A few weeks ago I was having dinner with some friends and the conversation came around to organ transplants. At the dinner table was the recipient of a kidney, his wife, a couple who were not medical, my partner (a doctor) and myself, a staff nurse in theatres. The question was posed “On the continent do they spend more money on organ transplants and in particular spend time counselling staff, including the surgeons and nurses involved in taking the organs”. It surprised me to realise that to the general public this may be a waste of money as it was just another operation for trained professionals. Can I now explain to you how I (and many of my colleagues) feel?.
I have been involved with several multi-organ harvests over the years. Most of them I can still remember with absolute clarity. Let me tell you about the sequence of events and feelings that are so typical. Sometimes you hear that a patient on I.T.U (intensive therapy unit) is not doing well and is a possible donor. Many hours pass until you know for sure. During this time two brain stem tests are done and many blood tests and tissue typing are done. This is also a time when the transplant team are contacting hospitals all over the country for possible recipients.
The operation takes place at a time that is a) the first available moment that all the transplant teams can arrive and b) when the emergency and booked lists have finished and a theatre is available. This is often around 10 pm. Everything at this point is just like a normal operation. Swabs are counted, trays opened, instruments checked and we send for the patient when everyone is ready. The patients that I have cared for have always been anaesthetized and looked after by an anaesthetist. This is also an area for debate – does someone with no brain function need an anaesthetic? There is a lot of conversation in the theatre with the various teams busy and liaising with the teams at their own hospital who are looking after the recipient. A full harvest may take 4-6 hours, but sometime before the end of the procedure there is an eerie silence. The monitors have been switched off and we can no longer hear the heartbeat. The impact of this hits hard. The various teams, anxious to get back, thank everyone and say their good-byes.
Very quickly an operating theatre that was busy and bustling with people talking and monitors bleeping is now very, very quiet and the handful of staff remaining feel very low. It must be remembered of course, that it is probably 3 a.m. You are tired and emotionally drained. The care of the patient is uppermost and we then start to give them a bed-bath, hair-wash, change dressings, remove drips, catheters etc in the hope that if or when their loved ones see them next they will know that we did everything we could. I feel very honoured to be able to care for someone at that time and know that there but for the grace of God it could be someone that I love. Sometimes their relatives have asked that we put on a particular pair of pyjamas or nightie.
When all is done we say good-night (although it’s probably morning now) and go home. The journey home is often a time for a quiet weep. So many people are going though such sadness. You get into bed but don’t sleep, thanking God it’s not one of your friends or relatives. Many of us find that thinking of the next stage, the transformation of the recipient’s quality of life is a great help and a few weeks later the transplant team send us a detailed letter of how all the recipients are getting on. This is always a lift and again they thank us.
Over the years I have coped with these cases by thinking far more about the recipient and knowing that it’s the only good to come from something so tragic. Everyone has the option not to do them, but everyone takes their turn. I think the younger nurses find it difficult at times and some counselling may help.
So if ever you think it’s just another operation, think again. It most certainly is not.
Page created: 1 November 2001
Last updated: 21 April 2008
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