowning or smoke inhalation) or a diffuse axonal injury (shearing or twisting) there is not. A CT scan 90 min after the event may not show much. So, the pt is monitored for a period of time, typically 4 days, and repeat imaging may show significant bleeding and swelling. During this time the pt may require a little sedation or a lot. Now, if they start waking up, well and good, but the drive to control your own breathing and keep foreign bodies out of your airway goes way back down into the lizard part of your brainstem which probably hasn’t changed much since the KT event, so if they’re passively tolerating the ventilator without sedation it’s considered an ominous sign, even if we still have to wait out the 4 days. IIRC, it was on the 5th day that Heche’s reps started saying things like profound brain injury, and not expected to survive.

In the Heche case, one of the questions was about the terms coma and medically induced coma. To external appearances, a person on sedating and paralyzing drugs may look the same as someone with a profound brain injury, but one is in a coma and one is in a medically induced coma. Having said that, I never hear medical people using the term medically induced coma, we just talk about sedation requirements.

Hit me with your questions.

2

Could you clarify the criteria and tests for brain death? For example do multiple doctors have to make an independent determination?

3

You say you were grateful to be made aware by snacks that a (transplant) nurse was in the hospital. Should I understand from this that these were particularly stressful periods? If so, was that primarily because of the stress of having to help the families through the process?

j

4

The dolls eyes reflex and the apnea test are the ones I remember assisting with. There are advanced brain perfusion scans, but I haven’t done those. The apnea test is no breathing for period of time, usually 10 min. Dolls eyes are presence or absence of eye movement with turning the head side to side. There would be multiple staff present for the tests, I don’t remember whether it had to be 2 MDs, per se, but probably.

Yes, knowing that this is evolving nearby is helpful, there may be a lot of family present, there may be a lot of grieving and a lot of questions.

5

KT event? What’s that?

6

K-T event

7

Yeah, that’s me being silly.

8

Glad that’s cleared up.

Thank you for the information in the OP. I’m still digesting that information but I’m sort of a ‘customer’ in this process. Or more accurately my wife is. She’s had two separate transplants.

9

Oh, good for her, I hope she’s doing well.

10

It’s time for me to go to bed. I read the thread title as" Organ Donation from a Nurse’s Purse."

~VOW

11

I’m going to ask a really basic question. Is pt an abbreviation for patient or does it mean something else?

12

Pt is patient.

13

I looked online and read some articles about becoming a Transplant Nurse. Most of them focused on the care of the living patient. Seems like they don’t want to focus on the idea of routinely being called to be there for the end of life of the donor.

How often do donations happen? Sounds like your Transplant Nurse isn’t on staff. Are they part of the nursing staff in your hospital system (if you are in a hospital system, like the Cleveland Clinic) or are they contracted from some sort of group that provides Transplant Nurses or what? Where and how do you find them?

14

It sounds like this would be tremendously difficult to be part of, but also somewhat easier than a normal death. Harder because it’s drawn out, but easier because it’s helps others. Is that accurate?

15

I would imagine that donor care and recipient care are essentially 2 different specialties with the donor prep being a much smaller group.

How often? I really don’t know, but not enough for our hospital to support its own staff.

Yes, the donor nurse came from an agency that covers a certain geographic area, and the surgical team, also specialists came, from L.A. (I was in Fresno).

16

Yes and no. Any unnecessary death is difficult, but in brain death cases the question is are we going to withdraw life support and send them to the morgue or are we going to send them to surgery, so organ donation is considered a happy ending, if only for someone else, or at least the best possible outcome. Additionally, people who are only mostly brain dead may be an even more drawn out process.

I had plenty of experience caring for patients (pts) waiting for organs. Sometimes they get sick, are deemed too weak to withstand the surgery, and are taken off the transplant list. We’d try to tune them up, get them strong enough to be transplant eligible, and hope the perfect match didn’t come and go while they were too weak. This may sound harsh, but with many more recipients than organs, some difficult decisions about the ability to benefit are appropriate.

It was not unusual for us to see the same pt multiple times, spending a week or a month in the hospital at a time, hoping to get back to being strong enough to receive an organ.

So, I implore you, if you’ve ever thought about looking into donation, or have been meaning to get around to doing the paperwork, please do so.

17

In this context, a transplant nurse is a nurse who works on a medical unit (which could also be an outpatient office) that treats people who have had organ transplants. The one I did clinicals on was incorporated into a general med/surg floor, although that was almost 30 years ago so I have no idea what they do now. Some recipients go straight to an ICU after the transplant is completed, and others can go to a regular floor, depending on their post-surgical condition.

Whenever we had an organ donor at my old hospital (which did not do solid-organ transplants), the Gift of Hope crew would come in from wherever they were headquartered, the patient would be discharged as a hospital patient and readmitted as “Organ Donor # XYZ”, and the pharmacy would fill orders written by that crew. We seldom found out exactly what was harvested, although I remember a person in their 80s who was not eligible for solid organ donation, but they could use tissues, and a stillborn baby whose obituary said she lived on through her donated heart valves.

The weirdest thing I recall seeing was 8mg of IV Narcan, which is 20 times the standard opiate antagonist dose. Apparently this does something positive to lung tissue if there’s a possibility that the lungs may be used.