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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on April 23, 2010, 02:25:40 PM
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Diary of a transplant co-ordinator: 'The donor's family hug him... I'm always so humbled by this selfless act of giving'
By Jamie Borg
Last updated at 10:00 PM on 17th April 2010
The news last week of organs being taken from registered donors without full consent may well damage the reputation of the NHS Blood and Transplant service, despite its enormous efforts.
It comes at a time when donors are desperately needed: more than 10,000 people are waiting for an organ transplant in the UK, yet last year just 3,500 of these lifesaving operations were carried out - and three patients currently die every day waiting for one.
A single deceased donor can help up to nine different patients, and it is the difficult job of the transplant co-ordinators to broach the subject with soon-to-be-bereaved families.
Here, we dispel the myths of how a transplant actually takes place as seen through the eyes of one co-ordinator. In a moving diary of his shift, he gives a fascinating insight into his often harrowing yet essential work.
Life Support: Paramedics attend to a casualty. If he cannot be saved his organs may prove vital
Life Support: Paramedics attend to a casualty. If he cannot be saved his organs may prove vital
14.00: I am in the middle of lunch - the usual sandwich-at my desk - when my pager goes off. A man in his late 40s has been admitted to intensive care having suffered a massive brain haemorrhage. He was brought in by ambulance after collapsing on the street.
There was no reason for it to have happened - no fall or blow to the head. His wife had kissed him goodbye that morning before he set off to work; just another day. The next thing she knows, a nurse is calling to break the most dreadful news.
In this job, you see just how fragile life is. As a transplant co-ordinator at Guy's & St Thomas' Hospital in London, I am on call six times a month - the shift covers one 24-hour period.
I oversee the process of organ-donation from first broaching the subject with the family, and I stay by the patient's side throughout the process of surgery, until the final viewing of the body.
There are more than 170 co-ordinators in Britain and 24 covering 44 hospitals in the London area, mostly within the M25. Although I am based at Guy's I can be called to any of the hospitals. There are always two coordinators on call.
Because of the volume of work involved, each coordinator can only really handle one case at a time. Typically, overseeing a single donation from start to finish will take around 20 hours.
My girlfriend Ria, 27, whom I live with in Wanstead, East London, is an intensive-care nurse. She understands how unpredictable the hours can be, although it did take her a bit of time to get used to my night-time callouts. But that is the nature of the job - you never know when or where a potential donor might appear.
Before retraining last year and becoming a transplant coordinator I worked for around ten years as a nurse in intensive care, so I am used to the utter grief of the suddenly bereaved.
The difference is that now I spend more time with an individual family, rather than rushing between patients on a ward.
Compassionate: Jamie Borg helps families deal with their grief by offering hope to others in need
Compassionate: Jamie Borg helps families deal with their grief by offering hope to others in need
I know some may find what we do unpalatable, but it is utterly necessary, lifesaving work.
In the past year about 3,500 organ transplants were carried out, from around 980 living donors and 900 deceased donors.
There are around 17 million names on the NHS Organ Donor Register who have consented for their organs to be used for transplant after they die, yet because of strict medical criteria that must be fulfilled before organs can be used, only a tiny fraction of them ever become donors.
By contrast, 10,000 UK patients are currently in need of an organ. The majority of these are on dialysis, with severe kidney disease.
A search on the Organ Donor Register reveals the man who collapsed had signed up three years ago.
His medical records and initial tests show no other medical problems such as heart or liver disease that might exclude him from becoming a donor.
If a person is not on the register, consent can be given by the family. And legally, even if an individual is on the register, the family must also consent before we take their organs, which is where I come in.
This will possibly be the most awful moment of their lives. I will try to support them, and hopefully help them see that even though their loved one is dying, they can get something positive back by giving a terribly sick patient a lifesaving transplant.
14.45: I am at the man's bedside in intensive care. The organs of patients who have died of disease are not usually suitable for donation as there can be risk of infection to the recipient. Donors need to be otherwise healthy patients that we know are going to die.
Almost all patients who are referred to us have been in a terrible accident or suffered a brain haemorrhage. Although there is no age limit to donation, the average donor is 46.
By the time I arrive, the consultant has already explained the situation to his devastated family - a wife and two sons - with the help of brain scans that clearly showed a huge dark spot where the haemorrhage had occurred.
The first thing paramedics do in these situations is sedate the patient so they can safely insert a breathing tube into the throat.
They are kept in this anaesthetised state once in hospital so they don't move while the doctors carry out scans.
Then we remove the sedation to see if there is any improvement. Nurses look for reflexes to pain and cold. In this case, the patient remained unconscious and unresponsive.
Pressure caused by major bleeding in the brain results in catastrophic, irreversible damage. Without life-support machines to aid his breathing and stabilise his blood pressure, he will die within an hour or so.
The consultant tells the family he is unlikely to recover, and that it is in his best interests to stop treatment. This way, he will quickly and painlessly pass away.
I wait until the family understands all of this - it is important they have accepted there is no chance their loved one will recover before we start discussing the option of donation.
I have with me a printout of the patient's donor registration form for them to see.
Despite their grief, his wishes are no surprise to them and they immediately agree, asking what will happen next.
16.00: Timing is of the essence but we give families a cooling-off period of at least 30 minutes even if they say yes straight away. I once had a case of a woman in her 50s who had been in a car accident.
She was on the register and her three children had initially seemed keen about organ-donation. But after I gave them time to think, they said no.
One of the siblings had become quite angry, which is natural. In the end they decided that if they couldn't agree among themselves, it wouldn't be the right thing to do.
It isn't my place to exert any pressure, even if it goes against the wishes set out by the patient when they sign the register.
We do know from studies that of families who have said yes to donation, around 95 per cent are still happy with their decision six months later.
Of those who say no, a third of families admit that if they could go back, they would have chosen to agree to donation.
But in this case the family is still happy to go ahead, so the process of screening the patient and finding a recipient begins.
Life-saver: Guy's & St Thomas' Hospital where Jamie Borg works
Life-saver: Guy's & St Thomas' Hospital where Jamie Borg works
17.30: The family must consent to the donation of each organ separately, so I go through a list with them, explaining what kinds of patients will be helped.
Heart transplants can come only from patients who are braindead, with no activity in the part of the brain that controls most essential bodily functions, including breathing.
Their heart will continue to beat for around 72 hours with the help of lifesupport machines but they are legally dead.
These patients - we refer to them as heart-beating donors - can be kept on life support until the heart is removed, which gives it the best chance of working once transplanted.
Other patients can be breathing but the damage to the brain is so bad that they will not recover, as in this case. He will be allowed to die naturally, which means we can't take his heart but we can use the heart valves.
21.00: At least six hours of medical tests need to be carried out to find out whether a patient's organs are viable.
We also look at how well each organ is functioning, as often, past illness can leave lasting damage to a particular organ, meaning it can't be donated.
The patient's medical notes obtained from his GP reveal that he was suffering from slightly high blood pressure, but our tests show he was in otherwise perfect health.
Then there is blood and tissue-typing - which looks at the kinds of antibodies a patient has - in order to match them as closely as possible to a suitable recipient.
The closer the match, the less likelihood there is that the organ will be rejected by the recipient's body.
The NHS Blood and Transplant offices in Bristol holds lists of all patients awaiting an organ. It quickly comes back with names of patients who closely match the donor's blood and tissue type.
By working through the list, calling my recipient counterparts on various hospital wards, I find two adult patients on dialysis awaiting kidneys in South London - one kidney will go to each.
The patient's liver will go to a 32-year-old woman in Manchester, and his heart valves to a teenage boy in Sheffield.
Cells from his pancreas will go to a man in his 60s with severe diabetes, and his lungs will be donated to a 26-year-old female cystic fibrosis sufferer - both also in London.
These are the only details I am permitted to give to the family. Organ donation is unconditional - you can't specify that you don't want the liver to go to an alcoholic, for instance.
00.00: The transplant surgeons have arrived, and the patient is taken to the anaesthetic room of the operating theatre.
The patient's wife and children are with him as the life-support machines are switched off. They take it in turns to hug him as he slips away.
There are tears, and the two sons thank him for being a good dad.
I'm not the type of person who cries easily but at moments like this I feel humbled by the selfless act of giving in such a heart-rending situation.
Of course I always remain professional, as families look to us for support. But I do feel emotional. I am only human.
04.00: I am in attendance as the surgeons carry out the delicate job of removing the organs. First they open the abdomen and take the liver, kidneys and pancreas. Then the chest is opened and the lungs and heart are removed.
Tissues such as the corneas - the transparent front part of the eye that covers the iris and pupil - skin and bone marrow are last.
We know from studies that organs remain viable for transplantation for only a few hours after death, as without blood supply the cells begin to break down.
The heart must be transplanted within six hours, while the liver can last up to ten hours and the kidneys 18 hours.
Each organ is bagged in frozen profusion fluid - an icy slush rich in nutrients that keep cells in good condition, minimising any decay or damage.
This is then put in a polystyrene box and handed to specialist medical couriers.
If there is a great distance for a heart to travel, it will usually be taken by air-ambulance or we'll get it on a scheduled flight. But in most cases a car is used.
I stay with the patient the entire way through the process. The families appreciate this and I see it as my duty of care.
06.00: The surgeons have finished their work. With the theatre nurses, I carry out what we call last offices. We give him a wash and a shave before the porters take him to the mortuary, where the family will view the body. It is a final mark of respect.
I'll be home by 8am, in time for breakfast. I'll spend the day sleeping and it's back to the nine-to-five tomorrow, which involves meetings, paperwork and more paperwork.
The job is challenging, exhausting and richly rewarding. This is what I have always wanted to do. I'm 33 years old and will carry on for as long as I have the energy.
For me, the biggest satisfaction comes from knowing that out of such pain and sadness comes hope and a second chance for someone who is desperately ill.
* Some details have been changed to protect confidentiality.
Which organs can I donate?
There are 23 organs in the human body. You can donate kidneys, heart, liver, lungs, pancreas and the small bowel as well as the eye corneas, skin, bone, tendons, cartilage and heart valves.
* www.organdonation.nhs.uk
http://www.dailymail.co.uk/health/article-1266802/Diary-transplant-ordinator-The-donors-family-hug--Im-humbled-selfless-act-giving.html#
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After it was too late for me to do anything about it, this was my dream job. What irony, seeing that where I am now is wanting to get on the transplant list. thanks for posting this.