Are we overlooking a hidden source of organs?

Nursing, Jan 2000 by Popernack, Myra L

I met his parents in the hall and tried to comfort them. Not only were they facing the loss of their child, but also the loss of any solace they might have derived from donating his organs to benefit another.

Unwilling to introduce therapies to prolong Ryan's life in a vegetative state, his family and the physician developed a new plan. We'd provide comfort measures and analgesics and let time do its work.

The next day, Ryan's body followed the spirit it had lost 10 days earlier and he died. The emotional stress had taken its toll on the family, and they chose not to donate his organs after his death.

When patient becomes donor

As advance directives become common and public awareness increases, families have become more willing to consent to heart-beating organ donation. If the topic is presented with sensitivity and compassion, NHB organ donation may soon gain the same widespread acceptance.

During this emotional time when a family is dealing with the impending death of a loved one and the possibility of organ donation, our responsibility is to support whatever decision they make. The task of approaching families to discuss organ donation should be the responsibility of the OPO personnel who've been educated in the eligibility criteria and the specific aspects of requesting consent.

Nurses, particularly those who work in acute care settings, should become familiar with the organ donation process, pertinent state laws, and hospital policy.

When cardiac or brain death is medically determined to be imminent, we must be prepared to shift our perception of patient care and advocacy from focusing on the recovery of one patient to facilitating organ procurement to benefit another.

As I can attest, an unsuccessful attempt to recover organs from an NHB donor requires compassionate care for the patient and additional emotional support for the family. They may suffer added stress and grief because of ambivalent feelings about the choice they made. They may wonder if the patient could have recovered with more time or if a miracle might have occurred. This tendency to second-guess after the event may require follow-up counseling.

The emotional impact this can have on the medical staff can't be underestimated. Despite experiences with heart-beating organ donation, I wasn't prepared for the internal conflicts I felt during this unsuccessful NHB organ donation. I was torn between my sense of patient advocacy, my responsibility to support his family in their choice, and my own ethical and moral standards.

From this experience, my respect grew for those who participate in NHB organ donation, especially the givers of the gift--4he patient and his family. I'm grateful for the generosity of Ryan's parents who tried to find some good in their tragedy and who, while grieving, still found time to thank the staff who cared for them.

Learn all the options

By sharing this clinical experience and some information on organ donation, I hope I've stimulated your curiosity about NHB organ donation. I encourage you to recognize the potential for pediatric as well as adult NHB organ donation. Because of the critical shortage of organs for children, more than half the infants and newborns awaiting transplants will die. One retrospective study done in the PICU of a children's hospital found that organ donation in their facility could have increased by 42% if organs had been recovered from NHB donors.