question re: donors

shodobe · Sep 3, 2004

I have had many "live" donors over the years. They will be brought down on a vent and anesthesia will stay with them until all organs have been harvested. Anesthesia will then turn off all monitors except the ekg, all gasses and they will walk away from the patient. It isn't as heartless as it sounds because this individual is doing a great thing for those out there that are in need of a heart, lung or liver. We still get a few harvests a year but unfortunately very few. I am a believer in organ donations and think all should think quite alot about it. The teams that come in to do the harvests are very professional and respectful of the donor and their family. I know there have been a few stories over the years that make these organizations look like a bunch of ghouls but that isn't true in all situations. This is something to discuss with your manager because if you have strong feelings against participating in this they need to know ahead of time, just in case you are on call and have to come in for it. They should respect your decision and not make it an issue. You have to view harvesting, not a good word, as a chance for someone else to live a normal life. It is too bad too many people in this country view organ donations with such a negative attitude. Good luck, Mike

angel03 · Sep 3, 2004

I have had many "live" donors over the years. They will be brought down on a vent and anesthesia will stay with them until all organs have been harvested. Anesthesia will then turn off all monitors except the ekg, all gasses and they will walk away from the patient. It isn't as heartless as it sounds because this individual is doing a great thing for those out there that are in need of a heart, lung or liver. We still get a few harvests a year but unfortunately very few. I am a believer in organ donations and think all should think quite alot about it. The teams that come in to do the harvests are very professional and respectful of the donor and their family. I know there have been a few stories over the years that make these organizations look like a bunch of ghouls but that isn't true in all situations. This is something to discuss with your manager because if you have strong feelings against participating in this they need to know ahead of time, just in case you are on call and have to come in for it. They should respect your decision and not make it an issue. You have to view harvesting, not a good word, as a chance for someone else to live a normal life. It is too bad too many people in this country view organ donations with such a negative attitude. Good luck, Mike

Mike ...I have done "normal Organ donations" I 'm really not a fan of this but I respect what is involved and the persons right to donate....what I am talking about is not brain death...the patient is actually alive could be very aware of surrounding if on a vent anesthesia is only responsible until the vent is shut off.....they do not go into the OR with the body....the patients family will be allowed to accompany the patient untill the pt. passes.....I don't remember what my friend called this.. heart beating donor. ..or something like that.......just don't like that idea...it was just passed in our OR about 2 months ago went throu ethics ect....see what you can find out...again its not the brain death criteria these people are actually still alive....

shodobe · Sep 3, 2004

Never heard of this. Seems there is a ethical problem here. They would have to be declared brain dead and the family would have to consent to donations. I am very opened minded, but if there was any suspicion on my part that the patient had any ingling on what was happening, I wouldn't do it. Period! Like I said earlier, I have had what your friend called a "heart beating" donor where all organs are harvested then the anesthesia is basically turned off and we walk away until the patient flat lines. This is so all the needed organs keep oxygenated until the end. I guess this is what is being refered to. We go through an organization called "One Legacy" and if you call them at 1-800-338-6112 you probably can get them to send you some info. I am not sure what part of the country you are in and if this organization is nationwide. Also, I would guess it would also involve what your concept and meaning of life is. Quite a mind trip when you think about it. I will see if I have anything else around here but try calling them, they are very helpful and the crews are very good. Mike

shodobe · Sep 3, 2004

I went back and looked at our manual and the phone # you want is 1-909-801-3701. The other is if you want to donate yourself! The company is only out here in Calif, but I think they could help you because they operate under JACHO rules. If they can't they may be able to give you a contact number in your area of another donor organization. Mike

angel03 · Sep 3, 2004

thanks for checking it out...I will find out what this is called.....Really kind of scary...when I find the proper name I'll let you know perhaphs its just being done around here....but can't imagine this concept didn't start out your way....

stevierae · Sep 3, 2004

Angel--I urge you to check out the thread in the neuro nursing section that is entitled, "Do you talk to brain dead patients?" I have posted quite a bit within that thread. There is a lot of confusion, even among nursing professionals, regarding criteria for organ donation and what constitutes death. There are several different states of consciousness, and within that thread I posted an article discussing and defining them.

Brain dead patients, as well as patients with some brain stem activity BUT NO CORTICAL FUNCTIONING, are DEAD. They may still be warm and dry, and have normal color, but it is the ventilator and various vasoactive drips that are maintaining that appearance. They may even still have a beating heart--for a while, after that vent is disconnected--but they are DEAD. We could not "harvest" their organs if they were not.

Now, I think what you MAY be referring to is this: patients who, because they have not received an EEG or serial EEGs, have NOT been declared brain dead.

This does not make them any less DEAD. Depending on state law and hospital policy, an EEG may not necessarily be required to prove that there is no cortical functioning. There are many other tests--you've probably seen cold calorics, among others done by neurosurgeons or neurologists--to determine that there is no cortical functioning.

There may be some brainstem activity--but if there is no cortical functioning, they are DEAD. They are not comatose or in chronic vegetative state--they are DEAD. They simply have not been officially declared "brain dead." As I said, in some states that is unnecessary--cessation of cortical activity is criteria enopugh to declare death.

We used to do, depending on the transplant team, a fair number of "harvests--" usually of kidneys--without anesthesia. Sometimes RT accompanies the body to the OR instead of anesthesia. It CAN be kind of unnerving, as you describe. Here's why: You have a patient with a beating heart. He is being bagged via ambu. The surgeon says, "OK--stop bagging him." You wait, and you wait--until cardiac arrest occurs. Sometimes this takes a WHILE, and it's really kind of a helpless feeeling, standing there waiting for the heart to stop--you just want to intervene--but you have to remember this patient is NOT salvalgeable--he has NO cortical functioning.

But, finally, stop it does, and the surgeon says, "Cardiac arrest has occurred. Let's CUT!" RT leaves. They then do a bilateral nephrectomy as quickly as possible and get those organs off to someone they can be of use to.

So, there you are, left alone with the dead body. It feels strange,but you must remember--you did not KILL this patient--he was ALREADY dead when he came to you. He had a beating heart, yes, and perhaps even some brainstem function, but--he had no cortical activity in his brain, which makes him already dead.

If there was ANY possibility that he was aware of pain and could hear things going on--well, then we would not be harvesting his organs. He'd be in a diferrent state of consciousness; not dead, and he would not be an organ donation candidate.

chris_at_lucas_RN, RN · Sep 3, 2004

stevierae, thanks for clarifying this.

I've been a tissue donor since October 1985 (over 12 gallons of blood and blood components--mostly platelets), on the marrow list almost that long, and my family, friends and the back of my driver's license have all been informed, documented and marked "DONOR."

There are needless deaths, considering the technology today, of persons with plenty more to give to their families and communities, who might be alive if organs had been available.

Horror stories, rumors, innuendo, suspicions, cannot replace the truth--we all lose when people are frightened away from doing the right thing.

Encourage organ donation. Get on the list yourself. Once you are physically eligible, in most cases, it's too late to verbalize the choice!

And while you are waiting, GIVE BLOOD!

elkpark · Sep 3, 2004

It is important to remember that these people (donors) are already dead (as Stevierae noted) -- the cadavers are just being maintained to preserve the viability of the organs for transfer. Years ago in my nursing program, we had two nurses who specialized in this area at one of the big teaching hospitals in the state come speak to us. It was v. interesting -- their job was to manage the donor cadavers on life support until the surgery (and "cadavers" was how they referred to them). They made all the issues v. clear in their presentation.

stevierae · Sep 3, 2004

stevierae, thanks for clarifying this.
There are needless deaths, considering the technology today, of persons with plenty more to give to their families and communities, who might be alive if organs had been available.
Horror stories, rumors, innuendo, suspicions, cannot replace the truth--we all lose when people are frightened away from doing the right thing.

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.

stevierae · Sep 3, 2004

It is important to remember that these people (donors) are already dead (as Stevierae noted) -- the cadavers are just being maintained to preserve the viability of the organs for transfer. Years ago in my nursing program, we had two nurses who specialized in this area at one of the big teaching hospitals in the state come speak to us. It was v. interesting -- their job was to manage the donor cadavers on life support until the surgery (and "cadavers" was how they referred to them). They made all the issues v. clear in their presentation.

That's a good way to educate both health care professionals and families--by repeatedly using the word "cadavers." In this way, they finally understand that this warm, pink, "person" with a beating heart and respirations is essentially a shell-- a dead body-- housing organs that are being perfused by artificial means--that is, machines and drips.

angel03 · Sep 4, 2004

I will check this thread out ...thanks for the info.....