Diagnosis permanent veg state can you donate organs

caroladybelle, BSN, RN · Sep 4, 2010

With the updates of medicine, if he is not brain dead because he could progress to a vegatative state as a max we are told, would we be able to donate organs if we wish to remove life support. We are in Connecticut.
It has been 7 days, if he has not opened his eyes by now, do you think he will in the next week or two?
Does the eye opening occur as the injury progresses spontaneously and he loses more control or the brain dies more? We are hoping he will not, as if we have to make the end of life decision, he has younger children and we feel opening his eyes gives them false hopes of an upcoming miracle, this is how they felt when he started to posture to stimulus . Very sad.

My thoughts are with you, at this time.

You will find that few nurses will respond to this, because we cannot do so with any accuracy. Because there is just no way, given the data presented, that we could answer with any accuracy. There are just way too many details that can alter the outcome. Opening eyes in those with a vegetative state may or may not occur - it is not remotely predictable. And it would not be appropriate to comment on that, because of that reason

The MD in charge of the case and the Neurologist would be the best, and most accurate source as they know the complete details of the case, certain nuances that we and you may not be party to

PVS or not, it does not matter. One cannot donate organs unless one is dead - brain dead is essentially "dead" but one still does not donate until taken off life support and heart/lung function stops, as far as I am aware. Now, with those cases, there is a great deal of prep done before removal of life-support, to facilitate probable donation once heart/lung function has stopped. Or one can being a living donor by agreeing to it voluntarily, usually family member or spouse donation to friend or family/spouse (kidneys come to mind) Barring that, I don't believe that you cannot "consent" for your PVS loved one to be a "living" donor. And PVS is still alive in the legal sense of the word vs. brain death which is dead in the legal sense.

Many hospitals initiate certain protocols when a pt drops below a certain goal level on the Glascow coma scale, and death appears to be imminent to initiate data collection for possible donation

Having said that, anyone, PVS or not, that qualifies as an organ donor, can donate after being taken off life support...just like the pt that dies suddenly in the ER after a head injury. They rarely qualify as heart/lung due to the time constraints, but kidneys and many other organs, not to mention bone, skin, corneas that have less time constraints. A lot depends on physiological condition at time of death, hydration status, metabolic function, perfusion, etc.

Again this a question for the neurologist/MD of the case to properly answer

rn/writer, RN · Sep 4, 2010

please talk to the docs involved. another option to consider is asking for the hospital's ethics committee to become involved. this is right up their alley. they would be able to explain the criteria for organ donation and what can or cannot be done regarding end-of-life decisions.

i'm so sorry your family is going through this.

speaking as an staff member--this thread can remain open for support and encouragement, but please stay away from medical or legal advice, as these are against the terms of service.

Nccity2002, MSN, RN · Sep 5, 2010

Hi Nurselizarddf,

First of all, my prayers are with you and your friend's family. Considering organ donation is a very noble act on the part of that family. Fisrt of all, let the nursing and medical staff know that the family is open to organ donation. Life Choices Donor Services is the organ procurement agency in Conneticut. Once you communicate your wishes, the hospital will contact the organ procurement agency. From your account I gather your friend is not brain death, but depending on the capability of the medical facility, the agency may be able to perform an ODACD (organ donation after cardia death)...again not all medical facility do ODACD. Communication with the nurses and the physician is essential.

Good Luck:hug:

Lizarddp · Sep 5, 2010

Thank you so much for your guidance, your right he is not brain dead, however... not brain alive either in our book---no eye opening, response to command etc... This is difficult for the family and we want something positive out of this and we know his wishes are not to live like this.

caroladybelle, BSN, RN · Sep 5, 2010

PVS or not, it does not matter. One cannot donate organs unless one is dead - brain dead is essentially "dead" but one still does not donate until taken off life support and heart/lung function stops, as far as I am aware. Now, with those cases, there is a great deal of prep done before removal of life-support, to facilitate probable donation once heart/lung function has stopped. Or one can being a living donor by agreeing to it voluntarily, usually family member or spouse donation to friend or family/spouse (kidneys come to mind) Barring that, I don't believe that you cannot "consent" for your PVS loved one to be a "living" donor. And PVS is still alive in the legal sense of the word vs. brain death which is dead in the legal sense.
Many hospitals initiate certain protocols when a pt drops below a certain goal level on the Glascow coma scale, and death appears to be imminent to initiate data collection for possible donation

My regrets - I made an error in the highlighted passage. It should read "Barring that, I don't believe that you can consent for your PVS loved on to be a "living" donor

Lizarddp · Sep 5, 2010

I want to clarify, I don't think he would be a living donor, as they discussed removing all vents, tubes etc.. and it could be minutes to several days of survivial without feeding etc... My question is once this is done and it everything is stopped can they reattached.

He is in a hospital that does organ donation.

Also, I see talk to the doctors - that is the plan on Tuesday, holiday weekend is on call only staff that don't even know his case - also the response of the doctors will go over all that on Tuesday. These are questions the family wonders about now as Tuesdays seems so far away and they have nothing else to do but sit and wait. That is why I turned to this forum, not for answers of (should we or should we not) but explainations of what usually happens, sequence of events in cases like this.

In otherwords, I don't understand how he can get to point B "death" to donate organs if the options are right now.

a) Live in vegatative state

b) Let nature take it course naturally when removing equipement.

If B was the choice I feel the organs would not be viable because they just underwent a slow death, which would be sad as he would want to donate.

Editorial Team / Admin · Sep 5, 2010

Sorry you are going through this. As far as donation after cardiac death, here's how it works at my hospital. After the family has decided to remove life support and donate, the organ procurement team steps in and makes arrangements (finding suitable recipients, bringing in the surgical team,etc), the patient is brought to the OR, and all preparations are done (prepping, setting up the instrument table, basically we're ready to go. Then the OR team leaves the room and the family comes back if they so desire. The resident removes the breathing tube, and the patient is allowed to pass. I don't know if it is like this everywhere, but if the patient doesn't pass within one hour, they are taken back to the ICU, but the breathing tube is never reinserted. Probably more than you wanted to know, and the transplant team will be able to fill in the specifics. Again, my thoughts are with you and the family.

caroladybelle, BSN, RN · Sep 5, 2010

I want to clarify, I don't think he would be a living donor, as they discussed removing all vents, tubes etc.. and it could be minutes to several days of survivial without feeding etc... My question is once this is done and it everything is stopped can they reattached.
In otherwords, I don't understand how he can get to point B "death" to donate organs if the options are right now.
a) Live in vegatative state
b) Let nature take it course naturally when removing equipement.
If B was the choice I feel the organs would not be viable because they just underwent a slow death, which would be sad as he would want to donate.

Unfortunately, that is an issue that cannot ethically be gotten around.

The hospital cannot "hasten" death to preserve organs, even in a pt in a PVS state. Once tubes are removed, nature takes what time it may. And, yes, this will cause some problems with the organs.

And once physiological/cardiac, respiratory death have occurred, to my knowledge - no reintubation occurs, no vent, vasopressors can restart. The heart has stopped, no circulation occurs and natural deterioration begins. If one were to "code" the pt and in the remote chance the heart restarted, the pt would still be considered "live" because the status as a PVS pt, they are still "live", just as they were before the cessation of pulse/respirations and unable to donate.

I suppose technically at that point, a EEG might determine brain death, changing the scenario. HOWEVER, you probably will not see that occur, for legal/ethically reasons.

Given the current public sentiment, quite a few legal cases, public perception, HCP liability, regs regarding UNOS (central donation agency), politics, religious pressures and HCP ethics - that would not be an acceptable solution. Please review the Terri Schiavo case. No matter whether every family member agrees to such a decision, there will be at least one person, staff member, concerned citizen, etc. that will come out and say that the organs were obtained unethically and this tars the whole system.

UNOS has determined that there are specific rules guiding donation, so that the public does not have objections and that someone will not be inappropriately/immorally harvested and especially that death is not hastened The integrity HAS to be preserved or the public will lose faith in the system and/or be very reluctant to donate.

This does mean that many organs will not be suitable for donation because of "letting nature take its course". But it preserves the integrity, and ensures that the public will not have cause to believe that they may be "killed" for their organs.

Please be aware, as in my first post, some organs do not necessarily deteriorate like the heart or lungs do. Bone can be harvested and used to repair bones in recipient pts. So usually some harvesting may occur, even if other organs have deteriorated.

Lizarddp · Sep 6, 2010

You nicely made that easier to understand with direction of of where else we can go. Thank you... it helps going forward with understanding the system more and a reminder of the other organs that can be donated, which was slipping my mind. I appreciate your time writing it up. dp