A successful kidney recipient waits to see his doctor for a checkup.
It is 5am on a Sunday morning and her telephone rings. She listens carefully then crawls out of her warm bed and dresses quickly. It is ice-cold outside and rain is threatening. She tries to stay alert as she makes her way across town to a renowned hospital with a large trauma centre. As she enters the unit, she passes a grief-stricken family huddled together in a lounge, unable to comprehend what they see. She talks to the nurses and doctors, and finally she makes her way to the family. She and the doctors sit down with the family members and deliver the news they are dreading. A doctor introduces her to the family. She explains why she is there.
“Do you know if he ever expressed a wish to be an organ donor?”
“Would you consider donating his organs so that others might live?”
One thing a transplant co-ordinator will tell you is: “Expect the unexpected, and never plan too far in advance.” A normal day can mean a co-ordinator will be in the hospital promoting organ donation to the nursing staff, and providing education on how to identify and refer potential organ donors. One telephone call can change all that. A transplant co-ordinator’s fundamental role is to procure organs from donors so that these organs can be transplanted into sick people who need transplants to survive. The waiting lists for hearts, livers, kidneys and lungs are very long. A transplant co-ordinator is a Critical Care or Trauma trained professional nurse with many years of experience, and the burden of trying to meet the pressing demand for life-saving organs falls on her.
When a co-ordinator is called to a hospital where a potential donor has been identified, she will meet with the nursing staff and treating medical teams to obtain a clear medical history and perform a full assessment of the potential donor. Her next task is to sit down with the potential donor’s family and loved ones, and discuss end-of-life options with them. It is not easy to ask a grieving family if they would consider donating the organs of their loved one, especially at such a time. But it is the only time.
Obtaining consent for organ donation from a grieving family is a very emotional process. It is often a difficult decision to make if the family is not sure how their loved one felt about organ donation. If it has been previously discussed then the decision from the family is usually a straightforward one, and this helps everyone involved in the process.
The co-ordinator now has her work cut out for her. Her responsibilities include sending blood specimens to the laboratory for a variety of tests. Added to that, she is responsible for the medical management of the donor in the ICU, and has to ensure that all steps are followed to ensure optimum medical care is provided for the organs required for transplants. She also has to follow a very strict legal process, which will include liaison with the forensic pathologist, hospital management and in some cases, Department of Health personnel.
Once all the blood tests and other investigation results have been received and confirmed, the co-ordinator will then notify all the surgical teams about the different organs — the heart and lung transplant teams, liver and kidney teams — often, each team is in a different transplant centre, and sometimes in a different city or province. Co-ordination of all these teams is essential for the successful outcome of the transplant process.
It is not unusual for organs to be flown between the various transplant centres in the country. The airlines in South Africa are very familiar with this process and are very helpful in assisting the transplant teams. Large companies with private jets sometimes sponsor teams to fly to destinations off commercial routes. No matter what mode of transport is required or used, it is the responsibility of the transplant co-ordinator to arrange for her teams to travel to wherever they need to go.
There are about 20 organ procurement co-ordinators in the country, of which more than half work in Gauteng and the Western Cape. These are the two busiest provinces, and the teams work closely together. Organs are procured for the community, irrespective of whether or not the patient is in a state or private facility.
The co-ordinator knows that many factors influence the organ donation process. Family consent is influenced by factors such as not knowing about organ donation, not knowing the deceased’s wishes, and sometimes it depends on the healthcare they have received or the interactions they have had with medical or nursing professionals. Religion and culture often influence the family’s decisions, and people react very differently to grief and difficult circumstances.
The transplant co-ordinator is the advocate for the deceased donor. It is her responsibility to ensure that the family’s wishes are honoured and that the donor is treated with the utmost dignity throughout the process. This she will do with integrity, compassion and empathy.
Written by Alexia Michaelides