Nurses and Organ Donation

allnurses Guide · Jul 16, 2009

With all due respect, you don't have to understand it or like it. To me, this is such a personal decision. I am very vocal about my reasons, some people are not. I don't think anyone should have to validate their reasons in this instance. This goes back to what I said before..the idea of organ donation as a gift is going away, people are just expected now to do it. In some cultures/religions, it is not accepted. Others, like me, have seen first hand the ugly side of it.
No matter, you will have some that choose to donate and some that choose not to.

I don't think you'll find that I said anyone had to validate their decision. I'm certainly not going to question anyone clinically who makes that decision, it's totally up to them. I did, perhaps naively, think that people who posted on a discussion board thread about organ donation would like to discuss their opinions - I hardly think that's unreasonable. There's a wonderful freedom online both to ask questions you're interested in, and to not answer if you don't want to.

pers · Jul 16, 2009

I am not a donor and don't ever plan to become one. I would consider being a living donor should the need arise but I would not accept an organ donation for myself. I don't have children but if I did, the decision to donate or receive a donation would be one made together with my partner and if appropriate, our child.

I do have POA for my parents and I'll be following their wishes exactly and it also does not include organ donation. I've never questioned them on it as it's really none of my business why, only that they don't.

With regards to opting out versus the current system of opting in, I'm against the idea. As others have already stated, donated organs are a gift not a right. However, should this ever come to be, I really hope that opting out will get the same amount of education and availability as opting in currently does.

cardiacRN2006, ADN, RN · Jul 16, 2009

I don't think you'll find that I said anyone had to validate their decision. I'm certainly not going to question anyone clinically who makes that decision, it's totally up to them. I did, perhaps naively, think that people who posted on a discussion board thread about organ donation would like to discuss their opinions - I hardly think that's unreasonable. There's a wonderful freedom online both to ask questions you're interested in, and to not answer if you don't want to.

Agreed. I see that a lot here on allnurses. People post their opinions, and then lash out if someone has an opinion different from their own.

I also thought being on a discussion board implied that a discussion would ensue...

I'll go one step further on the organ donation situation:

People who say that they'll never donate, but would consider accepting donations are selfish hypocrites.

leslie :-D · Jul 16, 2009

People who say that they'll never donate, but would consider accepting donations are selfish hypocrites.

hmmm...

would be interested to hear the rationale about that.

but i will say, it doesn't sound too cool.

leslie

rnmi2004 · Jul 16, 2009

I will be an organ and tissue donor. I would not hesitate to donate the organs of a family member.

I agree that donation should be opt-out rather than opt-in. Other countries that have this in place have far fewer people dying while waiting for a transplant. IMO, there would be less reason to fear abuse of the system or situations where people from third world countries are paid as living donors if organs weren't so scarce.

Basically, an opt-out system is less of an evil in my mind than what we have going on now. Any person that feels that strongly about not donating organs can take steps to make their wishes known.

cardiacRN2006, ADN, RN · Jul 16, 2009

hmmm...
would be interested to hear the rationale about that.
but i will say, it doesn't sound too cool.
leslie

Exactly. People have the right to keep their own organs. It is a personal choice, and I have no right to tell them what to do.

But, if people choose to keep their organs, but are open to accepting them for themselves or their family, well, then they are a selfish hypocrites. And I do have a right to discuss that on this board. Quite frankly, it makes me sick. I hate, despise selfish people. Funny how everything changes when it's their family. THEN, organ donation is good. When it's THEIR children.

Honestly, reading the responses really enlightened me. I had no idea how clueless and ignorant some people are when it comes to the practices of the organ donation process.

Do people really think that I, as an ICU nurse, get money if I convince my pt's family to donate? Or that I will hurry their death? Or do anything OTHER than care for my pt honorably?

Donation is almost a 2 day process, once accepted after brain death. So the whole, "drive the ambulance straight to the OR" is a boatload of crap too.

I do what the family wants. If the pt is brain dead (so, so rare), and the family wants to donate, then yippee! I'm happy that they are doing something so incredbily good, selfless and caring for a stranger. They can sleep at night knowing how wonderful they are in this world.

If they choose to withdraw care, extubate, sit with their family for the few minutes it takes for them to pass. Then I do that too. I am there for them. Support them in any and every way that I can. We don't bring donation up again. In fact, I have NOTHING to do with donation. That is handled by someone else. I am there for the pt, not organ donation. I sit with the family, if that's what they want. Give them as much time as needed.

And that make ME happy that I did something good in this world...by supporting a family through that difficult time.

jnrsmommy · Jul 16, 2009

I used to think I would, but ever since I was permanently banned from donating blood (which I used to do on a regular basis) for having lived in Germany in the early 80's (supposedly a risk for Mad Cow Disease - wow, very likely, especially since I'm a vegetarian!) I don't think I will. They probably wouldn't even want me to, I surmise. After all, who would risk getting a heart and Mad Cow Disease as a bonus? :icon_roll
DeLana

I have been listed as an organ donor on my drivers license since I was 15, I'm registered w/ the Bone Marrow Registry, and until early 2000 gave blood regularly. That's when I was informed about not being able to donate blood due to having lived in Germany in the late 70s early 80s as well. I never thought about how/if that would affect organ donation. Gonna do some research on that now.

*Just got off the phone w/ someone at LifeSource (a real person, not a bunch of automated voices and choices), and was told that having lived in Germany does not exclude one from donation. Does make you a "high risk" donor, but that the information is relayed to the potential recipient, then they can choose if they still want to receive the organ. Although, makes me wonder, if they say no, does that lower them on the waiting list.

allnurses Guide · Jul 16, 2009

No - people on the main transplant list are not dropped because they refuse an at-risk organ. That is their right. They get a certain amount of "1A" days where they can be elevated to the top of the list. They only get dropped down the list if something happens clinically, or they go out of town etc.

They do sometimes have marginal candidates on an "alternate" list who agree to accept less satisfactory/at risk organs etc. For example, someone with Hep C who needs a heart may agree to accept a Hep C organ.

The person who said I don't need to understand the rationale of people refusing donation - I beg to differ. The first step of any process is assessment and understanding the rationale... how will we ever increase organ donor rates if we do not understand why people refuse to consider it?

If someone is well-informed and chooses not to donate, then that's fine. But if they are refusing out of ignorance of the facts, I don't think it's pushy or unreasonable to set them straight. Changing their mind is not my goal; facilitating an informed decision is.

Otessa, BSN, RN · Jul 17, 2009

Yes, I am designated an organ donor and my family is aware of this wish.

I would donate the organs of loved ones-we have talked about this and have noted this properly.

I think it is a personal decision.

psychonaut · Jul 17, 2009

[snip] People who say that they'll never donate, but would consider accepting donations are selfish hypocrites.

Yes and yes.

And were I ever in that situation, in the aftermath I'm sure I would feel that I owed an incredible debt that I could never repay. That would make me feel most like a hypocrite, that I would have accepted this boon and could make no repayment in return.

I will add that were I utterly alone then I would absolutely be an organ donor. I see this analogous to the wealthy recluse who leaves their estate to charity. However, as long as I have loved ones to support, it is my duty (even in death) to do so to the very best of my ability.

I fully understand the bewilderment (and disdain) of those who favor organ donation to the dissenting voices offered here and in your day-to-day practice.

allnurses Guide · Jul 17, 2009

I will add that were I utterly alone then I would absolutely be an organ donor. I see this analogous to the wealthy recluse who leaves their estate to charity. However, as long as I have loved ones to support, it is my duty (even in death) to do so to the very best of my ability.

What I don't understand about this - you don't get paid to NOT donate, so how is not getting paid TO donate any different for the family left behind... know what I mean? It's not like you'd be missing out on any money for them by donating. I think I'd consider it a gift richer than money to my family if I ever donated that they would always have that consolation that my death was not in vain.

BTW - I don't know that everyone understand how rare it is to be in a position to donate organs. You really have to have a "perfect storm" of conditions to be eligible to donate - injuries that are not consistent with life, but have not significantly damaged the organs you're talking about. Being listed as an organ donor doesn't mean you'll necessarily be in that position.

I do not have "disdain" for people who do not want to donate for any reason. I think I am passionate about it because I work everyday with both candidates and recipients. After caring for children from 10 weeks old to teenage who were able to have a new, healthy life after receiving an organ - it just seems like magic.

NurseKitten, MSN, RN · Jul 17, 2009

I am absolutely a donor, and my family, every other nurse in the neuro/trauma ICU (my place of employment) and the three organ procurement coordinators in our area know it.

Sooooo many misconceptions here, and although most have been addressed, my OCD won't let me leave it alone! LOL!

We are not allowed to initiate OPO contact until the GCS has reached 4 (?). Same criteria applies for EMS transport into the ER - I work there, too. If they are in the unit for another case, and I know a certain case is heading south, quick, I have been known to give them a "heads up" so they can plan their staffing, but that's because I know them as people, and know they would never do anything disrespectful. They do not review records or any kind of patient data until the GCS is 4, though.

Our OPO is very respectful. We can't mention donation to the families...and if they bring it up to us, we have been CAREFULLY schooled on what to say, "I understand you have questions, but I'm not the best person to answer them. Why don't I call someone to come talk with you who can answer all your questions completely?"

At that point, if they still want to talk to someone, we can call OPO, and they'll come talk with them, but if the patient does NOT meet criteria, all they do is answer questions, with the very clearly understood caveat that all this is non-applicable currently, and it's only a question and answer session.

These are not organization or facility-specific guidelines. These are federal UNOS guidelines, and if the OPO's and hospitals want to continue to recieve federal money, they will follow them to the letter. Period. The End. UNOS does not play about this - there was an OPO that got shut down for not following them last year.

As someone already mentioned, it is almost a 2-day process, after pronouncement. In my state, there has to be either a negative radionucleotide flow study or two attending physician's clinical exams, 24-hours apart, and one of them must be either a neurologist, neurosurgeon or trauma surgeon.

There is no "we don't take as good care of you if you're an organ donor". That's crap. We go balls to the wall until we see Beck's Triad - seen too many come back from the brink not to give them every chance possible.

As for DCD, the last one I participated in, the young man was horrifically brain injured, but the stem was intact. He would never know who he was, who anyone was, or have any kind of quality of life again. His cerebral cortex and much of upper cerebellum was mush. It was awful.

His mother, God bless her, knew he wouldn't have wanted to be like that. He had been my patient for 3 days, trying everything we knew to improve his situation, but after we saw that MRI, we knew it was not gonna happen. She consented, we took him to the OR, the trauma surgeon extubated, we gave a little morphine (4 mg, hardly a lethal dose) and the OPO coordinator leaned down, and started softly talking to him...telling him how much his mother and girlfriend loved him...telling him it was OK to let go...assuring him his loved ones would be OK...then she softly sang to him, stroking his forehead the whole time. It was the sweetest, most tender thing I have ever seen, and I have tears in my eyes now, just like I did then. He died peacefully within 10 minutes.

The transplant surgeons were not in the room until a full 5 minutes after asystole. They were VERY conscious of this, and the trauma surgeon was the one who pronounced him.

Nobody did a damn thing to hasten this poor boy's death. Those who talk about doing that with a "wink and a nod" should be flogged.

I encourage those who have "heard" things about organ donation to educate yourself. Ask to shadow an OPO coordinator for a day. Most of them would love it.

It remains a personal choice, though, and I do fully respect those who choose not to. I may not understand it, but it is my professional duty to respect their wishes.