Late in the summer of 1984, in the nine-bed medical ICU of a community hospital in Arlington, Virginia, I started my day listening to report from the night shift charge nurse. The patients to be cared for that day were from the usual scenarios – COPD with respiratory failure, uncontrolled seizure disorder, liver failure with GI bleeding, and so on. These were patients I had learned to love over my four years of critical care – standard diagnosis but with complex multisystem challenges. Until we came to bed 9.
Bed 9 was an 18-year-old girl with a traumatic head injury post automobile accident – and she was my neighbor, the babysitter for my children and someone I sang with every Sunday. Two months before that morning she sat on my front porch. She was excited that she had been accepted to nursing school. However, she was also feeling very unsure of what was to come next. To this day, I believe she had a premonition.
We had never seen a potential organ donor in that unit. Indeed, I don’t know that we would have recognized this case as a donation, but this young woman’s brother was a medical student who, when faced with this terminal diagnosis, asked if she might be considered as a donor.
This was my introduction to organ donation and transplantation and a pathway I might not have chosen for myself. How many of you, as critical care nurses, have looked back and wondered how you got where you are now, and did you really know what lay ahead on your journey?
By 1987, I had become the organ donation expert in my small ICU. I was often called to work an extra shift when a case presented itself. I knew the routine, the process and how to answer the questions of a new nurse, a physician and, most importantly, the families who were traumatized and grief-stricken. There was no national system of Organ Procurement Organizations (OPOs) then. Our organ procurement staff were members of the local urban transplant center. I got to know these people well, and they eventually asked me to join them. In April, I left my safe ICU and ventured into a new world – still a critical care nurse but in a new arena.
Thus began my 37-year adventure as a critical care nurse in the world of organ donation and transplantation. What began in that small ICU took me to work as a transplant/donation coordinator at a transplant center to becoming an organ procurement coordinator at a newly formed OPO and eventually director of clinical recovery services there. The journey continued until 2003 when I returned to acute care within academic healthcare and to the other side of the equation as the nurse manager, director and eventually transplant administrator for a large multiorgan transplant center.
My story involves both my professional career and a personal experience. As we know, working with patients and families in critical need is extraordinarily challenging, rewarding and rarely impersonal.
Critical Care Is Personal
I know how fortunate I am to have experienced life inside many ICUs and to work at both an OPO and a transplant center.
I have witnessed and wept with families who were living through the sudden and unexpected death of a husband, a father, a sister, a brother, a mother. I remember the case of a 40-year-old woman who had a massive cerebral hemorrhage while bowling with her family. Her husband was inconsolable. Her 12-year-old daughter and her twin sister sat with me and gave me the necessary medical/social history for a donation. They insisted that’s what “Mom” wanted.
I have held the hand of a man, a high school teacher and coach, with end-stage liver disease and probably within days of dying. When given the option to accept a liver from an 84-year-old donor, he gladly opted to take a chance. It has now been over 10 years since his transplant. I continue to see him in our hospital where he comes by several days each week to visit with and encourage other patients who are waiting for their chance. (Isn’t the liver an amazing organ!)
I have attended memorials and celebrations of life in the OPO and transplant community. There I have heard the testimony of numerous donor families who years after the event have expressed the consolation and peace they found knowing that something good came out of a tragedy.
More recently, I’ve been blessed to meet many living kidney donors and their recipients – some friends, some co-workers, some new to each other.
Finally, it comes to the personal aspect. In 1994, my 21-year-old son, Tim, died in that sudden unexpected manner. My own OPO team had to approach me about donation. It was not, as you might assume, either an automatic or easy decision. Trauma and grief can scramble the mind. In the end, it was a family choice, and Tim’s driver’s license confirmed the decision.
I bring this story to you now because as you read this story, April is here. In the Northern Hemisphere, there is more daylight, and signs of new life are all around us. The perfect month to learn, to reflect and to celebrate the gift of life through organ donation and transplantation. How can you, as a critical care nurse, facilitate these gifts?
Critical care nurses are constantly learning and relearning. You may be a novice about the experiences of an organ donor. You may, on the other hand, have participated in many such cases – a donation or a transplant – over many years of nursing. In either case, I encourage you to take time this April to learn more and spread the seeds of your learning to your colleagues. Who is your OPO? What are they doing in your community? What about a living donation – how could you sign up for that?
Resources for You and Your Colleagues
- Organ and Procurement and Transplantation Network
- HRSA’s Organ Donation and Transplantation site
- UNOS manages the national system for donors and recipient matching
- National donation organization for education and community awareness
- How to register to be a donor
Insight into OPOs – Here are some choices (there are more than 50; who is your OPO?)
- Washington D.C. metro: Be a Donor
- New England: New England Donor Services
- California: One Legacy
- Arizona: Donor Network of Arizona
- Philadelphia: Gift of Life Donor Program
Notable Organ Donation Awareness Days in April 2022 (detailed information at donatelife.net)
- Donate Life Living Donor Day: April 6
- Blue & Green Spirit Week: April 16
- National Donate Life Month Blue and Green Day: April 22
- National Pediatric Transplant Week: April 24-30
This April and throughout the rest of the year, I will continue to celebrate all nurses. In particular, I celebrate the accomplished, dedicated and brave critical care nurses I have known and the ones I have yet to meet. Your work is a blessing – and it is personal.
Have you made an informed decision about your own wishes regarding organ donation and let your family and friends know about your decision?
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