Published
Just read on the wire service that a teenage female was transplanted with organs that do not tissue match and she is expected to die within a matter of hours.
How could this happen? I'd hate to be the one responsible for writing an explanation of this sentinel event.
I'd hate to have this on my conscience.
Hope we find out where in the checks and doublechecks the process failed.
I work in a blood bank/transfusion service. We do not do transplants in our facility, but we do fight a constant battle to get staff to check arm bands, label tubes correctly, have 2 signatures on the transfusion record, etc. I spend a lot of time explaining to disgruntled nurses, resident MDs , surgeons and anesthesia as to WHY I cannot issue blood crossmatched on an UNLABELLED tube, etc
They usually respond by SHOUTING that a patients life is at stake...we are a trauma center and get a lot of John/Jane Doe folks....but I must follow my policy to provide the correct blood to the correct patient. The consequences of not following policy are too horrible to contemplate. I hope that Duke takes a closer look at their pre transplant policies ....what a mess.
Tinkertots
29 Posts
I am an Agency Rn, but work mostly on a Transplant unit. When we know we have an organ, we call in all patients waiting for that organ. We have had 20 people show up. We have 15 min to get the blood to the lab to cross match. Not only that, the work up for a transplant takes several days to weeks. It doesnt just include cross match!!! We have teams of doctors, nurses, transplant coordinaters, PharmDs that are in the decision process. I can't understand how this could happen! I read last night where the surgeon was taking sole responsibility. I just don't get it. Not only will it kill this poor girl, but he could be the cause of another death. Those organs could have been used for the right match....possibly preventing another death.