Organ donor network nurses know that when life is ending for one patient, organ donation can mean new life for another.
According to the New York Organ Donor Network, a nonprofit, federally designated organ procurement organization, every 10 minutes a name is added to the national waiting list and every two-and-a-half hours someone is added to the New York waiting list. Despite this need, only 18% of New Yorks population is registered as an organ donor, compared to 43% nationwide.
The metropolitan area has about 60,000 deaths annually and only 1% to 1.5% are potential organ donors, reports the NYODN. What some healthcare professionals dont know is the donors organs must be maintained in the donor’s body while being perfused and oxygenated.
“Our job is to manage the donor and improve organ function with the goal of offering the best working organs so the recipient gets the best quality of life,” said Julie Mirkin, RN, MA, vice president of operations at NYODN. “The ultimate goal is to maximize the donors organ function and attempt to reverse any injury or damage to the organs that may have occurred due to the donor’s illness. We use donor management goals as the standard of practice for donor management, which actually are consistent with the goals for managing non-brain dead critical care patients.”
In donor management, the NYODN transplant coordinators and hospital staff work together to treat any donor medical conditions, whether it be acidosis, hypotension, hypothermia or hypoxemia, using specific clinical pathways for the care of potential organ donors.
Critical care, critical timeStanding in front of the etched glass walls around the conference room are, from left, Monica James, RN, inhouse transplant coordinator; Kervens Louissaint, RN, clinical manager; and Julie Mirkin, RN, vice president for operations. The names etched in the glass are the first name and last initial of the NYODN donors from the years 2000 to 2010. “The etched names serve as a memorial and a tribute to our donors and a constant ‘connect to purpose for our staff,” Mirkin said.
After determination of brain death has been made and consent has been given by the family, the NYODN transplant coordinator collaborates with the hospitals nursing and medical staff to manage the donor and optimize organ function. This includes ordering blood work or giving the donor fluids or inotropic medications to maintain hemodynamic stability. Often additional tests, such as bronchoscopies, endocardiograms, cardiac catheterizations, liver biopsies and CT scans are needed to determine organ suitability. While not applicable to all organs, generally, once organs, such as the heart, lungs, and pancreas, have been procured for transplantation, they must be transplanted to the recipient within six to eight hours. The liver and kidneys may remain out of the body for a little longer period of time.
“The lungs are the most difficult organ to maintain suitable for transplant, for a number of reasons. It is also important that the donor’s oxygenation status remain adequate to help maintain the suitability of the other organs,” said Charles Gonder, RN, MBA, RRT, CPTC, clinical manager, who was a respiratory therapist before becoming a nurse. “After 24 hours or more of hard work, we are extremely satisfied if we can successfully procure and have the lungs be transplanted.”
The transplant coordinator is responsible for organizing the entire OR process, which involves arranging a recovery time that is suitable for all of the recipients surgeons — in some cases four to six different teams — at the hospital that provides the OR staff for the case and the family.
“Each individual case has its own complexities, for example, there are cases where the liver may be split intraoperatively to save two lives versus one, which causes the need for additional recovery time,” said Kervens Louissaint, RN, BSN, CCRN, CPTC, clinical manager at NYODN. “Or there may be a required intraoperative three-hour delay for the heart recipient to be prepped for transplant at the same time of procurement.”
Unique role, unique circumstancesMembers of the NYODN team include, back row, from left, Lisa Nardello, RN, transplant coordinator; Julie Mirkin, RN, vice president for operations; Monica James, RN, inhouse transplant coordinator; Charles Gonder, RN, clinical manager; Kervens Louissaint, RN, clinical manager; and Maritza Torres-Quinones, RN, transplant coordinator. Front row, from left, are Tara Sherer, RN, transplant coordinator, and Karen Gans, RN, transplant coordinator.
An autonomous role, procurement RNs spend much of their time working with nursing and medical staff at the facilities they are assigned. Coordinators must possess at least three years of critical care experience, work collaboratively with the healthcare team in critical care settings and be aware of many cultural beliefs and practices.
“For example, Muslims honor what the potential donor would have wanted over their own cultural beliefs. In our undocumented population some may be afraid to identify themselves as the next of kin for fear of being deported,” said Karen Gans, RN, CPTC, transplant coordinator. On a number of occasions, NYODN nurses and the hospital social worker have reached out to consulates in an attempt to bring family to the U.S. to see their loved ones.
The NYODN nurse may begin interacting with the family once the patient’s family has been notified of their loved one’s grave prognosis. The NYODN nurse will help the family understand and work through the brain death process. According to state guidelines, two physicians must concur and verify the patients condition in determination of brain death.
Once brain death has been confirmed and the family has been informed of the patients condition and understands brain death, the procurement RN works with a family services coordinator, also a member of the NYODN team, to provide comfort and support to the family. “Its not easy to explain brain death to families, especially when it is a young person and there is no hope,” said Lisa Nardello, RN, transplant coordinator at NYODN.
Transplant coordinators also spend time supporting the family services coordinators in their efforts to help the family with funeral arrangements after their loved one’s donation is complete. Sometimes the coordinators, who usually dont get to meet the recipients, meet the donors family and recipient and his or her family.
“In one case, we had successfully procured six organs from one donor and the organs were transplanted to six different recipients. There was even a child, who received half of his liver. It was an amazing experience for me,” said Tara Sherer, RN, transplant coordinator at NYODN.
Every day NYODN nurses educate facility nursing and medical staff about the process of organ donation and donor management. “We help them understand, for example, that sometimes a marginally functioning organ can still save a life, until a more suitable organ becomes available. This is referred to as a bridge organ,” Gonder said.
NYODN nurses also educate the public at local department of motor vehicles. “We like being there because we can explain the donation process, respond to myths and misconceptions and provide information in different languages,” said Monica James, RN, BSN, MPA, CPTC, NYODN inhouse transplant coordinator.
Donor management can be completed expeditiously if the donor is registered, whether it be through a DMV consent form or the four-step process online. On May 1, Facebook CEO Mark Zuckerberg announced that users could sign up as a donor on the social networking site, and thousands responded by the end of the first week. The more nursing and medical staff understand about organ donations, the more appropriate referrals can be made. With more public awareness, more lives can be saved through organ transplantation.
“My role is the most challenging, most difficult and most interesting job I have ever had,” said Maritza Torres-Quinones, RN, BSN, CPTC, transplant coordinator who has worked at NYODN for 18 years. “But the biggest reward I receive is gratitude for having the privilege of saving so many lives.”
For information or to sign up as a donor, visit www.DonateLifeNY.org.