“Harvesting” Part 1 by Gary Grist RN CCP Emeritus

I don’t like the term “organ harvesting” in describing how organs are obtained for transplant. In a way, the term dehumanizes the unfortunate donor. I think “organ harvesting” must have been coined by some surgeon over half a century ago to avoid the emotional impact of ending one life, no matter how hopeless this individual’s survival maybe, to save the life of another.  I like the term “organ procurement” much better. “Pro…cure” makes me think of the positive contribution the human donor is making to “cure” a fellow human being.

The Dawn Of Transplantation

Early in my career as a perfusionist (1968), I was a part of my hospital’s kidney transplant team. A perfusionist is trained to operate the heart-lung machine and other specialized equipment. The reason a perfusionist was on the kidney transplant team was to operate an organ preservation machine called a Swenko*.  This was at the dawn of organ transplantation in the USA. Only kidney transplants were being performed by our hospital, no hearts or lungs. There was no United Network for Organ Sharing (UNOS) which today is a private, non-profit organization that manages the U.S. organ transplantation system from procurement to transplantation. Back then my hospital was acting independently and learning as it went.

Looking For Donors

As part of our daily routine, transplant team members would scan the newspapers for reports of automobile accidents and in particular motorcycle accidents whose victims might have severe brain damage. (This was before the existence of any helmet laws.) Various hospitals were called to obtain information on accident victims to see if they might be potential kidney donors. Sometimes we even “cold-called” units to inquire about any possible donors. In those days ICU nurses would freely give information to family, friends, and other healthcare workers on the patients’ condition.  We were looking for brain-dead donors whose families could be approached about organ donation. I know that sounds a little ghoulish, but we had no other way of actively locating possible donors. Relying on “word of mouth” referrals to passively locate a donor was much less productive.  I was always pretty smug when I found a potential donor, not realizing what it actually meant to the donor and his/her family. When a donor was located the perfusionist on call was notified by beeper (there were no cell phones) to gather the Swenko organ preservation equipment and also the instrument pack that the procuring surgeon would use to “harvest” the kidneys. While others on the harvest team (surgeons and nurses) proceeded directly to the donor hospital, the perfusionist was required to pick up the equipment from the home hospital before proceeding to the donor hospital.

The Best Recipient

Since there was no metropolitan organ bank and mine was the only hospital doing kidney transplants in the city, it had to do the tissue typing as well.  Potential transplant recipients with compatible blood types with the donor were called and told to remain NPO (consuming no food or drink).  When the kidneys were collected, blood specimens were also collected for tissue typing upon return to the home hospital. When this was completed, the best recipient was called into the hospital for transplantation. Often, we had two kidneys. So, two recipients were called and two transplants were performed. Once back at the home hospital, the task of slowly decompressing the kidneys within the hyperbaric chamber of the Swenko was timed to be completed just as the transplant surgeon was ready to implant the organ.

The Oldest Hospital

One day I was dispatched to the oldest hospital in the city, built around the beginning of the 20th century without central air conditioning. Let me set the scene in the OR. The anesthesia machine looked like something out of Frankenstein’s lab with a maze of dials, gauges, and tubes. The electrocautery was the size of a small refrigerator. Nowadays they are the size of a shoebox. And all the medical gases were supplied from standing tanks in the room rather than from wall outlets. Surgical suction was captured in non-disposable glass bottles and all the suction was supplied by noisy vacuum pumps in the room. Nowadays, suction comes from a quiet wall source and uses disposable canisters to keep from contaminating nurses at clean up. Still, when I entered the OR where the donor was located, I was surprised to see open windows with screens along one wall of the room. The OR was on the top floor (5th) of the building and it was a sweltering midsummer’s day.  I wondered why they did not have at least a window A/C unit. The fact that this was a state-run hospital probably had a lot to do with its obsolete status.  This hospital was part of a medical school and there were a lot of students, interns, and resident doctors in the room to learn about rare organ procurements.  So, it was crowded and noisy with conversation; unusual during most other surgeries.

Gun Shot To The Brain

The donor lay on the OR table and was being ventilated by the anesthesia ventilator. New state law required a flat electroencephalogram (EEG) on a beating heart donor to document brain death. At the head of the table stood an EEG technician who was trying to attach electrodes to obtain a brain wave study.  The EEG technician was having some difficulty because, in this case, the donor had attempted suicide by shooting himself through the roof of his mouth and blowing the top third of his cranium off. What remained of the brain was a gory mess of grey matter and blood dripping on the floor. The bullet must have missed the brain stem because the heart was still beating on its own. I doubt that in her training the EEG technician was ever taught to make a study on a mutilated brain such as this. She placed what electrodes she could on the parts of the cranium that were still intact. Then she began pushing the remaining electrodes into the exposed brain goo. She finally completed the study, but I always wondered if following the letter of the law for brain death was necessary, at least in this case.  This was a new law to protect donors and nobody present wanted to forgo it though brain death was quite obvious even to the uneducated observer. The organ procurement proceeded without interruption thereafter. I placed the kidneys in my Swenko organ preservation machine and headed to my home hospital to prepare for the transplant procedures and a new life for two kidney transplant recipients. This episode taught me to expect the unexpected; anything from old, obsolete equipment to a mutilated organ donor.

 

* I have written before about the Swenko organ preservation system: Grist G. Hedlund K. AmSECT History Committee: Swenko. AmSECT Today, Apr/May/Jun 2021, 23(5): pg 46-47.

 

I don’t like the term “organ harvesting” in describing how organs are obtained for transplant. In a way, the term dehumanizes the unfortunate donor. I think “organ harvesting” must have been coined by some surgeon over half a century ago to avoid the emotional impact of ending one life, no matter how hopeless this individual’s survival maybe, to save the life of another.  I like the term “organ procurement” much better. “Pro…cure” makes me think of the positive contribution the human donor is making to “cure” a fellow human being.

The Dawn Of Transplantation

Early in my career as a perfusionist (1968), I was a part of my hospital’s kidney transplant team. A perfusionist is trained to operate the heart-lung machine and other specialized equipment. The reason a perfusionist was on the kidney transplant team was to operate an organ preservation machine called a Swenko*.  This was at the dawn of organ transplantation in the USA. Only kidney transplants were being performed by our hospital, no hearts or lungs. There was no United Network for Organ Sharing (UNOS) which today is a private, non-profit organization that manages the U.S. organ transplantation system from procurement to transplantation. Back then my hospital was acting independently and learning as it went.

Looking For Donors

As part of our daily routine, transplant team members would scan the newspapers for reports of automobile accidents and in particular motorcycle accidents whose victims might have severe brain damage. (This was before the existence of any helmet laws.) Various hospitals were called to obtain information on accident victims to see if they might be potential kidney donors. Sometimes we even “cold-called” units to inquire about any possible donors. In those days ICU nurses would freely give information to family, friends, and other healthcare workers on the patients’ condition.  We were looking for brain-dead donors whose families could be approached about organ donation. I know that sounds a little ghoulish, but we had no other way of actively locating possible donors. Relying on “word of mouth” referrals to passively locate a donor was much less productive.  I was always pretty smug when I found a potential donor, not realizing what it actually meant to the donor and his/her family. When a donor was located the perfusionist on call was notified by beeper (there were no cell phones) to gather the Swenko organ preservation equipment and also the instrument pack that the procuring surgeon would use to “harvest” the kidneys. While others on the harvest team (surgeons and nurses) proceeded directly to the donor hospital, the perfusionist was required to pick up the equipment from the home hospital before proceeding to the donor hospital.

The Best Recipient

Since there was no metropolitan organ bank and mine was the only hospital doing kidney transplants in the city, it had to do the tissue typing as well.  Potential transplant recipients with compatible blood types with the donor were called and told to remain NPO (consuming no food or drink).  When the kidneys were collected, blood specimens were also collected for tissue typing upon return to the home hospital. When this was completed, the best recipient was called into the hospital for transplantation. Often, we had two kidneys. So, two recipients were called and two transplants were performed. Once back at the home hospital, the task of slowly decompressing the kidneys within the hyperbaric chamber of the Swenko was timed to be completed just as the transplant surgeon was ready to implant the organ.

The Oldest Hospital

One day I was dispatched to the oldest hospital in the city, built around the beginning of the 20th century without central air conditioning. Let me set the scene in the OR. The anesthesia machine looked like something out of Frankenstein’s lab with a maze of dials, gauges, and tubes. The electrocautery was the size of a small refrigerator. Nowadays they are the size of a shoebox. And all the medical gases were supplied from standing tanks in the room rather than from wall outlets. Surgical suction was captured in non-disposable glass bottles and all the suction was supplied by noisy vacuum pumps in the room. Nowadays, suction comes from a quiet wall source and uses disposable canisters to keep from contaminating nurses at clean up. Still, when I entered the OR where the donor was located, I was surprised to see open windows with screens along one wall of the room. The OR was on the top floor (5th) of the building and it was a sweltering midsummer’s day.  I wondered why they did not have at least a window A/C unit. The fact that this was a state-run hospital probably had a lot to do with its obsolete status.  This hospital was part of a medical school and there were a lot of students, interns, and resident doctors in the room to learn about rare organ procurements.  So, it was crowded and noisy with conversation; unusual during most other surgeries.

Gun Shot To The Brain

The donor lay on the OR table and was being ventilated by the anesthesia ventilator. New state law required a flat electroencephalogram (EEG) on a beating heart donor to document brain death. At the head of the table stood an EEG technician who was trying to attach electrodes to obtain a brain wave study.  The EEG technician was having some difficulty because, in this case, the donor had attempted suicide by shooting himself through the roof of his mouth and blowing the top third of his cranium off. What remained of the brain was a gory mess of grey matter and blood dripping on the floor. The bullet must have missed the brain stem because the heart was still beating on its own. I doubt that in her training the EEG technician was ever taught to make a study on a mutilated brain such as this. She placed what electrodes she could on the parts of the cranium that were still intact. Then she began pushing the remaining electrodes into the exposed brain goo. She finally completed the study, but I always wondered if following the letter of the law for brain death was necessary, at least in this case.  This was a new law to protect donors and nobody present wanted to forgo it though brain death was quite obvious even to the uneducated observer. The organ procurement proceeded without interruption thereafter. I placed the kidneys in my Swenko organ preservation machine and headed to my home hospital to prepare for the transplant procedures and a new life for two kidney transplant recipients. This episode taught me to expect the unexpected; anything from old, obsolete equipment to a mutilated organ donor.

* I have written before about the Swenko organ preservation system: Grist G. Hedlund K. AmSECT History Committee: Swenko. AmSECT Today, Apr/May/Jun 2021, 23(5): pg 46-47.

 

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Perfusion Theory is an educational platform for the Oxygen Pressure Field Theory (OPFT). August Krogh’s theoretical concept of the oxygen pressure field is explained and then applied to clinical applications in perfusion practice.

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