I used to be a registered donor, but dropped that after CCM fellowship. The OPO we had in that state was absolutely horrible. They'd literally hide outside the ICU and wait for the tearful family to finally agree to go comfort on their not brain dead, but severely injured family member, then pounce, tell the family to bugger off, and that since the patent is a registered donor, they now belong to them. After a few days of working them up to see if there was anything worth getting (and having us fellows do all the procedures and order everything), they'd often determine there wasn't anything major worth taking, leave, and have us call the family back to withdraw life support. The OPO where I am now is better with engaging families early, but still not great to work with, outside of actual brain dead donors.
Absolutely the same boat ! It’s completely changed my dealing with the donor networks. I absolutely feel like they’re the scum of the earth and every single intensivist has been asked to do unethical things by them.
When I pushed back and said someone needs to explain why you want XYZ, they could never beyond “it’s our protocol.” They’d call their actual medical director, then back down.
Because of this, my boss had to have a heart to heart with me since it did cause some “issues,” for me. We did come to an agreement, but it still felt very slimy.
Even worse is changing the code status back to full code for someone not brain dead, just not likely to make a full recovery, so that they don't die too early. I have serious ethical qualms about doing chest compressions on someone who was still alive, with higher brain activity, who's family does not want this, just so the OPO can get their juicy organs in another day or two.
Had this happen, they didn’t talk to family about what would happen with code status.
By default most of them would have their code status changed from DNR to full with telling the family that means putting the Lucas on to prolong chance for organs recovery.
I was always told this never happens, then it happened to me.
There is nothing more horrible than running a code on a dead person, Lucas thumping on chest. It’s traumatic for the whole staff.
Back to Anesthesia 100%, so I no longer have to deal with the donor network people, but the donor network is run by the most unethical people I’ve ever seen in medicine.
When I was pushing back against them, their local director offered me a “speaking engagement,” of course my time reimbursed with prepared slides. This absolutely felt like, if we paid this kid some money, maybe he will shut up.
I politely declined as I was already scheduled for anesthesia shifts fortunately.
I also found out, hospital gets a huge amount of money, once the patient is donor designated and gift of life “takes over.”
The funny thing is, they make “suggestions,” that aren’t really suggestions, but your medical license is writing the orders.
I absolutely hated DCD. With Brain death, I always felt it was fine, since we did physician exam first (must be done by attending, me), then followed by cerebral perfusion scan. You could opt for two physician exam, but it wasn’t standard for my partners and I.
I will tell you, without getting super specific to dox myself, we had a junior partner who was cocky, he broke protocol and it burned him avoiding cerebral perfusion scanning.
Physician exam first with cerebral perfusion scan to gave me total peace of mind for brain death determination. DCD always felt unethical to me.
www.pulmccm.org
donatelife.net
