Friday, October 08, 2004

The Perils of Organ Donation

As a nurse, working primarily in pediatric ICU, I witnessed many wonderful kids' lives changed by organ donation. Seeing what good could come from such a simple act made me change my belief system (the one I'd grown up with) about organ donation and I have since signed the back of my driver's license. My family, while not agreeing with me, has assured me they will respect my wishes and donate my organs on the event of my death, if appropriate.

I was reading a recent article in the Rocky Mountain News, however, that has made me wonder a bit about the wisdom of donating my organs. The article said a young man (31yo) attempted to commit suicide by shooting himself in the head. Two hospitals declared him brain dead prior to harvesting his organs. Unfortunately, the coroner has since ruled the man didn't fit the qualifications for brain death! Consequently, he has ruled the man's death a homicide. The criteria for brain death are usually very simple; two consecutive brain scans (usually 24 hours apart) showing absence of brain waves (although the criteria can be different from state to state). The brain scans are only done when the patient has no evidence of brain function (i.e., is unable to breath on his own, is comatose and unresponsive to deep painful stimuli).

What shook me up about this was the memories it brought back of comatose patients I'd cared for; ones I'd felt the need to protect from hovering transplant surgeons. Unfortunately, these patients weren't rare, at least in my experience, nor was the aggressiveness of the transplant surgeons rare. Sad to say, there were multiple times when I would have to remind a transplant doc that the patient he was questioning me about (usually a child in a persistent vegetative or comatose state whose parents weren't deeply involved in their care) was not his patient. This meant he had no right to be perusing the patients chart, nor did he have the right to be asking me, day after day, whether I'd spoken the the parent's about organ donation and what their response was. While I could understand why these docs felt the need to be so aggressive (oftentimes they'd developed strong relationships with their patients who needed organs), but I couldn't help but feel sickened at how they went about seeking organs! So many times, families of patients with significant head injuries were newly grasping the probability that their child wouldn't survived and were grieving over this. To have an unknown physician come into this environment and start pushing the idea of organ donation was, to say the least, painful. Oftentimes parents approached in this manner began to ask if we'd given up on their child; were we only concerned about this other child who could be saved with an organ donation?

I can't tell you the sadness (and, yes, anger) I felt in these situations. I wanted so desperately to help these kids and their families, and sometimes it would take weeks to gain their trust so they could make a suitable decision regarding their child's care/life. To have a transplant doctor come in and try to force them to make a decision when they weren't ready was infuriating, to say the least. That's why I had no fear in telling these doctors off (i.e., that they were acting inappropriately and had no right being at the child's bedside or reading his chart, let alone trying to speak with the family about organ donation)!

Don't get me wrong, though, organ donation is generally a wonderful thing! One of the joys of my life is to hear a little boy I took care of as a newborn following a heart transplant speak on the radio about how his life was impacted by his new heart. To know he is almost a teenager and is well and happy is just fantastic! I'm so thankful for the opportunity of caring for him and his family. I'm not saying I've changed my mind about donating (this is especially important for those of you family members reading this posting)! I guess I'm saying I can understand how such a serious mistake could happen and I pray it doesn't ever happen to me. Regardless, it would still be worth it; to give my life so someone else can live.

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