ICU: A lesson in organ donation

I came to work today to find that the patient I'd helped admit early yesterday morning had officially been declared brain dead after she lost her cough and gag reflex (and failed her apnea test). She was still in her room, but LifeGift (the people in charge of arranging organ donations) was taking care of her now, keeping her condition stable until her organs were ready to be recovered. Right before I went home this afternoon, I talked to my patient's LifeGift nurse to ask about the "harvesting" process. He said that the organs are viable in the first twenty-four hours after brain death is declared, and those twenty-four hours are spent contacting organ donation companies and doing crosstyping and HLA typing across a registry to find the closest matches. Then, after matches have been found and the surgical team is ready, the organs are recovered and then flown to other hospitals for the recipients. In order for the organs to be in top shape, they must be removed within one hour of all support being turned off, assuming the patient stops breathing and flatlines within that hour. If not, then the organs are essentially useless and cannot be donated. That happened to our other lady with a stroke from several days ago. She still had some breathing function, so she wasn't totally brain dead when life support was removed. Her O2 sat remained at 60% and her BP was fairly stable for about 6 hours before her circulatory system collapsed, and by then, of course, her organs were in no shape to be transplanted (even though her family had given consent). Too bad. The LifeGift nurse said that I could watch the surgery if I wanted to, and though I was tempted, I declined. I have no idea what the new ORs look like or where I can find which room the surgery is in, and on top of that, they didn't know what time they'd be doing the surgery yet. The question was asked whether the LifeGift nurse had trouble getting patients' families to allow organ donation, and he said the harder part was just waiting for a qualified donor to come along (usually brain deaths). He said there was no age limit to donation (newborn to 90s; in older adults, the liver is most viable b/c it regenerates), and I asked if teenagers ever get middle-aged organs. He said it's happened, and on the other spectrum, older adults have received teenage organs only to pass away within ten years. *sigh*

We only had nine patients to see this morning, and we finished with enough time for Dr. ML to give us a lecture on mechanical ventilation that was actually very helpful. Then we got our first crisis after lunch: AG, our septic patient who treated JPS like his home between drunken binges, was transferred to Tele but his BP began dropping soon afterwards (we're talking 50s/30s) and he had to be moved back to the ICU. Eddy kept muttering about how he couldn't believe this was happening, and when we got to the ICU, Dr. ML said that I could do the art line. The problem: AG was infamous for having bad veins and pulses (I remember this tidbit from my medicine rotation), and I couldn't find a pulse. "We'll have to go in blind," said Dr. ML, and we each took an arm and attempted to do an art line. Needless to say I failed, but Dr. ML was able to get a stick. And the blood that came out did not look like blood at all: it was bright red and watery, almost like Kool-Aid (not my idea). His H&H turned out to be 7.7/25, so orders were immediately written for blood transfusions. On another patient, Garrett got to put in a chest tube, which looks like a painful procedure (thankfully the patient got lots of lidocaine; he never flinched even though he was conscious). I think he liked that; anesthesiologists are more hands-on people.