“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 some surgeons must have coined the term over half a century ago to avoid the emotional impact of ending one life, no matter how hopeless this individual’s survival may be, to save the life of another. I like the term “organ procurement” much better. “Pro…cure” makes me think of the human donor’s positive contribution 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 specialized equipment. A perfusionist was on the kidney transplant team 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 my 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. Helmet laws did not yet exist. 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 patients’ conditions. We were looking for brain-dead donors whose families could be approached about organ donation. I know it sounds a little ghoulish, but we had no other way of actively locating possible donors. The public was not yet aware of the need for kidney donors as part of the general public consciousness like it is today. 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 really meant to the donor and their 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 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 First Fixed Wing Air Transport Organ Retrieval
One of the heart surgeons, Dr. Clarke Henry MD for whom I ran the heart-lung machine, was also a licensed pilot with a multi-engine rating. On one occasion, the transplant team learned that a kidney donor in Springfield, Missouri was available to donate for one of their patients in Kansas City who was awaiting a transplant. The surgeon, who was not on the kidney transplant team, offered to fly his plane from Kansas City to Springfield to retrieve the kidney for transplant. At the Springfield hospital, he assisted in the surgery to harvest the donor kidney before flying it back to Kansas City. This may have been the first fixed-wing aircraft organ retrieval ever performed in Kansas City and maybe even in Missouri. It is surely the only time that the pilot was also the retrieving surgeon.
I did not participate in this harvest, but my boss, the Director of Special Technical Services, accompanied the surgeon on the flight. She said: “In those days we didn’t have kidney perfusion machines which keep the kidneys functioning up to 72 hours after removal. We had to bring the kidney back in a preservation unit, which was something like an ice chest. We were under a bit of pressure for time.”
The Best Recipient
Since there was no metropolitan organ bank and mine was the only hospital doing kidney transplants in the city, it also had to do tissue typing. 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. The best recipient was called into the hospital for transplantation when this was completed. 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. It was built around the beginning of the 20th century and was without central air conditioning. Let me set the scene in the operating room (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, not the shoebox size of today. 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 noisy vacuum pumps in the room supplied all the suction. There is no quiet wall source suction and nor disposable canisters to keep nurses safe from contamination during clean up.
The OR was on the top floor (5th) of the building, and it was a sweltering midsummer’s day. 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. I wondered why they did not have at least a window A/C unit. This was a state-run hospital; that fact 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 conversations, unusual during most other surgeries even today.
Gun Shot To The Brain
The donor lay on the OR table and was ventilated by the anesthesia ventilator. A 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 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 how to make a study on such a mutilated brain 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 new law protected 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 after that. 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.