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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on February 26, 2011, 10:49:24 AM
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Dark Angels: The Silent Lives of Transplant Coordinators
Posted February 26, 2011 16:34:00
Andrea S. Pineda
Philippine Daily Inquirer
IN the world of organ retrievals, they are called dark angels.
On call 24/7, the work of transplant coordinators (TCs) has long been associated with cadavers, human organs, and of course, death. Their job is crucial in the harvest of healthy organs from deceased donors for patients waiting for a new heart, kidney, a liver: a second life.
One potential multi-organ donor or PMOD can save at least seven lives. And that may be the greatest miracle wrought by the donors’ families who have said yes to giving the ultimate gift of life.
People involved in the Organ Procurement Organizations (OPOs) say the most challenging part is convincing the grieving family of brain dead patients to give away their organs without any condition. It is a job solely assigned to a transplant coordinator – a task they stress is as crucial as the transplant operation itself.
A few moments after the patient has been officially declared brain dead, the TCs come in. Says Grace Suguitan, supervising transplant coordinator of HOPE or Human Organ Preservation Effort of the National Kidney and Transplant Institute: “We do understand that it is not easy for the family members to give their consent, especially when the possible deceased donor is a minor or is at the prime of his or her life at the time of the fatal accident.”
She has come to expect, and has actually encountered families who became angry or agitated during the process of getting their consent.
“Because death can come unexpectedly, TCs execute difficult steps under great time constraint and intensely emotional circumstances,” describes Don Mejia, a transplant coordinator under HOTTProg or the Human Organ and Tissues for Transplantation Program Network based at the St. Luke’s Medical Center.
Still, Don and Grace believe that it is important for all family members of the brain dead donor to understand the aspects of organ donation to make the right decision.
A fact we all need to know is that once the patient has been certified to be brain dead, it means that the brain has ceased to function, but not necessarily the other vital organs. The patient is also considered legally dead.
“It’s kind of difficult to explain to the relatives that the patient is already gone, particularly when they can still see traces and movement in the cardiac monitor,” says Czarina Sanchez-Bayani, a transplant coordinator from IPOD or Integrated Program on Organ Donation (IPOD) based at the Capitol Medical Center.
“It takes hours just obtaining the consent because we give them time to grieve and be with their loved one,” she adds.
According to Dr. Rosemarie Liquete, transplant surgeon and chief of the HOTTProg Network, it is very important that the patient still has stable vital signs to maintain organ function. This is critical in screening the organs in preparation for the retrieval surgery.
Thus, timing is very crucial. According to Dr. Liquete, “Organ retrieval should be done at the right time, the right place, and with the right people.”
Aside from being frontliners in securing donor consent, transplant coordinators are key in coordinating the team of surgeons, doctors, nurses, and a network of hospitals for a successful retrieval.
“We are on-call 24/7, so we must always be on our toes. We cannot afford to lose even a single referral,” says Czarina who, with the rest of transplant coordinators from these OPOs respond to referrals all over the country.
They even provide psychological support for the grieving families, adds Dr. Liquete. “TCs help lessen the impact of the loss of loved ones by offering them an opportunity to give the gift of life to others,” shares Dr. Rica San Diego, a Transplant Procurement Manager of the LifeShare program in Medical City.
But as in any other job, there’s not always a happy ending. There are families of donors who turn down the opportunity of donating their kins’ organs due to cultural belief, family influence, and lack of awareness. Sometimes, the organ itself becomes unsuitable due to various circumstances.
“We do feel bad when a kidney [or any organ] goes to waste, because we always exert effort whenever we have a deceased donor referral,” says Grace. She explains that a donor is properly evaluated before he is considered to be eligible. Usually, those with hepatitis, elevated creatinine levels and/or those with sepsis are medically unsuitable.
Likewise, Don feels disappointed when the organs are not medically suitable. “Much more if the relative of the patient did not consent for organ donation. However, we have to respect their decisions and their beliefs about deceased organ donation.”
This can be doubly disheartening for the expectant recipient who has spent years waiting for a new lease on life.
“Many Filipinos are still not amenable to donating the organs of their loved ones due to the cultural belief that it is not good or acceptable when a body is not complete when buried,” shares Dr. San Diego.
Aside from gypsies and the Shinto religion, most other religions, including the Roman Catholic Church support organ donation. “However, for families of Jehovah’s Witnesses, they require that organs be drained of any blood due to their interpretation of the Hebrew Bible/Christian Old Testament as prohibiting blood transfusion, Muslims meanwhile require that the donor provided written consent in advance,” she adds.
In the absence of deceased organ donors, most patients turn to living related or non-related donors as a possible source. However, in the past decade, people have discovered that they can make money out of selling their organs. Most of them are Living Non-Related organ donors who were paid around P90,000 to P150,000 or more for a single kidney.
This has fueled a big controversy in the media and the organ transplant industry. Transplant professionals such as Dr. San Diego, has been working very hard to underscore a very crucial fact: human organs are not for sale.
“All living donors need to be aware that there is no monetary reward involved when they decide to donate their organs. Otherwise, this will be considered as organ trafficking,” explains Dr. San Diego.
With the issuance of Administrative Order 124 in 2002, kidney sale has been prohibited by the Department of Health that regulates kidney transplants from living non-related donors.
Once found guilty on organ trafficking, a person may be imprisoned for as long as 20 years and be imposed of penalty of not more than P2 million.
Transplant candidates without living and related donors can register in the Transplant Waiting List of Transplant Centers for organs that will come from deceased donors.
Human organs should never be bought or sold. The act of giving away of one’s organs should be a donation solely based on altruism or giving without condition.
On the other hand, it is the responsibility of the organ recipients to pay for the medical check-up of the potential donor for living donors. These expenses include hospital stay during donation and post-operative medical check-ups. The Hospital Ethics Committee then investigates the possibility of commercialism and/or absence of altruism.
According to Grace of HOPE, families of deceased donors do not receive any monetary compensation. At most, the families of patients offer funeral assistance to them. More than money, improved awareness about the program is the key to make people welcome it.
Dr. Liquete recommends that organ donation and transplantation should be introduced early in school and promoted through tri-media. “It needs a joint effort by the Department of Health and NGOs to promote this program. There should be enough funding to do this.”
Other TCs and doctors also believe that they can get better response from families who are more aware of this option. “I have learned that the higher the educational attainment of people I talk to, the easier it is to discuss with them the idea of organ donation. Hence, it is very important that each and everyone in our country is not deprived of education, “Dr. San Diego shares.
After battling intense circumstances, fulfillment comes when they meet the recipients who can now see with new eyes or stride with a new heart, lungs, or a kidney. They are “Angels of Death” no more, but unsung heroes of those blessed with a second life.
“I’ve learned to appreciate life… even the small things around me. To be thankful for all the blessings and merely for life itself... knowing that you have helped people desperate to live a normal life,” admits Czarina.
Grace adds, “As we always say in every advocacy campaign, “Don’t take your organs to heaven. Heaven knows we need them here!” So go recycle yourself, be an organ donor.
Organs that are most needed here in the Philippines are kidneys, liver, and cornea. Anyone can be an organ donor at the time of one’s death, and they can signify their intention of becoming one by signing an organ donor card which can be obtained from the four OPOs mentioned: LifeShare (Medical City), IPOD (Capitol Medical Center), HOTTProg (St. Luke’s Medical Center) or HOPE (National Kidney and Transplant Institute).
It is also important to inform relatives about their decision. Living organ donors should undergo a complete medical screening to determine if they are eligible to donate their organ. Once they pass, they will be evaluated by an ethics committee of the hospital where the transplantation will be done. •
For further inquiries or possible referrals, you can contact these OPOs through their coordinators: Grace (HOPE): 0917-5544545; Czarina (IPOD): 4164763 / 0917-8934763; Dr. Rica San Diego (LifeShare): 470-4411; Consultation is every Mon/Wed 10 a.m.-1 p.m.; Don (HOTTProg): 0922-8372446.
http://www.inquirer.net/mindandbody/spaheaven/view.php?db=1&article=20110226-322369&pageID=6