I'm talking about care prior to death. There are rules about this but...
Curious about what you mean by this. I'm asking from the viewpoint of having taken care of many "donor patients".
I'm an organ donor, but in all honesty the way my state handles donation bugs the **** out of me. We're supposed to call them even before addressing the issue with the family - I believe they are way too aggressive in their practices for how sensitive an issue it may be.
drizzt3117 may be encountering a similar issue.
eldoctor and others - I think you're barking up the entirely wrong tree with the issue of physicians "trying hard." There is much more to it than what you realize.
You need to get the donor network on the case as soon as you think you have a candidate. They can review history, assess for appropriateness, discuss issues with the healthcare team etc, before the family is even approached. The usual scenario in these cases is that the family has a conference with the healthcare team early on and discuss the prognosis and when appropriate bring up that donation may be an option and that we are available to answer questions should they have any. In the cases of beating heart donors, as the neurologic assessment declines and the patient heads toward brain death, the family is kept informed and updated about how things are going. Often soon before and certainly after brain death ensues, hemodynamic lability will require aggressive management and at that point if the family desires, all interventions can be discontinued, or we can stabilize the patient until brain death is officially diagnosed and at that point the family has to decide to either allow us to maintain their loved ones physiologic functioning for the purpose of saving the organs to be allocated or removing the machines. That's it in a nutshell. I can go into more specifics if you like. At any rate, getting the donor network on board ASAP is key. Their staff is also particularly skilled in handling these sensitive situations. And just about every situation is sensitive.
I can't speak for drizz - I'm throwing out an idea based on my opinion on the issue that may coincide with his (but obviously I have no idea).
To expand on my opinion - I don't think I've met a physician in my hospital that wouldn't bust their ass for each and every patient, including those that likely have no chance of survival. It has absolutely nothing to do with whether or not a physician will decide to "stop trying" with a given patient. The issue arises with the organization responsible for handling organ donation in my state - they are aggressive in how they operate such that I think it is borderline inappropriate.
Please elaborate what you consider inappropriate. It's not an issue of the physician "busting ass"? at all. You cannot reverse brain death, and managing rising ICP and preventing herniation is still quite limited. Neuro patients with high ICPs are monitored and managed aggressively from a neuro standpoint and especially so from a cardiopulmonary, renal standpoint since either way in order to hope for survival or optimal organ candidacy, you must maintain physiologic function. There actually is no conflict of interest in that regard whatsoever.
I think there's a couple issues. I don't like the interaction between the transplant team and the care team, I don't like how care centers do very little due diligence as to the source organs (there's a big article about organ purchasing and how the transplants are done at centers like Sinai and Penn) I don't like how it might affect some medical decisions (either consciously or unconsciously) I don't like how the lists are handled. Anyone who has taken care of chronic/terminal patients know that provider attitudes arent always as nice as you think.
I agree, provider attitudes can be quite cynical. However, and I can only speak for my hospital and CTDN (our network organization)- we have a great working relationship. As for the source of organs, yes, there are some donors that have HCV, for instance, and they still may be eligible to donate for certain populations of recipients. I'm not sure if that is what you were referring to or there is something else. As far as list handling, I have no idea how that goes. My hospital provides a lot of donors and the surgeries are done here to recover the organs, but we do not do transplants here.
If you are a organ donor, physicians will be looking forward to your death to save bunch of others. I just find it creepy.
Dr. X: Is he dead yet?
Dr. Y: Not yet
Dr. X: Damn
Absolute and complete myth. The general public is quite uneducated about organ recovery and donation.
Here is an article on that subject
www.aacn.org/WD/CETests/Media/4000-J53.pdf
he's dead serious (hahaha). honestly, this exact conversation has taken place in an OR somewhere while the harvest team waited to start their work. yes they're called "harvest teams." a little medical semantics there for ya....
much of Europe is opt-out. it's a little more communitarian over there.
Pssst.... the politically correct term is "Recovery Team". We don't use the term "harvest". And what you're referring to is donation after cardiac death (and I've taken care of one patient who became a donor in this manner. He had so many skull fractures that his brain became incredibly edematous, however because his "box" was so open, the pressure never became great enough to progress to true brain death.... anyways....), and that is a whole different can of worms. The recovery team must wait for
cessation of cardiac and respiratory activity in order to proceed. However, the longer that process takes, the less likely you will be able to successfully recover healthy, suitable for donation organs because if a person dies slowly, those organs go for a longer time without receiving optimal perfusion. It sounds morbid, but if you understand that the hope for going through this and the family going through this is to give another person a second chance at a better life, than you want things to proceed in the best manner possible.
