organ donation

PageRespiratory! · May 28, 2008

Is an organ harvest performed on a live Pt? I've observed a few and the Pt's weren't brought to the OR until they expired.

PageRespiratory! · May 28, 2008

BTW - I'm not a CRNA.

allnurses Guide · May 28, 2008

I asked this question to my sister-in-law who is a SRNA but I just wanted to get the opinions of some CRNAs. I recently observed an organ procurement in my OR rotation. I was a little shocked by the fact that the donor did not receive any anesthesia what-so-ever. I know that she was brain dead, and that was the reason for not giving any anesthesia but I thought to myself, " how does anyone know that this woman can't feel this?" My sis-in-law stated that there are ways to tell if a person is able to "feel" or know they are experiencing pain. I was wondering if someone could explain this to me a little bit. She said that the person's BP and HR would skyrocket but I was thinking that if they are brain dead, maybe those funtions wouldn't work right. My husband and I are organ donors and nothing would change that, but we have children who, until I saw that surgery, we had decided to donate their organs if something ever happened to them. Now we're not so sure. Can anyone help me understand this a little better?

Basically, if the brain is dead then the cerebral cortex is not processing information and there is no pain. There can still be spinal reflexes, but true pain would be contraindicated/impossible in brain death. http://en.wikipedia.org/wiki/Spinothalamic_tract This is very brief summary of pain perception concerning the spinothalamic tract and here is in depth explanation of pain perception. http://meagherlab.tamu.edu/M-Meagher/%20Health%20Psyc%20630/Readings%20630/Pain%20mech%20read/pain.ppt We spent two semesters discussing pain in neuroscience. It takes a lot of background just to get a moderate level of understanding of pain perception/transmission.

I hope this helps..maybe someone else can explain it better.

core0 · May 28, 2008

I asked this question to my sister-in-law who is a SRNA but I just wanted to get the opinions of some CRNAs. I recently observed an organ procurement in my OR rotation. I was a little shocked by the fact that the donor did not receive any anesthesia what-so-ever. I know that she was brain dead, and that was the reason for not giving any anesthesia but I thought to myself, " how does anyone know that this woman can't feel this?" My sis-in-law stated that there are ways to tell if a person is able to "feel" or know they are experiencing pain. I was wondering if someone could explain this to me a little bit. She said that the person's BP and HR would skyrocket but I was thinking that if they are brain dead, maybe those funtions wouldn't work right. My husband and I are organ donors and nothing would change that, but we have children who, until I saw that surgery, we had decided to donate their organs if something ever happened to them. Now we're not so sure. Can anyone help me understand this a little better?

Not a CRNA but as someone who does the other end of things on a regular basis I can give you some answers.

I have a hard time believing the patient was given no anesthesia. Usually anesthesia uses some opiods or propofol as there can still be sympathetic pain responses even in patients without higher brain function. A paralytic is pretty much obligatory in any abdominal surgery to be able to get exposure. They may not be getting inhaled agents but the patients are still getting anesthesia.

The role of anesthesia is critical in organ procurement (harvest is generally not used anymore). The patients are often wildly unstable and the ability of anesthesia to maintain blood pressure and perfuse the organs is key. Usually once we cross clamp they shut everything down and leave.

There is a pretty good thread here:

https://allnurses.com/forums/f16/organ-harvesting-anesthesia-258257.html

The post on the second page by nitecap describes things pretty well.

To Pagerespiratory: There are three types of organ procurement done in the US. The deceased donor protocol is used most often. In this case the donor has been declared brain dead by protocol and is brought to the OR for procurement.

The second is DCD or donation after cardiac death (also called non-heart beating donation). In this case a donor who continues to have some brain function but has sustained a non-survivable event and whose continued care is futile then consideration is given if it is in the patients best interests to withdraw care. Only after this has been determined (in the absence of discussion of organ donation) can the family be approached about donation. If the family agrees the patient is taken to the OR and supportive measures are withdrawn. Comfort measures are still in place. The procurement team can have no direction over withdrawing measures (its a little more complicated than this but thats the basics). If the patient arrests within a set time period then the patient is rapidly cooled and perfused with preservative fluid. The team then procures the organs. If the patient does not arrest during the set time period they are usually taken back to the ICU and given comfort measures.

The third type is living donation and anesthesia is usually there for the whole case or it gets kind of messy:cool:.

To the OP: The protocols are set up to ensure that the donor does not suffer. Last year there were 21,000 families that made a difficult decision to donate. However there are still 98,000 patients on the waiting list.

David Carpenter, PA-C

stanman1968 · May 29, 2008

As a CRNA who has provided anesthesia for organ procurement, I can tell you anesthesia is often used for the reasons posted above, as for pain there usually is some physiologic response to pain (catecholamine release inflammatory mediators etc) that can cause damage to organs before procurement, but there is no AWARENESS of pain. At least none we can detect.

RRTNeuroRN · May 29, 2008

David,

I am an Neuro ICU nurse and deal with brain death and organ donation on a daily basis and you have given one of the best explanations I have ever read.

June,

Each hospital has there own protocol used to determine brain death. Many steps are taken to insure that there is no mistake in pronouncent of the patient. At my hospital we have to do two bedside exams by two separate physicians and a cerebral blood flow study. No blood flow to the brain equals brain death. We are certain the patient cannot "feel" pain because in order to feel and be aware you are feeling, the brain has to be alive and has to have blood flow. As others have stated you will sometimes have a sympathetic pain response which in no way indicates that the paitent can "feel", it is just a sympathetic response. Sometimes the patient will also have spinal reflexes present. Meaning that the patient can sit up in bed or twitch a leg or an arm. It is very disconcerting to see this!!!! I remember being a new nurse and having a patient who was pronounced earlier that day (we were waiting on the family to say their goodbyes), and while I was fixing the sheets to make the patient presentable I noticed his foot jerk...of course I was terrified and had to have the more seasoned nurses explain what was happening!!! That being said please know that you are doing a wonderful thing planning to donate your organs. We had three brain deaths this week already and one family donated and the other two did not. This is a very personal decision and I am in no way saying if you don't donate it is wrong, but what a wonderful feeling it is when a family gives the ultimate gift of life from thier loved one!!! I have also spoken with families of some of our donors and later on they have all said that it gives them some comfort to know that they stopped another family from feeling the pain that they themselves felt. I have never had one family tell me they regretted donation, but I have had some say they wish they had.

allnurses Guide · May 29, 2008

Also not a CRNA, but speaking as someone who takes care of pre-transplant patients, I would urge you to find out more from your local organ donation agency and/or your transplant coordinator at work. I have taken care of a 10yo little girl who died while waiting almost a year for a heart, and it's just heartbreaking.

Your children won't need their organs anymore if (god forbid) something happens to them. Lots of other little kids will.

bishmilla · Jun 8, 2008

I asked this question to my sister-in-law who is a SRNA but I just wanted to get the opinions of some CRNAs. I recently observed an organ procurement in my OR rotation. I was a little shocked by the fact that the donor did not receive any anesthesia what-so-ever. I know that she was brain dead, and that was the reason for not giving any anesthesia but I thought to myself, " how does anyone know that this woman can\'t feel this?" My sis-in-law stated that there are ways to tell if a person is able to "feel" or know they are experiencing pain. I was wondering if someone could explain this to me a little bit. She said that the person\'s BP and HR would skyrocket but I was thinking that if they are brain dead, maybe those funtions wouldn\'t work right. My husband and I are organ donors and nothing would change that, but we have children who, until I saw that surgery, we had decided to donate their organs if something ever happened to them. Now we\'re not so sure. Can anyone help me understand this a little better?

They are BRAIN DEAD.... that means DEAD. There is NO RELIABLE way of knowing if someone is aware of surgery in a non-dead patient...BIS..EEG.. etc. ( OK maybe burst suppression) But with burst suppression you are creating brain death of all practical purposes. Think about it,, you are worried this person could be AWARE of the organ harvest .. BUT are not concerned that they are removing organs from a sentient being and the moral and ethical implications of that?

allnurses Guide · Jun 8, 2008

They are BRAIN DEAD.... that means DEAD. There is NO RELIABLE way of knowing if someone is aware of surgery in a non-dead patient...BIS..EEG.. etc. ( OK maybe burst suppression) But with burst suppression you are creating brain death of all practical purposes. Think about it,, you are worried this person could be AWARE of the organ harvest .. BUT are not concerned that they are removing organs from a sentient being and the moral and ethical implications of that?

I think the OP has already stated they don't have any moral/ethical dilemmas with organ donation. The OP was just worried that somehow even though the patient is brain dead that they could feel pain. As the other posters have already posted there cannot be pain in a brain dead person, but anesthetic is still used to blunt spinal reflexes.

bishmilla · Jun 8, 2008

So I am guessing this would not be a good time to bring up and discuss something called NON BRAIN DEATH ORGAN DONATION..

allnurses Guide · Jun 8, 2008

So I am guessing this would not be a good time to bring up and discuss something called NON BRAIN DEATH ORGAN DONATION..

Cool...I like to hear about that! That is something I haven't heard of...at least not in this country.