Read on Twitter
Ok for the 24 people who said yes, here is my first Tweetorial. It won't be nearly as brilliant as @tony_breu but I'll try. It's about a subject near and dear to me: Organ Donation in the United States.
For 7 years I was a Procurement Transplant Coordinator (PTC) for an Organ Procurement Organization (OPO). One of 58 such designated to obtain organs for transplant. This is my personal experience. It's a glimpse into what a PTC does and how organs get from donor to recipient
If this doesn't sound like your particular cup of tacrolimus feel free to move on. Otherwise come with me. I may or may not add personal feelings. I haven't decided yet. Let's see!
Organ donation happens in 3 ways in the US. Deceased donors and living donors. OPO's are in charge of the deceased and transplant centers handle the living donors. Deceased donors can be either brain dead donors, or donors after cardiac death (DCD)
OPO's have a particular service area. They partner with hospitals in their service area to call when a patient meets a certain set of criteria. Usually in the setting of impending brain death or if a family is withdrawing care (DCD)
Ok first brain death. It is a valid form of declaring death. According to law it is the irreversible cessation of brain and brain stem function. Hospitals must have protocol in place for declaration but it usually includes a clinical exam and
test like a nuclear med study to determine if all blood flow has stopped to the brain. During the whole process an OPO's Family Services member has been working with hospital staff (RN's, MD/DO, Chaplains) to determine when to approach the family after the pt is declared dead
Ethically the approach should happen after death. Sometimes the family doesn't know their loved one's wishes as far as donation. If the donor is on a registry in a state where that's considered an advanced directive it's presented to the family as
one less end of life decision to make. Every conversation is undertaken with the utmost compassion and respect for the family who's just lost someone. Consent is not required for registered donors and we work with families if they have questions or are unsure.
If the person is not registered then consent is obtained.
This is where I come in. And donor management can begin
This is where I come in. And donor management can begin
As it turns out, your brain is really important! The hundreds of autonomic processes we don't think about come right to the forefront when the brain has died. The donor is intubated and requires ventilator management
They usually need vasopressor support since the vasomotor center is gone. The need labs and fluids and electrolytes. We try our best to maintain homeostasis and optimize organ function. OPO's all have different management protocols.
It is mostly art. There is very little science to it. There is a lot of what I like to call "voodoo". As in, let's infuse some shit and hope it works. We had a cocktail that we thought would help with stabilization. Pushes of dextrose, insulin, thyroxine, and DDAVP
During the juggling act of keeping the organs happy, blood is sent for ABO and for HIV/HCV/HBV/Syphilis testing. Blood is also sent for Human Leukocyte Antigen (HLA) testing. ABO and HLA are extremely important for matching organs to the recipients
Transplant immunology is endlessly fascinating. Similar to blood donation, A can go to A or AB, B to B or AB, O to all, but O and AB recipients can only accept an O or AB organ. Rh is curiously unimportant in transplant.
There are lots of HLAs but only 3 are important for transplant: A, B, and DR. The fewer mismatches between donor and recipient, the lower the chances of rejection and graft vs host disease.
Blood type, HLA, labs, donor exam and history are all uploaded to the United Network for Organ Sharing (UNOS) website to generate a recipient list for each organ we are looking to recover (recover, NOT HARVEST). Offers are made electronically to transplant centers from top down
Once each organ has been accepted, a time for surgical recovery can be decided on. This is an undertaking in itself. Since each surgical team wants what time is best for them and sometimes the children don't play nicely together.
TO THE OR! Each organ is carefully dissected down until they're ready to come out. The aorta is cannulated and cross clamped at the diaphragm. Blood is removed and replaced with cold preservation solution. Organs are packaged or placed on perfusion pumps.
The huge midline incision is closed and the donor is taken to the morgue. The family is notified after and informed of which organs were recovered. The whole process from declaration to end of recovery usually takes about 16-24 hours.
This is a simplified explanation and I can assure you the experience is much more exciting and exhausting. I haven't discussed a few things. If there is interest I will do threads about DCD (which I hate) or how the recipient lists work.
I welcome all questions and personal experiences! If you're reading this, thanks for sticking with this thread.
