Organ Donation.

[imhumanoid]

What do you guys think about organ donation?

What do you do if you respond to a fatal MVA and you see the person as "organ donor" on their drivers license?

I am curious on some input on the subject from a different view.

My VERY short version of my story
Shortly after I was born I became very ill and was flown to Denver Children's Hospital, I was placed on a list for a liver transplant. When I was 3 months old I received a new liver, but due to complications I was again placed on the transplant list. At 9 months old I received my second transplant.
I was in the Children's Hospital for my first year of my life, and weighed 10 pounds on my first birthday.
Through God's help with medical miracles I am alive today.

 

[s4l]

I'm all for it.

Basically, if you don't die in or right in front of the hospital, your organs are probably going to spoil before they get you into OR, get your organs out and on ice.

 

[EMSLaw]

I think there was a thread on this not so long ago. Things are split fairly evenly.

 

[Mountain Res-Q]

I think there was a thread on this not so long ago. Things are split fairly evenly.

Started out as a thread on if you personally are an organ doner:
http://www.emtlife.com/showthread.php?t=15174

OP... no personal opinion about organ donation. Not opposed to them taking anything they want from me when I am good and dead and giving it to someone that could use it. I have no plans to give anything of mine right now unless it was family (and even then, I would have to like them, and those folks are few). I honesty do not feel comfortable with donating to science; just creeps me out even though I understand the need. However, one thing grabed my attention in you question:

What do you do if you respond to a fatal MVA and you see the person as "organ donor" on their drivers license?

Are you asking about if that person should be treated special because they are a donor? Do I believe that a obviously dead person who happens to be a donor should be flogged by EMS in the hope that we can keep the tissues perfused and get them to a Hospital for harvesting? Complicated Issue. Personally, if I was the DOA, I would not mind them doing what they needed to take what they needed. However, I believe it is disrespectful to flog a patient who is dead without knowing how they and/or their family would want. It was/is their right to donate or not donate... and is their right to die in peace then and there or have their bodily functions prolonged to help others... and without knowing their wishes on the second issue, I could not work a DOA even if there was a chance it could help another...

 

[VentMedic]

I'm all for it.

Basically, if you don't die in or right in front of the hospital, your organs are probably going to spoil before they get you into OR, get your organs out and on ice.

Seriously?! Do a little research about organ donation. You can read what I posted and the links on the other thread.

Are you asking about if that person should be treated special because they are a donor? Do I believe that a obviously dead person who happens to be a donor should be flogged by EMS in the hope that we can keep the tissues perfused and get them to a Hospital for harvesting? Complicated Issue. Personally, if I was the DOA, I would not mind them doing what they needed to take what they needed. However, I believe it is disrespectful to flog a patient who is dead without knowing how they and/or their family would want. It was/is their right to donate or not donate... and is their right to die in peace then and there or have their bodily functions prolonged to help others... and without knowing their wishes on the second issue, I could not work a DOA even if there was a chance it could help another...

I am going to suggest you do some extensive reading on organ donations. We DO NOT "flog" dead patients in hopes they are organ donors. In fact, if a patient has been worked as a code, the major organs will probably be too damaged to use.

Educate yourself before making statements that are no where near accurate. On the other thread I posted some links. Understand what you are saying before just typing such gross mistruths.

 

[Mountain Res-Q]

I am going to suggest you do some extensive reading on organ donations. We DO NOT "flog" dead patients in hopes they are organ donors. In fact, if a patient has been worked as a code, the major organs will probably be too damaged to use.

Educate yourself before making statements that are no where near accurate. On the other thread I posted some links. Understand what you are saying before just typing such gross mistruths.

WTF??? I posted no mistruths. Because of the way the OP posted the question I made it clear that I didn't believe it ethical to attempt resuscitation efforts on an obvious DOA in the hopes that they could be a donor. How the hell is that a mistruth? I didn't make any claims that this is what is done; nor did I approach the logistics of harvesting from someone with medical issues that caused the code…. I am not in the business of harvesting organs for transplant and honestly could care less about that aspect of medicine since it has no bearing on me, which is why I made no medical statements here, but voiced my ethical (not medical) view of a question the OP made.

You might want to try actually reading what others write instead of playing Hostile Paramedic Burnout that is constantly looking for a fight. I will "educate myself" to your highly exulted level (as if it would be possible) the second you get a personality and demeanor that is acceptable for someone professing to be a Professional and an Educator.

-----

Ya know, I have continued to read your posts despite some personal opinons I have of you, but quite honestly, despite some good information you post, why would anyone wish to listen to someone that acts as you do. You might be a great Medical Provider, but you show yourself here to be a poor human being. Add one more to the (ever growing) Ignore List.

 

[MSDeltaFlt]

What do you guys think about organ donation?

What do you do if you respond to a fatal MVA and you see the person as "organ donor" on their drivers license?

Okie dokie. Back on target. Spirra, I'm all for organ donation. I also treat my pts the same. I give them my best regardless of their donation status.

 

[usafmedic45]

In fact, if a patient has been worked as a code, the major organs will probably be too damaged to use.

Other than valves, skin, corneas, bone, vascular tissues, kidneys, etc. These are all recovered post-mortem/post code. Also, I recall seeing a report from one of the OPOs that stated that 20-30% of all cardiac donors by brain death criteria had undergone CPR at some point, so I wonder how much damage is really done by a brief period of CPR. The literature seems to back up the idea of short resuscitation intervals not negating the ability to procure since there has been a lot written on the subject. Now if we're talking an extensive 20-30+ minute code (your typical prehospital arrest without ROSC prior to hospital arrival), then yeah, the heart is probably going to not be that functional and on that point we agree that probably the heart and possibly the liver are going to be not worth taking.

Not that it has any significant weight but I've also seen three cases (one as an RT and two as a deputy coroner (since we had to sign off on the donations)) that I can recall off the top of my head where an extended CPR interval (>10 minutes) lead to ROSC and eventual cardiac donation. I saw one of the cases come in for the postmortem exam afterwards and the OPO took everything- heart, lungs, liver, bone, skin, blood vessels, kidneys, intestines, pancreas, etc. The only thing they left were the corneas (I would not approve the cornea harvest due to the nature of the case), the spleen, and the bladder.

Basically, if you don't die in or right in front of the hospital, your organs are probably going to spoil before they get you into OR, get your organs out and on ice.

Uh, not quite. See the aforementioned points about certain tissues being recovered after a lengthy post-mortem interval.

I also treat my pts the same. I give them my best regardless of their donation status.

You have to. The same care that makes a good donor case is the care that will save a viable patient.

Also, 99% of the time as an EMS provider I was unaware of the person's donation status until after they arrived at the hospital. If they are as unstable as would make them seem like a possible donor in the field, digging around in their wallet is the last thing we had time to do.

 

[Seaglass]

Also, 99% of the time as an EMS provider I was unaware of the person's donation status until after they arrived at the hospital. If they are as unstable as would make them seem like a possible donor in the field, digging around in their wallet is the last thing we had time to do.

This. Unless someone tells me there's a DNR, relevant medical history, or something else that I need right away in the wallet, I'm not going to touch it.

 

[Smash]

What do you guys think about organ donation?

What do you do if you respond to a fatal MVA and you see the person as "organ donor" on their drivers license?

I am curious on some input on the subject from a different view.

My VERY short version of my story
Shortly after I was born I became very ill and was flown to Denver Children's Hospital, I was placed on a list for a liver transplant. When I was 3 months old I received a new liver, but due to complications I was again placed on the transplant list. At 9 months old I received my second transplant.
I was in the Children's Hospital for my first year of my life, and weighed 10 pounds on my first birthday.
Through God's help with medical miracles I am alive today.

So was it god that wrecked your first liver, or your second? Or god that ensured that someone else had to lose their son or daughter so that you could have a lump-o-liver from them?

Or is it just god that made you all better?

If I respond to a fatal MVA and the deceased is an organ donor I notify the appropriate people through the appropriate channels. Local protocol may vary.

 

[usafmedic45]

So was it god that wrecked your first liver, or your second? Or god that ensured that someone else had to lose their son or daughter so that you could have a lump-o-liver from them?

Or is it just god that made you all better?

Smash....don't be a **** to the kid and let's not turn this into a religious debate.

 

[RyanMidd]

One man's trash is another man's treasure.

I plan on "parting out" my cadaver inch by inch to whoever would like it. If I can be the cornea that helps a 14-year-old with macular degeneration see? Awesome.

If I can be the embalmed GI tract that teaches a pre-med student how probiotic cultures work, cool.

But basically, I have no qualms with putting use to something that would otherwise turn to dust.

 

[imhumanoid]

So was it god that wrecked your first liver, or your second? Or god that ensured that someone else had to lose their son or daughter so that you could have a lump-o-liver from them?

I really prefer not to get into one of these debates, but seriously?
I can tell right off your atheist, fine, but was the smart comment necessary?
_____________
I am glad to hear patients are treated the same.

If you guys don't look for ID's and stuff what is the point of having one? Maybe that just came across wrong. (I have one)

 

[VentMedic]

WTF??? I posted no mistruths. Because of the way the OP posted the question I made it clear that I didn't believe it ethical to attempt resuscitation efforts on an obvious DOA in the hopes that they could be a donor. How the hell is that a mistruth? I didn't make any claims that this is what is done; nor did I approach the logistics of harvesting from someone with medical issues that caused the code…. I am not in the business of harvesting organs for transplant and honestly could care less about that aspect of medicine since it has no bearing on me, which is why I made no medical statements here, but voiced my ethical (not medical) view of a question the OP made.

You might want to try actually reading what others write instead of playing Hostile Paramedic Burnout that is constantly looking for a fight. I will "educate myself" to your highly exulted level (as if it would be possible) the second you get a personality and demeanor that is acceptable for someone professing to be a Professional and an Educator.

-----

This is exactly why I called you out on your post. The organ donor of major organs will have to be alive without coding for 24 - 48 hours for a thorough workup to see if they can donate and who they match.

I personally could care less what you think of me but when you spout out crap that you obviously know little about and then refuse to even take the effort to read about the process, there lies a problem and it is largely with you.

 

[VentMedic]

Smash....don't be a **** to the kid and let's not turn this into a religious debate.

Exactly!

Spirra911 is someone who can post about his experiences as a patient and can answer many questions about medications, reactions, pain management, concerns about diseases such as the flu, IV start difficulty and many other interesting topics about something even those in EMS will see. Yet, instead of treating him as other health care professionals would with a genuine interest from a medical perspective, he gets ridiculed by those who believe their 3 weeks of training is the end all to all things to know about medicine. Why must some show such immaturity when there is so much to learn?

Other than valves, skin, corneas, bone, vascular tissues, kidneys, etc. These are all recovered post-mortem/post code. Also, I recall seeing a report from one of the OPOs that stated that 20-30% of all cardiac donors by brain death criteria had undergone CPR at some point, so I wonder how much damage is really done by a brief period of CPR.

Yes, there are many valuable parts that can be taken post-mortem. But, even the kidneys can be rendered useless if the code lasts for more than a few moments. One also has to consider the amount of pressors being used. We prefer to consider organs that are from donors that we have been able to check out, match and find the most appropriate donor. This process can take more than 24 hours. Often it is during that period that the heart that has suffered an arrest is found to have suffered loss of wall motion and may be not suitable for transplant.

You might also have read about the cardiac death (in the OR) rather than brain death declaration for procurement.

TBIs with young strong hearts make the best donors. Thus, I do enourage gang members during their visits to our ED to do a nice head shot if they want to kill each other and will also advise them to avoid drugs and cigarettes to keep their organs healthy enough for donation. And yes, I do say this with a straight face as I am very serious about organ procurement jsut as they are about killing each other.

 

[Seaglass]

TBIs with young strong hearts make the best donors. Thus, I do enourage gang members during their visits to our ED to do a nice head shot if they want to kill each other and will also advise them to avoid drugs and cigarettes to keep their organs healthy enough for donation. And yes, I do say this with a straight face as I am very serious about organ procurement jsut as they are about killing each other.

While I know that nothing you say is going to stop them from shooting each other, do you think that this advice could reinforce the relatively common perception that the medical community is more interested in their organs than keeping them alive?

 

[bunkie]

I really prefer not to get into one of these debates, but seriously?
I can tell right off your atheist, fine, but was the smart comment necessary?
_____________
I am glad to hear patients are treated the same.

If you guys don't look for ID's and stuff what is the point of having one? Maybe that just came across wrong. (I have one)

He could be catholic. Lots of atheists on here not getting into the religion debate. I'm glad you benefited from an organ donor. Just more motivation for me to encourage others to do the same.

 

[s4l]

Seriously?! Do a little research about organ donation. You can read what I posted and the links on the other thread.

I'm just saying what I've heard from a few nurses around here.

 

[usafmedic45]

But, even the kidneys can be rendered useless if the code lasts for more than a few moments.

Which I find odd give the use of cadaveric or cardiac death criteria (on the table) donations of kidneys. Even with a quick surgeon, you're still looking at a delay of three plus minutes just to get back to the kidneys and on the two procurement operations I witnessed, the kidneys were among the last things taken. As one of the surgeons put it (I asked) "The kidneys stand up better to a no-flow situation better than the liver does.". That said I do see where you're coming from- especially with the pressors comment- and admit you probably have more experience with pre-donation donor care than I do.

This process can take more than 24 hours. Often it is during that period that the heart that has suffered an arrest is found to have suffered loss of wall motion and may be not suitable for transplant.

Which is why you'll sometimes see the heart left behind after the procurement procedure. Just because the heart is failing, doesn't mean they can't harvest the other solid organs after the brain death call is made even on someone who was initially resuscitated from an arrest. I saw this type of thing happen quite a few times when I used to work at a much larger hospital than I do now. It's not ideal, but it does happen.

If you guys don't look for ID's and stuff what is the point of having one?

I don't make it a point to go through wallets and such unless I have a reason to. Honestly a medic alert pendant or bracelet is a better idea with a card in the wallet with more detailed information. The jewelry would cue me to look in the wallet. Otherwise, we leave the "Oh, he's an organ donor" part for the hospital staff.

Of course, I'm glad I didn't make it a habit of searching wallets or I would have probably been even more scarred than I am by the death of my best friend after a car accident (as I was trying to tube him). He was so banged up that I could not recognize him. I found out who he was from a face sheet in the emergency room. BTW, if anyone is wondering why I am so bitter about things: that day- in large part- was what made me this way.

Thus, I do enourage gang members during their visits to our ED to do a nice head shot if they want to kill each other

Glad to know I'm not the only one who does that. Great minds think alike, eh Vent?

 

[VentMedic]

While I know that nothing you say is going to stop them from shooting each other, do you think that this advice could reinforce the relatively common perception that the medical community is more interested in their organs than keeping them alive?

When many of these kids (15 - 22) are in the ED for their 3rd or 4th gunshot wound, it becomes almost pointless to tell them not to shoot each other. So, you just tell them not to damage their organs too bad by drinkin and smoking so they can make for donors for that one day when they don't walk out of the hospital with just a bandaid and bragging rights. Some will get the message when they realize you are actually talking about death in a way they hadn't thought about before. The process becomes a little more illustrated and final than the cool thing they had always thought it was.