Thursday, July 26, 2007

This is why we do it...

There's a saying my friends and I have when we go backpacking. You're out in the wooks for three or four days without showering, living on gorp and couscous. By the time you hit a trail center you're a little ripe. People are looking at you funny and trying not to get to close. Like being out for 24 hours in a row, when you start to smell ripe and look a little weird from lack of sleep and eating out of snack machines. So we ask ourselves, "Why do we do it?" The answer, of course, is because it feels so good when it's done.


I've written a couple times in the past few weeks about trying to get consent and recover organs from less than marginal donors. "Extended criteria" is what we call them in my business. Now, extended criteria means(if I don't get it exactly right, I'm sure I'll be corrected) a donor who:is older than 50 with a history of hypertension or stroke, someone with a history of Hep B or C, or someone who's admission creatinine is >1.5. Apparently, NJ is the extended donor capital of the world, or something. When we go onsite, though, sometimes we are evaluating people who are far worse than just having hepatitis or a high creatinine.

Often I will get a doctor or nurse who tells me a patient is not eligible to be a donor because of x,y, or z. Sometimes it's something simple like pneumonia. As long as they're getting antibiotic treatment, they may be a lung donor, but they could donate other organs. People with brain tumors can donate-depends on the type of tumor and whether or not it's been resected. Bacterial meningitis also is not an absolute rule out. If they've been treated and have negative cultures, we'll pursue it.

There's not many absolute rule outs besides most cancers and HIV. Although some programs are recovering from HIV+ donors to transplant into HIV+ recipients, but I believe that's still considered experimental and would need a consent for research. Recently, we had a family consent but there was a strong suspicion of viral encephalopathy, maybe West Nile Virus. We wound up walking away. WNV is lethal to recipients.

Back to last weekend. I can't go into details but we had couple of referrals that just made you go, "ick." Several times I, as triage, had to listen to some bitching about why we were going onsite. (you know who you are!) I can't go into details, but the patient was what we would call a "train wreck." The family wanted everything done, even though it appeared she had been brain dead for a long time. Neurology wouldn't do brain death. Everything pointed to this being a no consent and, at best, we were looking at "liver only." Maybe. So why are we putting all these resources into it? Hanging out at that hospital, sending labs, supporting the family, etc. This isn't going to go anywhere, right?

Yesterday, the patient became a liver donor. The family consented, we were able to offer them the opportunity to donate and, AND, someone's life was saved. Someone got another chance at life. That's why we do it.

11 comments:

Anonymous said...

How timely that you should write about expanded donor criteria. I was 3rd runner up yesterday for a kidney from a 50 year old with hx of hypertension and smoking, but had good kidneys (creatinine 0.8).

I told my TC I would take it, but someone ahead of me got it (no big deal; I was just thankful to finally get a call; at least I have an idea now of where I'm at on "the list").

TC said...

I can't imagine how hard the waiting must be. Thanks for writing and good luck.

BreathinSteven said...

Hi TC...

That truly IS why you do it -- Thank you so much for thinking that way...

It's so easy to throw up one's hands and "rule out" a potential donor -- and I know we're all dreaming of procuring 6-7 organs, when sometimes it's a "liver only"...

But sometimes when you're in the middle of that "liver only" calculation -- there's someone else out in the world whose not thinking "liver only"... They're thinking, "That's my Dad", or my Mom, or my Sister or my Wife or my Husband or my child, and they "only" need a liver...

The two perspectives can become amazingly different -- a team is kinda let down because they only got a liver -- but a family somewhere else is elated thinking, "OH MY GOD -- THEY GOT A LIVER!!!"

I did a post on our Revive Hope blog about a precious young lady who just got two lungs -- but it was also a little about a procurement nurse who reads your site regularly -- my post is titled "Ducklings"...

You take care, TC -- Thanks for doing what you're doing... I'm glad you're alive.

Love,

Steve

TC said...

Thanks again, Steve. Your comments couldn't have come at a better time. And a big shout out to Loyola!

PJ Geraghty said...

As they say at the Collaborative meetings, it's all about the ones.

Steve said it much better than I will (and if you ever get a chance to hear his whole story, LISTEN!) but once upon a time we had case out here in AZ where the coordinator didn't understand why we were pursuing for "just the liver." I explained to him that this was the most important organ we would recover that whole year--to that recipient. That recipient doesn't care about the multi-organ donors we had worked up before; all he cared about was that liver, that day, that would save his life. Keeping that perspective is an important part of what we do.

PJ Geraghty said...

Also, Steve, the new CT surgeon at Loyola, Dr. Bob Love, is one of the best physician/surgeon speakers I've ever met. Unlike so many docs, he can really speak clearly and coherently in front of an audience. Plus he's a Cubs fan. Hope you get to hang out with him (in a personal, not clinical) capacity.

TC: you don't have Jersey Girl on your playlist? Whiskey Tango Foxtrot? :-)

TC said...

Ahhh, Jersey Girl....I remember driving in my high school sweetheart's '71 Chevelle along the strip in Seaside Heights listening the that song. I was actually mad when he married that chick from the west coast. Sigh. I loved that car.

TC said...

The Boss, that is, marrying the west coast girl. I think my high school sweety married a girl from down the street.

Happy Camper said...

Thanks to you and your colleagues, I received a liver. I was near death (so I'm told, I wasn't too with it) and was blessed with a liver from a wonderful family. It's been 4 1/2 years. I have taught my son to drive, watched him go to the prom, and have been there for countless wonderful occasions with my daughters.

therapydoc said...

And we're glad you do.tglil

BillyBob said...

I love it!