To Donate or Not to Donate

[La Fiera]

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When I did my last ICU rotation, we had a ESRD patient with Hep C who coded but was brought back to "life"- he ended up being brain-dead so the Organ Donor Network was notified, and the family agreed to donate whatever organs were needed.
I was amazed at what transpired next: we placed every kind of line possible, and the braindead patient was transferred to a different hospital for a few hours to get a cath; he came back and had a pan scan, and a biopsy etc. The amount of manwork that was placed into this brain dead patient was almost sickening, as the ODN was constantly requesting blood draws abg's, and cultures and this that and the other. I found myself asking if we should actually be concentrating on the patients who were still clinging on to life in the ICU as opposed to concentrating on the dead patient!
In the end, not a single organ was donated.
The whole experience resulted in me changing my status from an organ donor to not being an organ donor.
I have a lot of empathy for those patients out there who have rare diseases and are sitting on waitlists for organs, but maybe the money and effort should be concentrated on prevention and the more general patient population.

 

[Stitch]

When I did my last ICU rotation, we had a ESRD patient with Hep C who coded but was brought back to "life"- he ended up being brain-dead so the Organ Donor Network was notified, and the family agreed to donate whatever organs were needed.
I was amazed at what transpired next: we placed every kind of line possible, and the braindead patient was transferred to a different hospital for a few hours to get a cath; he came back and had a pan scan, and a biopsy etc. The amount of manwork that was placed into this brain dead patient was almost sickening, as the OND was constantly requesting blood draws abg's, and cultures and this that and the other. I found myself asking if we should actually be concentrating on the patients who were still clinging on to life in the ICU as opposed to in comparison to concentrating on the dead patient!
In the end, not a single organ was donated.
The whole experience resulted in me changing my status from an organ donor to not being an organ donor.
I have a lot of empathy for those patients out there who have rare diseases and are sitting on waitlists for organs, but maybe the money and effort should be concentrated on prevention and the more general patient population.

With Hep C and ESRD which organs could you even donate? I'm quite surprised that the donation team even considered him. My experiences with organ donation in the ICU setting have been very positive, both on the donating and receiving ends.

 

[docB]

The amount of manwork that was placed into this brain dead patient was almost sickening, as the OND was constantly requesting blood draws abg's, and cultures and this that and the other. I found myself asking if we should actually be concentrating on the patients who were still clinging on to life in the ICU as opposed to in comparison to concentrating on the dead patient!
In the end, not a single organ was donated.
The whole experience resulted in me changing my status from an organ donor to not being an organ donor.

I had similar experiences in residency. I recall being so mad I couldn't see straight one night because I was obligated to try to keep this brain dead patient's perameters within donor limits for hours, which was literally a sit at the bedside and fiddle with drips endevor, just because the donor worker didn't want to ask about donation yet. She thought she might fare better if she waited for a certain family member to come back. After ~36 hours they came back and the family still refused to donate. As she walked out the door the donor network worker said "Oh well. He wouldn't have been a candidate anyway because he was too acidotic on day one." I almost beat her.

 

[quinsy]

Yes, I've seen some organ donation related things that really burned me up, people ruining their first liver and somehow qualifying for a second one, people only needing to be off EtOH for a few months before getting on the transplant list seems WAY too lenient to me. But that is a problem with the way they screen patients for transplant, and knowing that a patient who successfully donate organs can save the lives of numerous innocent people, and make many other lives better, I try to focus on those potential wonderful, innocent people that I might save/help as an organ donor and just try to let the transplant people be the ones to sit in judgment on the others.

I can't imagine being tied to a dialysis machine so many hours every week - how amazing it would be to get working kidneys instead! Even just corneas and tissue donors, which you can do even if you have cancer or something else that disqualifies you for organ donation, is pretty cool. I mean, I'm not using them anymore, I love the idea that someone else can use them, what a gift to be able to give.

If my organs could be of use to someone and I denied them, that would not make me feel good. It's not a question of money. I don't like wasted resources either but we are talking lifesaving interventions here, not meaningless medical treatments. I wear a 'donate life' tag on my coat.

 

[Pharmavixen]

At the jail we have a guy who's been a frequent flyer for years, usually for drug-dealing and theft. He's also an Oxycontin addict on methadone, and he has extremely high BP; coming in with 220/115 sort of thing. His dr prescribes antihypertensives, but he fills these scripts sporadically, preferring to smoke crack and chew Oxycontin.

Our dr at the jail has read this guy the riot act over the years about his BP, telling him stroke, MI, etc. Anyway, a year ago, the guy became ESRD and went on dialysis.

In the past wk, apparently his brother came forward offering a kidney. So the guy has been going back and forth to the hospital for pre-transplant work-ups.

Considering that the only medications he's ever been compliant with are crack and Oxycontin, I wonder how compliant he'll be with his cyclosporine and mycophenolate.

 

[skiz knot]

When I did my last ICU rotation, we had a ESRD patient with Hep C who coded but was brought back to "life"- he ended up being brain-dead.

This is the quote as it should have appeared in the original post. Everything that followed was 😕