ICU nurses- your thoughts on organ donation?

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Specializes in Hospital, PDN, rehab, corrections.

Hi everyone!

I just wanted to do some recon and get your views on the donation process to try to see things from your eyes.

What have you seen that you liked? What did you dislike?

What could have been done better?

What sort of questions were raised by your last experience with a donor?

Do you feel that there is enough education about donation?

What would you like to see from your organ procurement org?

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While I realize the importance of organ donation and the lives that it saves, this is one field that MUST have proper training. I have worked in a ICU that handled alot of organ donations. I have seen families approached by the GIft of Hope aka ROBI at very inappropriate times, put them thru rigorus questioning to the point the family was exhausted to turn them down. I have seen these people swoop in like vultures and once there, did not give much room for the nurses to do there work. I have made more than my share of phone calls to complain. Like I said, I have been thru many organ donations, the one that stands out in my mind and has forever changed my way of thinking was when a 25YO male who was a quad fought a hard battle against aspiration pneumonia. After coding several times, and with little hope being offred, his parents and family determined, with the help of Gift of Hope/ROBI to take him off the vent and harvest his organs. What they wanted was an asystolic donation. The problem...the pulled him off the vent, rushed him to surgery, prepped him, and then stood back and watched him struggle to breath on his own. This young man who was still with us was tortured in my eyes. We could not give him any further drugs such as Morphine, nor could we do touch him, etc. The people there made very inappropriate remarks about this young man and within his hearing. Fianlly, I threw away all reagrds to their policy and went and told the patient that if he wanted to go home he could, if he wanted to stay that was fine too. WIthin 15 minutes, he passed and they jumped on him like he was fresh meat. Total time that we were there 1hour and 15 minutes. Memory time....forever. I will never forget this nor will I ever donate my organs and I do not push anybody to sign up for organ donation. There needs to be more training for these people. The should be nurses and doctors who care for a better life, not the almighty dollar and a point on the board.

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Specializes in Neuro Critical Care.

We have awesome procurement coordinators in central Ohio. I have never had a problem with any of the coordinators, they treat the nurses, the family and the patient with respect. The one thing that continually amazes me is the length of time it takes to place the organs.

When talking to the family the chaplain is present as well as the coordinator and usually the doctor has spoken with the family. I work in a neuro critical care so most of our procuement patients are a result of brain herniation so the patient truly is already dead.

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Hey Y'all

Worked a good bit in NeuroTrauma. Spent some time in PICU. Also Surgical and TraumaSurgical. Have dealt with Transplanters fairly often. In 25yrs, probably 30 or 40 pts ended up as donors. All are different in their ways but the similarities are hard to ignore.

First, as long as my Pt is 'alive' I am (in my own mind) bonded with him. I have been known to promise my Pt "we are going to see the sunlight come through that window together, buddy!" It might not always happen but in my mind it's a pretty meaningful pledge. So when I have accomplished that, and come to work the following afternoon to find that the diagnosis of brain death has been made during the dayshift, it's a difficult emotional transition.

Second, I am obsessive about turning my pts, arranging their limbs and pillows and tubes/lines to create a tableau of comfort. And about giving pain meds and sedation when neuro and vital signs allow. It is a wrenching change of direction to tape the eyes, put them in supine and pour in Ringer's Lactate until someone in some far off office can match up the kidneys.

Third, I'm used to dealing with physicians who (mostly) really care about their patients pretty much as I do--as a person, with a family. The Transplanters seem skilled at dealing with families. Probably they're as empathetic and kind-hearted as anyone could be. But their concept of my patient is different from mine and once the family has said their good byes and gone home--the kind of care and orders and---well, 'nursiness'---of the situation changes. There is no longer a person there. (I know-I know, the 'patient' is now 'dead'. But I can't spin myself about on a dime like that.)

So I guess I have objections to transplantation that are not philosophical or ethical. (Really, I understand that they're DEAD now.) My objections are emotional and esthetic. It just don't FEEL RIGHT.

And thank goodness I've never gone to OR with them to witness the sort of struggling transition from life to death that was described above. At that point I'd have had to be in restraints myself to keep me from giving 10mg of Morphine.

To confuse me on this issue even more, I've had several friends who've been recipients. The joy my one friend in particular takes at being free from Dialysis is wonderful to see. He goes WATERSKIING! He has a girlfriend! So I understand, I really do, that there can be good outcomes.

But I have to work from my guts and emotions. Otherwise I'd go back to roofing.

Yer Papaw John

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While I realize the importance of organ donation and the lives that it saves, this is one field that MUST have proper training. I have worked in a ICU that handled alot of organ donations. I have seen families approached by the GIft of Hope aka ROBI at very inappropriate times, put them thru rigorus questioning to the point the family was exhausted to turn them down. I have seen these people swoop in like vultures and once there, did not give much room for the nurses to do there work. I have made more than my share of phone calls to complain. Like I said, I have been thru many organ donations, the one that stands out in my mind and has forever changed my way of thinking was when a 25YO male who was a quad fought a hard battle against aspiration pneumonia. After coding several times, and with little hope being offred, his parents and family determined, with the help of Gift of Hope/ROBI to take him off the vent and harvest his organs. What they wanted was an asystolic donation. The problem...the pulled him off the vent, rushed him to surgery, prepped him, and then stood back and watched him struggle to breath on his own. This young man who was still with us was tortured in my eyes. We could not give him any further drugs such as Morphine, nor could we do touch him, etc. The people there made very inappropriate remarks about this young man and within his hearing. Fianlly, I threw away all reagrds to their policy and went and told the patient that if he wanted to go home he could, if he wanted to stay that was fine too. WIthin 15 minutes, he passed and they jumped on him like he was fresh meat. Total time that we were there 1hour and 15 minutes. Memory time....forever. I will never forget this nor will I ever donate my organs and I do not push anybody to sign up for organ donation. There needs to be more training for these people. The should be nurses and doctors who care for a better life, not the almighty dollar and a point on the board.

OMG. I can so see this happening. My experiences with the organ donation process has been troubling as well. I find I resent the intrusiveness and entitlement of the 'organ vultures'. they have become quite insistent, even trying to guilt people into it. Many families are traumatized when I ask them about donation, and that hurts me....sometimes I cry with them as I explain I must, by law, offer this to them. They're trying to grieve and sort out feelings, only to get this thrown at them as well.

I also resent that the organ companies keep databases of nurses and their rates of denials when we ask families to donate. Big brother is into organs now too. :(

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I've worked with a wonderful team in the Dallas area. Nothing but good things can be said about them.

Even the tech from the eye bank that came in to harvest at the end of it all was superb and respectful,

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Specializes in Critical Care.

The Soutwest Transplant Alliance out of Galveston, TX, is a first rate organization.

I can see that there could be problems, and I can even field a complaint or two about the money end. And by definition, we are asking families to jump through the stages of grief and get past denial and anger in order to make decisions that can lead to acceptance FAR before they are ready for acceptance. But that can't be helped - there IS a time factor there . . .

BUT.

Never forget that the goal is to put those organs into people that will die without them. There are so many pointless things that we do with our technology for me not to stand up and cheer about the use of technology in such a wonderful way.

Every donation process I've participated in has been handled by first rate professionals. After my kids are grown, I'd think I'd like to work for a transplant team: I just can't be on call like that while trying to be a single parent. . .

~faith,

Timothy.

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I work with an absolutely wonderful team right now.........Nothing but kudos to them. And it is much harder here, I work in a PICU.

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My experience in dealing with the transplant organization in my area was disgusting. We'd have to call them on every death in the ED, even a 99 yo pt with multiple medical problems. Very intrusive, rude.

And I have a hard time with the way the way the pt is depersonalized; he becomes something to "harvest." You harvest corn or other crops, not peoples' organs.

I hate it at holiday time when the news inevitably runs some story about someone who is "just hoping and praying" for a new kidney/heart/liver, etc. The attitude of, "Gee, I hope something horrible happens to someone else so I can live."

I have specific instructions on my advance directives, and my family knows very well that if anything happens to me, I do not want these vultures coming in and browbeating my family at such an emotional time. I won't accept a transplant either.

At my one job, we saw a film of an actual transplant team talking to a potential donor family. This was supposed to be a "good" representation. Yeah, right. They kept at that family until the family was exhausted and finally gave up. You could almost see the procurement people high-five each other in the hallway. And as soon as they got the OK from the donor family, that donor family was left alone; no support or compassion from the procurement people. It was like they got what they wanted, and now the family was no longer of any importance.

No way will I donate.

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Specializes in Critical Care.
No way will I donate.

And by the same token, I sincerely hope you or a loved one never find yourself in desperate need of such a life saving measure.

I see technology abused everyday. I'd go so far as to say that sometimes I feel quite unethical. What makes me sleep at night is the knowledge that sometimes, what I do is truly miraculous. This is one of those sometimes.

It can be difficult to approach family about donation: by definition, they aren't ready for such conversastions (stages of grief) and there will never be a way to discuss donation in a nice, sit-com bonding way. That's why most donation groups encourage people making decisions in advance. But it's not about successfully supporting family's stage of grief at this point, it's about another/several lives that can be saved. And in the end, when the family DOES reach acceptance, often times donation is the best legacy those family members can attach to the whole death process: it is ultimately most times a blessing, not only to recipients, but to family members coming to terms with the death of their loved one.

And the reason why it's law for you to call after every death is to make sure that your discomfort doesn't deprive someone of a life saving gift.

~faith,

Timothy.

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I believe I already said that I would not accept a transplant. I can't speak for any of my family; what they decide is up to them.

It's not about my discomfort...it's about the total lack of sensitivity from the organ procurement people in my area that contriubtes to my feelings about transplants. I don't believe in bullying or browbeating people for any reason.

I am fully aware of what the law requires; you don't need to educate me about it.

If it could be done with a little more humanity, I might change my mind. But as long as the donor pt becomes some "thing" to scavenge over, sorry. That person has a family who loves him/her just as much as someone waiting for an organ. We should never lose sight of that.

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'But it's not about successfully supporting family's stage of grief at this point, it's about another/several lives that can be saved.'

Sorry but this is a personal value judgment on YOUR part. "IT" will ALWAYS, for ME, be about supporting MY patient's family in their grief. First and foremost.

I feel no obligation in any respect to support the organ vultures ahead of my patient's family. And I feel much like Fab4fan after so many years playing this game. I also resent the pushiness of organ procurement proponents out there, who are so sure of their morally superior POV.

JMHO and you are entitled to yours; just don't push it on others please.

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