To donate or not to donate

  1. Hi all my fellow NPs,

    I am new to this site.. so bear with me. Have a patient on my stepdown, who is declared brain dead, now on pressors etc, awaiting family's decision re :donation. As f/u, the liveOn coordinator obtained consents to proceed, only for spouse to pull back because he did not want her tested for infectious diseases and for him to disclose her substance use history, if any. This is sad, even though he was willing to donate just kidneys and liver. Albeit, she is still young and the situation is sad, but the lay public just doesn't get it. Any thoughts.....
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    About Sas0930

    Joined: Nov '18; Posts: 3; Likes: 3

    4 Comments

  3. by   juan de la cruz
    It's a personal decision and unfortunately, this spouse's unfounded fears affected his decision. While many people with end stage organ failure on the transplant list die while waiting for a donor, I don't get involved with family member's decision in terms of organ donation during end of life situations like you mentioned because that role should be left to your state's organ procurement organization representative.
  4. by   offlabel
    I think framing the choice not to deliver his wife to harvest in terms of "not getting it" and "unfounded fears" is pretty paternalistic. The thought of my child or spouse undergoing organ harvest, especially in the circumstances that these deaths occur in, is unimaginable to me. Having done the anesthetic management for beating heart harvest procedures, I can attest that, because of the necessity to be quick, it is anything but elegant, to say the least.

    I can say very confidently right now that my decision for organ harvest for a loved one would not be a sure thing at all. There's no telling what this guy brought to the table to make him make the decision he did. Lamentable for those waiting for an organ? Sure. But that guy didn't cause those organs to fail and he had no obligation at all to say yes, especially given the situation he was in.

    Sad all around.
  5. by   juan de la cruz
    Quote from offlabel
    I think framing the choice not to deliver his wife to harvest in terms of "not getting it" and "unfounded fears" is pretty paternalistic. The thought of my child or spouse undergoing organ harvest, especially in the circumstances that these deaths occur in, is unimaginable to me. Having done the anesthetic management for beating heart harvest procedures, I can attest that, because of the necessity to be quick, it is anything but elegant, to say the least.

    I can say very confidently right now that my decision for organ harvest for a loved one would not be a sure thing at all. There's no telling what this guy brought to the table to make him make the decision he did. Lamentable for those waiting for an organ? Sure. But that guy didn't cause those organs to fail and he had no obligation at all to say yes, especially given the situation he was in.

    Sad all around.
    I was going by the OP's account of the spouse not wanting the patient be checked for infectious diseases and unwillingness to disclose a substance abuse history. I may have been "judgmental" in calling it an unfounded fear not knowing the entire situation. As you mentioned, the revelation of such information gleaned from those tests may bring undue heartache to an already tough grieving process. At any rate, like I said, I don't bring up the topic of organ donation to families as a provider for the fact that a conflict of interest may be questioned (we are a multi organ transplant center). My duty is to call our region's organ donor network representative in cases of brain death and have them deal with the rest of the process.
  6. by   Sas0930
    Quote from juan de la cruz
    I was going by the OP's account of the spouse not wanting the patient be checked for infectious diseases and unwillingness to disclose a substance abuse history. I may have been "judgmental" in calling it an unfounded fear not knowing the entire situation. As you mentioned, the revelation of such information gleaned from those tests may bring undue heartache to an already tough grieving process. At any rate, like I said, I don't bring up the topic of organ donation to families as a provider for the fact that a conflict of interest may be questioned (we are a multi organ transplant center). My duty is to call our region's organ donor network representative in cases of brain death and have them deal with the rest of the process.
    Thanks for the feedback. However, I had not provided all the necessary details as this has been a struggle for the family, a busy unit and family dynamics, given that the patient has been declared for a few days...Just to clarify, my institution has organ donation coordinators, so providers do not approach families to initiate this sensitive topic. Organ donation is up to the individual's known request (desire) and NOK. We are happy if they chose to proceed and sad if they don't, but not judgmental in the process at all, because we have to respect choices and cultural differences. What was difficult for us 'back and forth' which while understandable meant significant delay. I am now happy to report that the family has re-visited their decision and (all) agreed to proceed with donation, without being coerced to do so by our coordinator/team.
    Last edit by Sas0930 on Nov 18 : Reason: typo

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