Not brain-dead, but ripe for transplant

I don't like the term 'harvest' at all. It strikes me as macabre. Ugh, I picture a room full of people on life support, disembodied brains, and Frankensteinian doctors with wild-eyed looks in their eyes, ready to bring in the harvest.

We recently had an inservice on this. Supposedly, the vent has to be off and the pt down for 5 minutes, then restart vent or reintubate while in OR.

I'm not an OR nurse, but from what I've heard, that's not too far off the mark. I've heard some vicious stories of surgeons pushing each other out of the way to get their organs first.

I still shiver every time I have to place the call to the Sharing Network. I'm such a softie...

That's why I will never be an organ donar. I'm not really in favor of the whole thing, too much room for abuse. I don't trust the medical system, which is all about making money.

Not to try and change your mind, but, heck ... I'll be dead, and I could care less if they all go crazy over me at that point. =) I had a cousin who died at the age of 17 and I think one of the only things that's helped me come to terms with that is that fact that others are alive and can see because of his organs and corneas. Personal experience will always colour our opinions, eh?

All the organ donations I have worked with (ten or so) have been heartbreaking trauma patients that something positive came out of....people received vital organs that let them stay with their family. In all cases it was the family's decision-and these were all patients who had zero chance of surviving...We do dcd, and my best friend is an OR nurse and has been in dcd situations and as never expressed discomfort. not disagreeing just giving my viewpoint!

We have had several DCD donors (and a few brain death) over the last several months. Working with our local organ procurement organization (OPO) has been quite interesting. They are a wonderful resourse to address your questions and concerns. If a nurse doesn't understand why the OPO wants to do something, they (the OPO) are always very willing to explain the rationale.

On a little bit of a more personal note..... I cared for patient who had a massive brain hemohrage. There was no hope of recovery, but unfortunately, this patient couldn't be declared brain dead because they were still overbreathing the vent as well as other things. The plan was DCD (family aware and quite cool with the idea - in fact had already said their good-byes). We supported the patient to support eventual retrieval of the liver and kidneys (only organs possible (I think) in DCD). However, a few hours later, the patient's heart rate skyrocketed and their BP plumitated and they quit over breathing the vent. An apnea test was eventually done and brain death was pronounced. We switched to brain death retrieval and organ support. It was awesome to watch and listen to the transplant coordinator call around the region to offer/place the organs (kidneys were placed quickly; the liver was soon after; the heart and pancreas would be offered/placed later after some studies were completed).

All that to say this...... It really made me think about those families whose lives were about to be changed yet again - the first time with the diagnosis of organ failure and now a phone call will change it for a second time. Life is now full of the possibilities of being able to play with the other children for the first time in a long time, to see their daughters/sons grow up and be married, to see and enjoy their grandchildren, to be able to have a full and happy life. This one patient was able to enhance the lives of at least 5 different families!! I don't know how much better things can get!!

LOL! Reminds me of a famous scene from monty python's holy grail ('i'm not dead yet!'...).
I could just see it '..wait! wash the betadine off and put away your razors...a lead was off!)

On a more serious note... i recently took care of a patient who suffered several massive embolic cva's from a left-ventricular clot...wiped out 'most' of his brain (entire right hemisphere, ~1/2 of his left...but brain stem was intact). 'Perfect' candidate...no chance of a 'meaningful' recovery. (so...not 'dead'...but being 'primed' for 'harvest') Family wanted to let him die and donate organs...and the organ recovery people were all over it.
The hitch was that the family wanted him extubated and sent to a more 'private' room out of icu(cant blame them). I may be wrong here...but there was something to do with a 90 minute window from time of death(maybe for some organs? 10minutes for others???)...Due to his stem being intact, the guy kept ticking after extubation (as expected). The organ-harvesters were kinda ****** as they wanted him left on the vent because in the 'event' of cardiac death, he could be pronounced dead...then 'resucitated' (all the acls stuff) and more effectively harvested. Kinda macabe. Organ donation is a WONDERFUL thing for the recipients...but i get a creepy feeling sometimes about the harvesters...like buzzards circling...

The term 'harvest' is falling out of favour in organ transplantation literature for the reasons already mentioned - the unpleasant connotations for staff and more importantly (from an organ procurment perspective) families.

There is growing concern in the health ethics field about the validity and application of brain death in general, and its close ties to organ donation in particular. I recently attended a conference where the plenary speaker (Allan Kellehear, Prof of Sociology at the University of Bath) spoke passionately about this for an hour and a half.

It's possible that cardiac death may alleviate some of these issues. Though, as Gwenith points out, it potentially opens the door for equally troubling issues.

And this is why health ethicists will never be out of work!

I was thinking the very same thing!!!