Organ procurement and transplant surgeries aren't common to all hospitals, and some teams may only assist in an organ procurement occasionally. But, when you find yourself in one of these very special procedures, what do you need to know? How can you be prepared to ensure a safe, successful surgery?
The organ procurement team is there to help
Not all health care facilities do organ procurements on a routine basis. If this is the case at your facility, know that the procurement team who comes will ensure the procedure goes smoothly. They are team members that you need to know and know how to work with! This team works with the family and with your department to ensure that the proper paperwork and documentation is in order. They know they are visitors to your hospital, but they are there to work with you to take care of the patient in their final heroic hours. They are happy to teach about the procedures and what they do. Befriend them and the procurement process will go smooth. It won't be as scary as you think, I promise.
Know which organs the family/patient has consented to donating
While surgical staff should not interact with the family due to the conflict of interest that comes with the procedure, it is still imperative the nurse knows what is being donating. We are still patient advocates, and we still must honor the patient's and their family's wishes. We must ensure that the consent is followed and only consented organs are procured.
Transplants and procurements can be done any time of day
Timing can be key for transplantation of specific organs so you may be doing a case at any time of the day. Certain organs have specific time limits from procurement to transplantation. Hearts have 4 hours. Lungs have 8 hours. Kidneys have up to 24 hours. Surgical and procurement teams are ready to go at all hours of the day to ensure safe surgical procurement and transplantation occurs.
There are two ways a patient can donate
A DCD—donation after cardiac death, is where a patient has sustained an irreversible brain injury but does not meet brain death criteria. A natural death occurs when the heart stops beating and then the patient is taken to the operating room. The second way is by being declared brain dead. In this case the patient will still be treated to ensure organs are being perfused before procurement.
There may be multiple teams present for procurement
Many times, transplant surgeons are specialized, so if more than one organ is being donated, you may have multiple teams in the room at one time. It’s still the nurse's job to ensure the consented organs are being donated and to maintain control of the room.
Transplants may be a living donor surgery
Kidneys and livers are the organs that can be donated with a living donor. For kidneys, one is removed from one person and implanted in another. Both patients live with one working kidney. For liver donation, a segment of liver is removed from the donor and implanted into the recipient. The donor’s liver will grow back to near original size. These procedures are done typically at the same time in side-by-side ORs and require intense coordination.
Any part of the body can be transplanted
It’s not just solid organs that can be transplanted. Skin, eyes, bones, and heart valves are just a few examples of tissue organs that can be donated. They are used in many surgical procedures such as skin grafts, valve replacement surgeries, and ortho and neuro spine cases.
Transplant surgeries are very long
The average transplant surgery can take anywhere from a couple hours to 12 hours, maybe even longer. Mentally prepare yourself for it. This will also require updating the family as they are going through the long surgery as well. While long, it can be very rewarding at the end of the case when you see the new organ working in the body.
Transplant surgeries can be a high stress environment
If a patient needs a transplant, chances are they are very sick. With multiple teams and the long timing of surgery, this combination can make for a stressful environment. Try to prepare yourself to go into these procedures by ensuring all equipment is in the room or readily available. All documentation is in order and briefings amongst the team have been conducted. Proper preparation and communication can help to reduce stress to ensure a safe, successful surgery.
Procurement procedures can be a somber experience
However, there is also great reward in knowing that your patient is giving life to someone else. With their final act of kindness, they are helping to give another patient a better quality of life and additional time with their family. It is the ultimate sacrifice that we should always appreciate and respect.
This is just scratching the surface of everything that goes into procurement and transplant surgeries. And while the procurement side can weigh heavily on us, seeing another patient get a new lease on life through the gift of organ donation is so rewarding.
Keep up the great work,
P.S. If you aren't a registered organ donor, you can sign up here!