A Minute-by-Minute Donor Case Scenario

Friday 8:43 p.m.
EMS teams deliver the patient, a 48-year old female, to the hospital emergency room. About four hours earlier, the patient had complained of rapid onset of severe headache with no response to over-the-counter pain medication. Patient collapsed while preparing for bed.

Friday 9:11 p.m.
Hospital Trauma Specialists stabilize patient and get diagnostic scans: CT/MRI of the patient’s head. Patient is placed on a ventilator to assist with breathing. The care teams consult with the family to assure them that everything possible is being done. While her family waits, physicians and nurses stabilize the patient and decide what the best options are for her care.

Friday 11:57 p.m.
Patient is still unresponsive with a deteriorating neurological condition. Vital signs are stable but the diagnostic scans show a severe hemorrhage (bleed) to major blood vessels supplying oxygenated blood to her brain. The brain has begun to swell causing more blood flow restrictions. Physicians order medications to help further stabilize the patient's blood pressure and other vital signs.

Saturday 12:18 a.m.
The patient is admitted to the Intensive Care Unit. The healthcare teams closely monitor the patient’s respirations and heart function and begin adjusting a care plan. Vital signs are taken every 15 minutes for the first two hours and blood is drawn to monitor vital organ function and oxygen levels in the blood. Medications are given to help with blood pressure and reduce swelling in the brain. Her family waits for any change. A hospital chaplain offers to help the family.

Saturday 2:47 a.m.
Vital signs are changing rapidly now. Blood pressure has climbed to 285/120 and the heart rate is in the 130s, a sign the patient’s brain is swelling even more. Her physician orders a Cerebral Blood Flow study to determine if any blood is reaching the brain. The doctor also performs additional tests to help with his diagnosis. If the patient meets the clinical criteria for possible donation, the unit supervisor or bedside nurse places a call to LifePoint. A LifePoint Family Support Counselor reports to the hospital to review the patient’s history to help determine if donation is possible and begins interacting with the family when appropriate.

Saturday 6:06 a.m.
The prognosis is grave. The family can feel the urgency of the situation as they wait for the results of tests to see what will happen next. More family members begin to arrive. Nurses continue to treat blood pressure and to monitor respirations and other vital functions.

Saturday 6:52 a.m.
The patient’s brain no longer controls any of her body functions, including her breathing. Because oxygen is being provided by a respirator, her heart continues to beat, keeping her other organs functioning. A neurosurgeon reviews the latest tests and determines that the patient is brain dead. The patient is pronounced dead.

Saturday 7:00 a.m.
In a quiet room away from the urgency of the ICU, the neurosurgeon talks with the family and shares the grim news that their loved one is dead. He explains brain death and the test results. There are many questions, doubts and fears. The grief process is just beginning for a family faced with sudden loss. The patient’s nurse is steadfast in her care and concern for the family. Right now they need time to think, share, question and grieve.

Saturday 7:30 a.m.
The patient’s husband holds his wife’s hand and tells the nurse that his wife wanted to be an organ donor. He asks if that is still possible. The nurse pages the LifePoint Family Support counselor. LifePoint determines that the patient had declared her donation wishes on her South Carolina Driver’s License.

Saturday 8:40 a.m.
The LifePoint Family Support Counselor spends time comforting the family while they express their fears, sadness and concerns. Family members begin to ask questions about how organ donation works, if transplants can really help and if they will still be able to say goodbye. The family has completed the medical/social history and their questions have been answered. After the patient’s family consents to donation, LifePoint begins the process of making sure the final wish to help others is fulfilled.

Saturday 8:59 a.m.
The LifePoint Family Support Counselor contacts LifePoint’s administrator on call and the clinical teams are notified. While the clinicians are en route to the hospital and throughout the various clinical steps they take preceding donation, the family’s wish to spend time alone with their loved one.

Saturday 10:02 a.m.
The LifePoint clinical team arrives. They review the patient's chart and medical history. LifePoint submits basic patient information to UNOS, the United Network for Organ Sharing. UNOS provides a list of waiting recipients. LifePoint calls each transplant center in the order they appear on the list and shares information about the available organs. Arranging for placement of the organs can sometimes take more than 100 phone calls over a period of 12 to 24 hours. Only the transplant physicians caring for waiting recipients can decide whether to accept an organ for transplantation.

Saturday 11:46 a.m.
The LifePoint clinical team reviews a variety of blood values to determine liver, kidney, pancreas and lung functions. Physicians perform other tests on the heart and lungs to determine final suitability for transplantation.

Saturday 12:10 p.m.
The LifePoint team and hospital staff allow the family private time to visit their loved one.

Saturday 12:42 p.m.
The donor's blood pressure begins to drop and medications and some fluids are given to help stabilize the pressure. This is important to ensure that the organs maintain function. Donors and their families want to help as many people as possible. This means clinical intervention is often necessary to maximize function of the organs.

Saturday 4:18 p.m.
LifePoint coordinates the various surgery and support teams. LifePoint’s Family Support Counselor explains the final steps of the donation process with the family. They begin saying goodbye.

Saturday 6:10 p.m.
Transplant coordinators from hospitals in Indiana, North Carolina and South Carolina have given LifePoint's clinical team their acceptance for all of the patient’s organs. The liver, kidneys and pancreas will be transplanted in Indiana, with one patient receiving both a kidney and a pancreas. The heart will go to a patient in South Carolina, one lung will go to a patient in North Carolina, and the other lung will go to a patient in Indiana.

Saturday 7:54 p.m.
Procurement surgery has been scheduled for midnight. The procedures for recovering organs for transplant are much like any major surgery. LifePoint coordinates the arrival of the different surgical teams from each state. The transplant surgeons, the LifePoint team and the hospital O.R. staff orchestrate the surgery. Up until the very last second, the patient's vital signs are monitored and adjusted to ensure that each organ is functioning at the moment of removal. Special preservation solutions are used to cool the organs and prevent cellular damage.

Saturday 9:06 p.m.
Usually the family goes home prior to their loved one being moved to the operating room in preparation for surgery. Despite their grief and loss, the family appreciates what is about to happen. They think about other families who won’t have to face the sadness of losing a loved one. It helps to know that life can go on and they are grateful for that.

Sunday 12:50 a.m.
The donor is moved to the operating room and the surgical removal of the organs begins. Each organ is delicately removed and packaged for transport to an anxiously waiting recipient.

Sunday 4:50 a.m.
The organ recovery procedure is complete and all organs are on their way to help save others. A LifePoint Family Support Counselor calls the family as promised. The family is pleased that all went well. They want to know about the people whose lives will be changed forever by this gift. Since this patient had indicated that she wanted to be a TOTAL donor, tissues will also be recovered. Special teams from LifePoint begin the surgical recovery of corneas, bones, skin, and certain connective tissues.

Sunday noon
The tissue teams have finished their work and prepared the body for the funeral home. Organ donation does not usually interfere with customary funeral arrangements. Donated tissues are used in a variety of surgeries to correct problems caused by injury or disease. While it can take up to several months for donated tissues to be used, donated corneas will likely be used right away.

Wednesday 10 a.m.
In this particular case, the corneas are implanted into two patients just three days after they were recovered.

Several weeks later
A LifePoint Donor Family Services (DFS) counselor follows up with the donor family to offer aftercare services. The counselor will remain close to the family, providing emotional support and facilitating anonymous communication between the donor family and the recipients if it is desired. In time, if both the donor family and the recipients want to meet, LifePoint helps facilitate that, too. For many donor families, this can be an important part of their healing process. LifePoint also gives the family a keepsake donor medal in memory of their loved one and their generous gift of life. Many services are available from LifePoint that provide ongoing support and gratitude to donor families.