Rev. Timothy Madison on organ donation from a different perspective

A Community Hospital’s First DCD Case

The practice of Organ Donation following Cardiac Death (DCD) is nothing new. It was a new event, however, for my community hospital in rural southern Illinois. I serve there in my seventh year as the first Chaplain and as a one-person department.

Definitions:

DCD – A method for procuring organ donations when the patient cannot be declared brain dead. Before extubation from life support, the patient is located in an area where he or she can quickly be taken to surgery upon pronouncement as dead. In my case, the patient was transferred into a surgical suite before extubation.

OPO – The Organ Procurement Organization is responsible for family consent, logistics, and expenses related to a DCD. A three-person team arrived at the hospital to fulfill these duties once the donor family had expressed verbal interest in the procedure. They stayed in contact with the family throughout the process, even attending the memorial service.

Designated Requestor – The OPO trains hospital staff to approach families regarding their interest in organ donation. In this case, the OPO asked me, as the Designated Requestor known by the family, to present the option of organ donation. The OPO did so after first making a preliminary determination that the patient was a potential donor and that the patient had signed up as an organ donor on a state-run web site.

Process Highlights:

Hours 0-2 – The patient’s family decides to extubate and allow natural death. The OPO is notified by nursing. The OPO asks me to make a first approach. The family expresses a strong desire to pursue organ donation, due to the patient’s prior expressed wishes. I provide anticipatory grief ministry to the family and notify nursing, administration, and the hospital surgical staff that a DCD may occur. Many logistical questions are raised with each notification. I reminded each party of the DCD “dry run” we held several weeks earlier and deferred detail questions to the OPO.

Hours 3-28 – Delay after delay occurs. The family is notified of three different times for extubation, only to have those times postponed. The delays were due to the multi-step OPO procedure of donor evaluation and recipient identification, the transport of a donation surgical team to our remote site, and planning around the already heavy hospital surgical schedule. Despite my frustration with the delays, the family responded with determination to fulfill the patient’s wishes “as long as it takes,” utilizing the time to continue their bedside grieving. The OPO used this time to educate the family and hospital staff about the actual procedure of a DCD. Some hospital surgical staff voiced resistance to participation, which was resolved by recruiting an all-volunteer team. Two physicians voiced opposition to a DCD. I joined the effort to explain that a DCD did not involve assisted suicide. Their opposition vanished when they understood that they would not have to participate. Per our hospital policy, a medical resident would be in the surgical suite to pronounce death.

Hours 29-30 – After a prayer, the family and I put on our “scrubs” and joined the patient in surgery. Extubation occurred and I provided grief ministry amid monitor beeps, tears, “above the neck” touching, and old memories. After 15 minutes, the patient died peacefully. Departure was awkward, but the family responded quickly when prompted to leave surgery. They were accompanied to a nearby room where they debriefed and received more OPO information. After changing clothes, the family departed, exhausted but appreciative. I followed up with participating staff the next day.

What went well?

• A determined, highly motivated family
• The presence of a well-trained health care Chaplain
• Quick educational responses to resistance
• The recruitment of a volunteer team in surgery
• The history of a “dry run”

Improvements?

• More medical staff education about DCDs
• Better preparation of the family regarding the length of the process
• Involve the pronouncing medical resident with the family before meeting in surgery
• Removal of an ice chest marked “liver” from the family’s path into surgery

 

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