Heroic and heartbreaking
Medical team honors family that sacrificed ‘precious possessions’
The woman lay draped and still on the operating table while nurses and surgical techs bustled around the room, placing surgical equipment on the tables surrounding her. As the surgeon moved closer to the patient, a tall man in scrubs stepped forward and cleared his throat.
“Time out,” Steven Ashley said, and the room fell silent.
He read a few words about the woman no one in the room knew, but who was the reason they were there that night. He shared personal messages from her family, including a few inside jokes, then he pulled a laminated card from his pocket.
“Remember,” he read, “this room becomes sacred when a family entrusts us with one of their most precious possessions.”
The middle-aged woman on the operating table, he reminded everyone, was both dear to her husband, children and other family members, and a hero. To honor her, he said, everyone in the room should conduct themselves as “though the family were present.”
There was a moment of silence, heads bowed, eyes down.
Most surgeries do not begin with such a preface. But this was no routine surgery.
Although the woman on the operating table continued to breathe with the help of a ventilator, she had been declared dead a day earlier.
This procedure was not to save her life but to allow her in death to save the life of others.
Much has been written about the dramatic world of transplant surgery — the journey that donated organs take to their new homes, the painstaking work the transplant surgeon does to stitch in a second chance at life for the recipient.
Hours, often days, before that surgery, a team of organ recovery coordinators lays the groundwork. This delicate process, which lasts 24 to 48 hours and in some cases longer, moves slower, and there is less action.
This is the story of that prequel.
Painful decision, positive outcome
On a recent spring evening, a team of organ recovery coordinators headed west from their offices at the Indiana Donor Network to the Hendricks Regional Hospital intensive care unit, where the woman had been treated.
Earlier in the day, a doctor had had the most difficult of conversations with her family, saying her prognosis was poor. In the morning, the family met with another Indiana Donor Network team, who talked to them about organ donation. Over the course of the day, they decided to donate the woman’s organs.
The woman’s family consented to have an IndyStar photographer and reporter follow the organ-recovery journey. They asked that her name, cause of death and other identifying details not be shared.
Though many people are registered to be organ donors, circumstances have to be just right for their organs to be suitable for donation. Each year, the Indiana Donor Network receives about 30,000 calls from hospitals about patients who might become candidates for donation. Of those, about 5,500 lead to referrals. Last year, 165 people in Indiana became organ donors.
Last year 34,768 people received organs, according to the United Network for Organ Sharing, or UNOS.
The Indiana Donor Network recovers on average 3.76 organs by donor, more than any other organ procurement organization in the country, staff members said.
“We maximize donations from the donor and save as many recipients’ lives as we can,” said Luke Jones, supervisor of organ services at the Indiana Donor Network.
Earlier that afternoon, the doctor administered a final, painstaking round of tests on the woman. He checked for a cough or gag reflex, noted her pupils did not react to light and she had no pain reflex. Speaking clinically, he declared her brain dead, meaning she had no blood flow to her brain. The ventilator ensured her body continued to receive oxygen, in turn allowing her heart to beat and circulate blood to her organs.
Her care transferred from the hands of the Hendricks ICU staff to those of the Indiana Donor Network.
The woman’s family had decorated her sterile room with personal touches, affixing photos and multicolored messages of love on a large poster. Three copies of a photo of a mother elephant and her calf nuzzling adorned the walls.
While members of her family clustered nearby, the team from the Indiana Donor Network eased in and out of the woman’s room, delicately navigating around the family’s emotional needs. Though their primary task remained the organs, they recognized they had a role to play in helping the family grieve.
“Generally, we introduce ourselves because we are in and out of there, testing,” said Anne Kasey, one of the organ recovery coordinators on duty that night. “This is a process not a lot of people know about. We want to let them know as much as possible. … We try to spend as much time as we can. It’s a way to educate them about something their loved one is going through.”
First, the organ recovery coordinators drew about 30 vials of blood from the patient. They took urine and sputum samples, as well as a blood culture. Then, they ordered tests such as a chest X-ray and EKG to assess the quality of the heart. In some cases, they will request additional abdominal scans to measure the size of organs such as the kidneys or liver.
A few hours after drawing the blood, they returned to the patient’s side to biopsy a few lymph nodes near her groin. These would be tested to ensure a good match between donor and recipient. Kasey’s teammate John Heflin noticed that the patient’s urine was as clear as water, suggesting she might have had diabetes insipidus, a common condition in organ donors due to insufficient levels of a hormone made in the brain. In keeping with network protocol, the woman received a medicine to reverse the condition.
Around 9:30 p.m., a few hours after the organ recovery team arrived, members chatted with the woman’s family. They recommended the family head home to rest and come back the next day to continue the vigil.
Through the night
The organ recovery coordinators worked through the night.
Recovery coordinators work 24 hours on, 48 hours off. The team in this case had started at 8 a.m., and members wanted to have everything in order by 8 a.m. the next morning, when another team would replace them.
At any given time, six organ recovery coordinators — typically in three teams of two — are on call throughout the state. One team is based in Fort Wayne.
The Indiana Donor Network’s 24 organ recovery coordinators can expect to be called to cases all over the state.
“We do this job with the understanding that you may be out to dinner with your family or friends, but you always have scrubs in your backpack, and you have to go out when you’re called,” said Kasey, who learned about the career while working as a nurse in an intensive care unit.
On this night, shortly before midnight, the organ recovery coordinators gathered in the donor’s room. Hendricks Regional Health staff and the surgeons started the procedure at mid- night, about 36 hours after the woman’s family learned doctors could do nothing more to save her.
Family members braced themselves for this moment. During the past 24 hours, one member of the Indiana Donor Network had made a recording of the woman’s heartbeat. This goes inside a teddy bear that is a keepsake for the family.
In the silent ICU, a family services coordinator stood close to the woman’s husband. The two walked beside the gurney as hospital staff wheeled it out of the ICU room and to the hospital’s operating room through an empty corridor. Only a hospital security guard witnessed the desolate parade. No one spoke. Every now and then, the husband choked back a sob.
The doors to the operating room opened, and the gurney continued. The woman’s husband could go no further. He exited the darkened surgical wing, then left the hospital.
The test results determined that the woman’s kidneys and liver would go to recipients. All went to patients in Indianapolis.