The Nurse’s Role in Organ Donation

April 18th, 2012

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By , BSN, RN

A team of nurses at a New York hospital has taken it upon themselves to improve the organ donation process at their facility and to increase the number of donors in their region. Overall, 2.7 million New Yorkers are registered organ donors, which works out to about 18 percent of the potential donors in the state. While this might sound pretty good, it is actually well below the national average of 42 percent.

Nine intensive care unit (ICU) nurses at Albany Medical Center, the region’ trauma center and largest source of organ donors have banded together to improve those numbers. Through a program of support and education they are guiding donors families through what is, without a doubt, a difficult, heart wrenching process.

They volunteer to stay with the patients and to help the families understand the donation process, which includes keeping the brain dead patient’s body functioning until the organs can be collected. "We try to make it so everybody has said their goodbyes and has no regrets," said Joshua Malone, a nurse in the medical ICU.

This effort is all part of a statewide drive to increase the number of organ donors. Across the United States, 113, 841 people are waiting for an organ transplant—10, 000 of those waiting live in New York State.

As reported last week, officials from New York’s Department of Health (DOH) and from the Department of Motor Vehicles (DMV) announced that New Yorkers can now register as organ donors on the DMV website. Since 95 percent of all donors register through the DMV, officials are hoping this new system will increase participation.

Meantime, the ICU nurses at Albany Med are doing their part to help those families who have already made the decision to donate. They have provided molds of patients' hands, locks of hair, and even arranged visits from family pets. The team also has run registration drives that signed up 152 new potential donors.

Organ Donation

According to the United States Department of Health and Human Services 18 people die each day waiting for an organ transplant. They also tell us that one organ donor can save up to eight lives. Those are significant numbers.

Couple that information with the fact that organ donation is an option in less than one percent of all deaths and you have a balance that will never be reached. The one factor that must occur for organ donation to be possible is brain death (the irreversible cessation of all brain functions, including the brain steam). The events that lead to brain death are:

  • Head injury (GSW, blunt head trauma
  • Anoxia (post cardiac arrest, hanging, drowning, drug overdose)
  • Cerebrovascular Accident (CVA), also known as a stroke
  • Aneurysm or arteriovenous malformation (AVM) which is an abnormal connection between veins and arteries and is usually congenital.

In brain death, there are no reflexes, breathing or seizures. The swelling of the brain cuts off all blood flow. When there is no blood flow to the brain, it dies.

Organ donation is the actual surgical process of providing one or more organs to be used for transplantation into another person. Organ donors can be deceased or living. Deceased donors can provide six types of organs: kidney, pancreas, liver, lungs, heart, and intestines. Deceased donors also can provide tissues (such as bones, skin, heart valves and veins) and corneas.

Living donors can provide a kidney or a portion of the liver, lung or intestine, and in some instances, eyes and tissues.

The Role of the RN in Organ Donation

The nurse can be very helpful in supporting families through the organ and tissue request process, as the Albany ICU RNs have demonstrated. As the process begins, the first and most important thing the nurse can provide is a private area in which the family can discuss all the issues. There, the staff member designated to make the request, whether a formal transplant coordinator, a social worker, chaplain or nurse can offer the family clarification of what defines brain death since the support system must remain in place even after the client is pronounced dead, for vital organ retrieval (i.e., heart, lungs, kidneys, and liver).

The nurse’s job is to reinforce explanations throughout the organ retrieval process. The family must know who legally can give final consent, what options there are for organ or tissue donation, and how donation will affect burial or cremation. Any nurse who could be working in this capacity should review their state’s organ retrieval laws and institutional policies and procedures regarding the final consent process.

What Every Nurse Should Know About Organ Donation

There are still many misbeliefs about organ donation. Here are some of the most common facts every nurse should know:

  • There is no cost to a family for the gift of organ and tissue donation.
  • All major religions in the U.S. support donation as an unselfish act of charity that will save or improve someone’s life.
  • If you are sick or injured and admitted to a hospital, the number one priority is to save your life.
  • When matching donor organs to recipients, the computerized matching system considers issues such as the severity of illness, blood type, time spent waiting, other important medical information, and geographic location. The recipient's financial or celebrity status or race does not figure in.

April is Donate Life Month

To steal a line from the organ donor program, “imagine how many lives could be saved if we all signed up.” Anyone, regardless of age or medical history, can sign up to be a donor. The transplant team will determine at an individual's time of death whether donation is possible. Signing up is just that bit of hope that we can continue to have a positive impact on life after our own is over.

Nurses play a huge role in not only the care of the patient but in the care of the family when tragedy strikes. As a support system we may can certainly influence the public’s view of organ donation, through sharing the positive outcomes we see in transplant recipients. I for one have signed the back of my driver’s license and have told everyone I know and love it is my wish to help if my body ever ends up as a potential donor. It’s something we all should consider.

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