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.