question re: donors

AmiK25 · Sep 9, 2004

I think what the OP may be referring to is "donation after cardiac death," which we are starting at my hospital as well. This program is for those few patients who have a very poor prognosis but do not meet the criteria for brain death (ie: they may have a small amount of flow to the brain, but are not expected to ever recover neurological function). If the family wishes to do a terminal wean on these patients, they may choose to do an organ donation. In this case, the nurse (and family may if they choose to) must accompany the patient to the OR, where they will be taken off the vent. If within two hours the patient passes away, the suitable organs will be harvested. If the patient does not pass away within two hours, he or she will be taken from the OR back to the ICU or to a hospice/private room and the organs will not be donated. That is the program that is being put into place at our facility. However, it has been in the works for some time but I think they are having some difficulties with it. I have not personally taken care of nor heard of any patients on our unit that have had this done and I'm not sure if our hospital has even done one. However, it do think it is a good option for those head injury/anoxic patients who never progress to brain death. I have had many families who have withdrawn care and have stated they would have liked to donate their loved ones organs. Anyway, sorry this is so long but I just wanted to clear some things up b/c I think this program is what the OP was referring to...not organ donation after brain death.

angel03 · Sep 9, 2004

I think what the OP may be referring to is "donation after cardiac death," which we are starting at my hospital as well. This program is for those few patients who have a very poor prognosis but do not meet the criteria for brain death (ie: they may have a small amount of flow to the brain, but are not expected to ever recover neurological function). If the family wishes to do a terminal wean on these patients, they may choose to do an organ donation. In this case, the nurse (and family may if they choose to) must accompany the patient to the OR, where they will be taken off the vent. If within two hours the patient passes away, the suitable organs will be harvested. If the patient does not pass away within two hours, he or she will be taken from the OR back to the ICU or to a hospice/private room and the organs will not be donated. That is the program that is being put into place at our facility. However, it has been in the works for some time but I think they are having some difficulties with it. I have not personally taken care of nor heard of any patients on our unit that have had this done and I'm not sure if our hospital has even done one. However, it do think it is a good option for those head injury/anoxic patients who never progress to brain death. I have had many families who have withdrawn care and have stated they would have liked to donate their loved ones organs. Anyway, sorry this is so long but I just wanted to clear some things up b/c I think this program is what the OP was referring to...not organ donation after brain death.

I believe that this is what they are talking about in our hospital thanks for clearing that up ...I guess it has not gone nation wide......

stevierae · Sep 9, 2004

I think what the OP may be referring to is "donation after cardiac death," which we are starting at my hospital as well. This program is for those few patients who have a very poor prognosis but do not meet the criteria for brain death (ie: they may have a small amount of flow to the brain, but are not expected to ever recover neurological function). If the family wishes to do a terminal wean on these patients, they may choose to do an organ donation. In this case, the nurse (and family may if they choose to) must accompany the patient to the OR, where they will be taken off the vent. If within two hours the patient passes away, the suitable organs will be harvested. If the patient does not pass away within two hours, he or she will be taken from the OR back to the ICU or to a hospice/private room and the organs will not be donated. That is the program that is being put into place at our facility. However, it has been in the works for some time but I think they are having some difficulties with it. I have not personally taken care of nor heard of any patients on our unit that have had this done and I'm not sure if our hospital has even done one. However, it do think it is a good option for those head injury/anoxic patients who never progress to brain death. I have had many families who have withdrawn care and have stated they would have liked to donate their loved ones organs. Anyway, sorry this is so long but I just wanted to clear some things up b/c I think this program is what the OP was referring to...not organ donation after brain death.

Right--again, BRAIN DEATH is not necessarily the ONLY criteria to declare someone DEAD. It depends on state law. LACK OF CORTICAL FUNCIONING--which means that the likelihood of ever regaining neurological functioning compatible with life is zero---is getting to be the more accepted criteria these days. Left to their own devices, these poor shells of what were once functioning human beings will eventually succumb to sepsis, pneumonia, or multisystem organ failure, including the heart. Their hearts will stop one way or another, and usually very soon. Their hearts may be beating, they may have some brain stem function, but the lack of cortical functioning makes them DEAD.

I can't imagine that it would take 2 hours for a heart to stop beating in a patient with no cortical functioning, but anything is possible. That seems like it would be really hard on the family, to accompany their loved one to the OR and hold what they must perceive (albeit inaccurately) as a "death watch"--2 hours!-- while waiting for the heart to stop beating. In my own experience, it occurs within mere minutes--and again, these people are already DEAD, by virtue of NO CORTICAL FUNCTIONING.

You are right that it would make families feel a LOT better if organs COULD be donated, when dealing with a patient who never progresses to brain death. My mom was comatose for several days after an anoxic brain inury--she had an MI at 47 and was not resucitated in a timely enough fashion to avoid anoxic brain injury.

When this occurred, 25 years ago, we wanted to donate her organs--she had wanted to, too, in the event of her death--but they were not deemed acceptable for donation--not sure if it was because of the MI, because of the anoxic brain injury, or because of donation protocols at that time--maybe because she never progressed to brain death, and lack of cortical functioning was not an accepted standard at the time.

Sounds like in today's world, under today's organ donation criteria, they could have salvaged more organs. As it was, all they were interested in was her eyes, so at least some good came out of it. We actually got letters from the families of the people to whom my mom's corneas went--they were very touching.

cadillac05 · Sep 13, 2004

This is so true. Generations of my husband's family and their friends (they are all Southern Baptist) have a deeply ingrained belief that God will not let them into heaven if they don't arrive with all "the parts" he gave them when they were created. Who knows how long ago--and WHY--this belief got started, it persists today.
Not one of them would be an organ donor. Even though there have been many tragic deaths within the family and their circle of friends since I married into it; deaths among healthy YOUNG people--evn babies and toddlers-- the family would not consent to organ donation. What a senseless waste. Those organs could have saved multiple lives.
I often wonder if any of them would feel differently if THEY were in need of a kidney, heart-lung, or liver transplant--if they'd be rushing to get themselves on a transplant list and praying for a donor.

Sorry to go off thread a bit, but the implication that the beliefs stated are related to Southern Baptist doctrine is incorrect. (www.sbc.net) In my own experience, Native Americans hold that belief. I've even saved hair shaved during preps. All excised tissue is saved from pathology for their ritual burial. Deeply held beliefs, religious or otherwise, rarely change with circumstances. Advocating for patients requires respect for their beliefs/preferences whether we personally approve or disapprove.

stevierae · Sep 13, 2004

Sorry to go off thread a bit, but the implication that the beliefs stated are related to Southern Baptist doctrine is incorrect. (www.sbc.net) In my own experience, Native Americans hold that belief. I've even saved hair shaved during preps. All excised tissue is saved from pathology for their ritual burial. Deeply held beliefs, religious or otherwise, rarely change with circumstances. Advocating for patients requires respect for their beliefs/preferences whether we personally approve or disapprove.

Well, I can only speak for what my husband's family SAID was the basis for their beliefs--that is, their Southern Baptist upbringing and the Southern Baptist church they went to every Sunday since forever.

I would never try to convince any patient to try to change a deeply held religious belief, but if I were a donor coordinator, I would certainly at least bring the subject UP--along with a bit of education about the GOOD it could do--and then, if met with resistance, back off.

In my husband's family, I think they are a bit hypocritical, which annoys me no end. I mean--none of THEM would ever consider donating a kidney--either as a live donor, or upon their deaths-- but when one of their family members needed a kidney, they were all about doing their best to advocate for him and making sure he was on the list for a cadaver kidney, and ensuring that he was supplied with a beeper so that he could be reached the minute one became available. :uhoh21:

I don't think I am disrespecting their religious beliefs by saying this. I am simply stating a fact--that they use those religious beliefs only in ways that suit THEM.

Ms.Hobbes · Sep 13, 2004

I can remember 12 years ago my brother was hit while on his bicycle and ended up with major head trauma besides all of the other injuries. He was in a coma for 5 days and even at that time it was quite evident that he had significant brain trauma..he was coded initially and came back, but I only think that was because he was a healthy 16 y.o., he was not even able to regulate his temperature and on his fifth day of the coma he spiked up so high creating even more swelling to the brain which in the end cut off the circulation to the brain. After a series of EEG"s was found to be brain dead.

I was finishing up my nursing degree at the time, as difficult as it was for my parents to sign the papers for organ donation we would not have had it any other way. Our bodies are just a host where our spirits live and if we couldn't have him alive we felt the greater gift was to give someone else a chance at a better life. Several weeks after his death my mother received a letter telling her age and sex of people who received his organs and how they were doing at the time. It was such a nice feeling knowing some good had come out of his tragic accident.

I have to admit,though,as we each went into to say goodbye to Timmy it was a weird feeling as he was still on lifesupport and I remember seeing the pulsing of his heart at the crook of his neck. We had such a great supportive staff and the nuns there for us that it all made it easier. So my vote is donate your organs, so much good can come from this!

Trauma Columnist · Sep 13, 2004

Ms Hobbs - what a touching story and the real reason for organ donation. Thanks for sharing with us...judi