June 7, 2018

Inside the 'sacred' vigil of preparing one woman's organs for donation

Daily Briefing

    The Indiana Donor Network receives about 30,000 calls a year about patients who could potentially donate organs—and each call sets off an intensely choreographed process that can involve a half-dozen surgeons, last up to 72 hours, and ultimately save multiple lives, the Indianapolis Star reports. 

    Here are 5 key tactics to attract and retain transplant patients

    The Star detailed the organ donation process in Indiana where a woman had been declared brain dead and her family had agreed to organ donation.

    Organ recovery coordinators run the tests

    From start to finish, the organ recovery process can take between 24 and 72 hours. In this case, the organ recovery coordinators began work at 8 a.m. with the goal of completing the process by 8 a.m. the following morning. To facilitate the long process, organ recovery coordinators work shifts that last 24 hours straight, followed by 48 hours off.

    The team began the process by drawing about 30 vials of blood from the woman. They then collected urine, sputum, and blood culture samples and ordered several tests, including an electrocardiogram and a chest X-ray. In other cases, organ recovery coordinators might ask for abdominal scans to measure the size of a person's organs, according to the Star.

    John Heflin, one of the organ recovery coordinators, examined the woman's urine and noticed it appeared as clear as water, which suggested the woman might have had diabetes insipidus, a condition that is common among organ donors and reversible with medication. A coordinator treated the woman's suspected diabetes insipidus per the United Network for Organ Sharing's (UNOS) protocols.

    Another organ recovery coordinator delivered the woman's blood samples to an Indianapolis lab to screen for infectious diseases, such as cytomegalovirus, Epstein-Barr virus, hepatitis B and C, and West Nile virus, and determine the blood type and proteins, which helps assess compatibility between a donor and recipient.

    Hours after they drew the woman's blood, the organ recovery coordinators returned to biopsy a few lymph nodes near the woman's groin—a step that helps further determine whether a donor and recipient are a good match.

    Finding a match

    By 7:30 am the next morning, the organ recovery coordinators had the test results back. Steve Ashley, one of the organ recovery coordinators, entered the woman's test results into a database operated by the UNOS, called DonorNet. The database uses an algorithm that takes into account a number of factors, including distance and health, to match organ donations with recipients.

    Anne Kasey, an organ recovery coordinator with the Indiana Donor Network, said matching the organ donations with recipients is the longest part of the entire process. Kasey explained that a medical center can decline to accept an organ donation, which leads to more medical centers being contacted until the organ recovery coordinator team knows where the donated organs are headed.

    DonorNet determined the woman's organs—including her kidney and liver—would go to recipients in Indianapolis.

    After confirming the recipients, the coordinators next made the arrangements for organ recovery—a delicate balancing act that involves figuring out when a hospital's operating room is available, when surgeons are free for the transplant, and who can travel to remove the organs. The number of surgeons involved in the surgery to remove the organs varies, with as many as six surgeons coming together for one procedure.

    Removing the organs

    At about midnight—36 hours after doctors told the woman's family they could donate her organs—surgeons and staff began the organ removal process. Indiana University Health's Burcin Ekser and a surgical fellow were in charge of performing the procedure to remove the woman's organs at Hendricks Regional Health. An anesthesiologist in the operating room monitored the woman's body to ensure her organs stayed oxygenated and healthy.

    Ashley began by leading a moment of reflection: "Remember, this room becomes sacred when a family entrusts us with one of their most precious possessions," he said, reading from a laminated card.

    Then, the surgeons, organ recovery coordinators, and hospital staff quickened their pace.

    Surgeons had to prioritize removing some organs first. The thoracic organs, such as the heart and lung, were the first to come out because they are viable for shorter periods of time than other organs. Abdominal organs came next.

    At 1:14 am, the procedure had reached a critical "cross clamp" moment in which the blood stopped flowing to the heart. At this point, the heart is typically removed and delivered to the recipient or somewhere else for research—but in this case, the woman's heart and lungs were not part of the donation, which meant the surgeons and others involved in the process were under less pressure.

    Therefore, surgeons and medical staff moved on to the next phase of the procedure: removing the woman's liver and kidneys. To prepare for removal of the organs, the team triple-bagged large metal bowls with clear sterile bags that were filled partly with frozen saline solution.

    At 1:28 am, the surgeons removed the woman's liver, placing it in one of the large metal bowls. Five minutes later, they removed the woman's right kidney, and three minutes later, they removed her left kidney. The transplant team received a last minute call from researchers interested in the woman's pancreas for a study. Once the donation was confirmed, the medical team prepared another receptacle to hold that organ.

    Once all of the organs were packaged for travel, the respective transplant teams hurried out to waiting cars that would take them to the life-saving organs to their recipients. The organ recovery team remained behind, packing up the surgical equipment in the now "hushed hospital," the Star reports (Rudavsky, The Indianapolis Star, 5/17).

    Here are 5 key tactics to attract and retain transplant patients

    Download this briefing to learn how to expand the pipeline of potential transplant patients and engage them across the care pathway.

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