Depression amoung OR nurses after organ harvesting

redding6 · Mar 13, 2005

Ugh! Up until one time in my nursing career, I would have had a hard time believing what you wrote except I too witnessed what I thought was a horrific practice of piling dead bodies in two and occasionally three layers deep, in the morgue, because the county could not accept anymore "John Doe's". Fortunately, it is the exception instead of the rule (as far as I know). I was a young thing working in the ER at Parkland Hospital in Dallas back in the 80's and one of my jobs as an aide was to transport bodies from the ER to the morgue, we ALWAYS put them in thier own space, whether it be a drawer/bin, or in a large walk-in cooler. But years later, at a hospital in Washington DC, I was initiated to the practice of piling bodies in the morgue. Words cannot describe the horror of what I thought was unthinkable, how undignified! Now I hear it is not so very rare, although not very common either to double duty the cadavers. Oh well, lets take care of the living as best we can.

redding6

years ago I helped harvest eyes for the corneas. This was actually done in the morgue, while another autopsy was going on. I was 23 at the time (now 41) and the experience at the time was not so terrible as the experience I had at home that night. The bodies were set up so that my patient (a dad of one of my friends) was at a T to the other body. In other words, behind my back, the autopsy patient was cross wise to me, and laid open pretty good. I was pregnant and had little to no room to move between the instruments and the ophthalmologist at the head of the bed. Anyway, that night I had HORRIBLE dreams about bodies cut up in my house-really wierd and frightening.

jnette, ASN, EMT-I · Mar 13, 2005

Dear Kathy,
we do 'brain death' harvesting in the twilight zone of the wee small hours with surgeons who swoop in from their various specialties in different institutions in the nearby major city and depart clutching their booty (We are a major regional center on the main highway about two hours away) Besides the fact that harvesting takes up the emergency theatre, with the likelyhood of on call staff get dragged in - leaving holes in the following shifts - and you know you're entrusting precious organs to an ice bucket on a notorious freeway, I, as scrub RN, was 'priveleged' to witness the liver dr fighting with the cardiac drs over clamping times and seniorority, not unlike vultures fighting over carrion. Scissors were waved, voices were raised, people stormed out and back, all while I thought it probably inappropriate to call them to order, although if it happened again I probably would. All I did was report to my nurse manager, as did my scout, and we got debriefed by the transplant co ordinator strssing the wonderful nature of the gift of donation etc etc... After the bunfight departed (and continued elsewhere) I was left with the gutted carcass of someone's 30 year old daughter who had gone to sleep one night and never woken up (?cerebral bleed I recall). I've done harvesting previously prior to brain death legislation when the race was on to get the kidneys ASAP, and saw the skin incisions made as the ECG began to waver, I must have been younger and more resilient. I know I won't be leaving my body to the contemptuous ministrations of disrespectful and ungrateful people.

Interesting take on this.. it does evoke some questionable emotions.

While my several of my patients in dialysis have been grateful recipients, I have always focused on the apprecaitive faces as they return and express their gratitude and joy at no longer having to return to dialysis... but have never really faced the realities of the "other side" as described above.

While I do wish the donors.. real people with real families who love and cherish them..could/would be treated with more dignity and respect during the procurement (and yes, I understand that they are dead.. yet STILL, a bit of dignity would be welcomed)... I also understand that time is of the essence, and that time does not allow for making pretty incisions in these cases. Time is of utmost importance to salvage these precious, lifegiving organs.. so that another might LIVE.

While I have never worked OR, I understand that squabbling and angry, vocal surgeons behave this way whether the patient is alive and recoverable or not.

Either way, such behavior is distasteful, IMO.

So yes.. many questions, many feelings (some troubling) on this subject.. but this is the first time I have read anything in more depth on this, and I appreciate the many points of view, and thank you all for this thread.

studentNY · Mar 25, 2005

My father felt very strongly about wanting to be a donor. At 63 he had a major CVA. I don't think people realize how hard it is to say goodbye when machines are still going beep, beep, beep. We have received letters about people who received organs. It's hard.

lifeLONGstudent · Apr 6, 2005

"procurement is over and anesthesia has long since left the room. It is very quiet in the ORs"

What does anesthesia do during a harvest? Sorry to sound niave, but if the patient is clinically 'dead', why is aesthesia necessary? Perfusion issues? Also, what is the usualy time frame from opening incision to organs leaving the room?

smarkley · Apr 7, 2005

It is very important to make sure the blood pressure stays stable and the heart is stable so the organs will still be viable. They also monitor urine output to make sure the kidneys haven't shut down. If the patient's organs start to fail, they can't be used in another person. Many times there are a lot of med drips to keep the BP and heart rate stable, so they monitor those as well. As soon as the heart has been flushed with cardioplegia and the other organs flushed, the anesthesia machine can be turned off...I also (if I remember correctly) think that they make sure the lungs are up before they shut the machine off...I know they were up when I packed them.

The time for each donor case varies, depending on what organs they are taking. I have seen some that have only taken a couple of hours start to finish and others that have been much longer. Hope this helps!

lifeLONGstudent · Apr 7, 2005

Hope this helps

yes it does! thanks. Sorry if my ? seems a little basic - I am starting my second career and nursing school starts next month. I appreciate you taking time to reply.

lifeLONGstudent

HeatherB,CST · Jun 26, 2007

Ok, this is a resurrecion of an old thread, but I thought it was fascinating and important to think about for any of us who work (or want to work) in organ procurement or transplant surgery. The OP had asked about depression following a harvest procedure. I wanted to paraphrase something someone (on another forum site) wrote about the experience.

He/she mentioned that after a "typical" surgery, there is usually a good outcome, the pt is closed neatly and looks like a normal person, healthy once again. Seeing that is where the reward lies. With a procurment, at the end there is the closing of an empty body...and it just feels WRONG to close an empty body cavity. That must be a very eerie unnatural feeling.

I could easily see a depression creeping in after an experience like that.

GadgetRN71, ASN, RN · Jun 27, 2007

I have not had to be in the room yet for an organ harvesting, but I'm wondering how to get through it. My aunt, who was like a second mother to me ,died at 57 of a massive brain bleed-we as a family made the decision to donate her organs(both kidneys and liver). I thought I was doing fine until we had an inservice one day from the organ bank and I had to leave because it was too much..I think the point where they turn the anesthesia machines off would be very difficult. Granted, I would do what I had to do as part of my job, but I could see myself getting depressed, at least for a while.

GadgetRN71, ASN, RN · Jun 27, 2007

My father felt very strongly about wanting to be a donor. At 63 he had a major CVA. I don't think people realize how hard it is to say goodbye when machines are still going beep, beep, beep. We have received letters about people who received organs. It's hard.

Hun, I know where you are coming from, and it is very hard..When my aunt was dying, I stayed at the hospital one night, because I know it was something she would have done for a loved one. The next morning, one of the residents on rounds saw me, and said "Um, she knows that she's brain dead, right?" What a jerk!! These patients(donors) are someone's loved one and are deserving of respect and dignity, even after they have passed. We also got letters from recipients and while it was good to know that she had helped those people, it was too hard to write them back..

heartICU · Jun 27, 2007

I think the point where they turn the anesthesia machines off would be very difficult.

It is difficult. I have not been practicing anesthesia for long, but I have done two - a two-year-old while I was a student, and a patient in their mid-thirties. Let me tell you, it is a hard thing to turn off the ventilator, turn off the monitoring equipment, and walk out. But when I thought of the overall picture, and how those organs were helping other patients, it did help. It's an odd feeling, more than anything.

akor · Jun 28, 2007

At my facility, we recently met with the organ procurement manager to go over the new paper work to be filled out and faxed back to them at the end of the procedure. However, a nurse brought up the difficulty of being in the room cleaning the corpse after the procedure....The manager rplied that they are working on getting a psychologist to be available to be able to go and talk to if needed.

I have been in on an organ harvesting case in the different stages....only once did I clean up the patient and it was o.k. because it happened during the evening when there was help. I think it must be harder at night when you are tired and all the caos is over. I think the more organs gone...the harder as well....we harvest bone as well ....it must be hard to see the corpse in that condition.....

elcue · Jun 29, 2007

i'm sorry these are so difficult for you. doing them in the middle of the night sure doesn't help.

i've participated in numerous procurements - also in transplants, and in pre- and post-op care of transplant recipients way back to the late 1970s.

yes, the procurement procedure is quite chaotic. but i actually like caring for these patients (except when the donor is a child, which is heartbreaking). i have been a strong proponent of transplants for years, carrying my own donor card since the '70s.

i don't struggle with depression afterwards. i think it is all just such a tremendous act of generosity on the part of the donor and their family. the family takes comfort in helping their loved one leave such a gallant legacy.

this may seem odd to some, but i actually quite like providing the aftercare of the donor patient. i like the quiet of the room, and the chance to be the last nurse who has the opportunity to care for this person who has given so much.

it's also a satisfying form of closure to receive followup from the organ bank nurses who always write us later to tell us a little about each of the recipients of our patient's generosity.

last week a framed photo showed up in our lounge - i swear this is true. a middle aged woman was standing with her ear to the chest of a healthy-looking young man. she was listening to her deceased son's heart beat in the young man. omg!!! there wasn't a dry eye in the place. i'll never forget that image.

try not to focus on the selfish, arrogant docs, but on the patients and families involved and you may find these procedures less stressful. maybe even somewhat satisfying.

good luck,

linda