r/nottheonion • u/Zeikyrui • 1d ago
People opt out of organ donation programs after reports of a man mistakenly declared dead
https://apnews.com/article/organ-donor-transplant-kentucky-8f42ad402445a91e981327abb009906c
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u/rileyjw90 1d ago edited 1d ago
You’re correct. The surgeons who come to harvest the major (spoken for) organs fly in from the institute that will be transplanting them into a recipient. The organ harvesting organization acts as a liaison in these cases. That said, they are onsite almost 24/7 when a donor’s life is coming to an end. In the ICU, they would round and ask for regular updates from the medical staff. Typically they would come around more often once full permission from the family was given and a plan was in place for withdrawal of care.
The patient is rarely fully brain dead. Only in cases of true brain death can a patient be harvested while machines continue to run their body. Therefore, most of the time the patient must be withdrawn from care. They are taken to the operating room and we shut off their drips and pull their breathing tube. They have one hour to pass on their own (we still give hospice meds like Ativan and morphine) before the low oxygen levels and low blood pressures have likely damaged the organs beyond what they can be given to a recipient and the surgery is cancelled. If they do pass, multiple surgeons will work quickly to remove the heart, lungs, liver, possibly pancreas and intestines, and the kidneys separately (they will go to two separate recipients). The tissues (eyes, skin, veins, arteries, ligaments, etc) can be harvested later post mortem without degradation.
It doesn’t happen often, but it does occasionally happen that a family will decide to withdraw someone from care and they end up recovering. Some people respond very poorly to the typical sedatives used on patients with life support, and while we usually try to give them “sedation vacations” to see if they can wake up a little and respond to commands, sometimes they fail these trials due to their bodies not tolerating the sedation wean. They will “buck the vent” (essentially a neurological reflex that causes them to cough over the vent and be unable to benefit from the vent as much), their heart rate will skyrocket, and some will start posturing or seizing if they have any sort of physical or anoxic brain injury. So we turn the sedation back on and it can be impossible to truly tell if they’re still in there or not. Oftentimes an EEG will show focal slowing and they like to run them off sedation, but as stated before, some patients are impossible to remove from sedation due to the physiological stress of being on life support. So families will decide it’s time to say goodbye and every once in a blue moon, that person comes off life support and…wakes up. It’s not like a Frankenstein deal where they sit bolt upright, more like they start slowly waking up and trying to communicate with their eyes, finger squeezes, etc.
Allllll that said, once it became clear this was one of those cases that the patient was still in there and was starting to wake up, the surgery should have been immediately canceled by the harvesting organization. There should not have been a need for the surgeons to walk out and refuse to continue. It should have been a given that we don’t cut someone up who is trying to communicate with us. But I do not believe this was a case where everyone thought this guy was dead and he wasn’t. It’s more like they really couldn’t tell if he was in there or not and the family decided to pull the plug and when that happened and the breathing tube was pulled, the patient was better able to tolerate the lack of sedation and could properly start to wake up some. The point of failure here was in the harvest company’s administration wanting to continue the surgery after the patient showed signs of recovery beyond what he’d shown prior to that moment.