Area Agency Coordinates Transplants : Procurement Unit Is Vital in Complicated Behind-Scenes Process

In 1985, the Regional Organ Procurement Agency of Southern California coordinated transplants for more than 400 patients, according to transplant coordinator Barbara Schulman.

Acquiring organs to be used for transplantation is a complex procedure governed by strict legal and medical criteria.

Howard Adams is Orange County’s field coordinator for the procurement agency. Adams, 35, is a nurse and a full-time professor of nursing at Saddleback College. It is his job to medically evaluate donors, counsel families and coordinate with a large team of doctors to successfully remove the organ and make sure it is safely on its way to the recipient.

Adams, who evaluated more that 80 donors in 1985, explained that he will usually receive a call from Schulman or one of the other transplant coordinators at the agency with the name of a possible donor. Typically this patient has suffered a traumatic injury that doctors believe will cause brain death but not damage vital organs.

Once the doctor informs the family of the prognosis, a social worker, or the doctor himself, may ask if the family is interested in donating the organs. Sometimes the request will come from the family. A new state law that became effective Jan. 1 requires all hospitals to have procedures for accommodating organ donation.

Assess Situation

If the family expresses interest, the agency will be called, and at the appropriate time, Adams or one of the other field coordinators will be dispatched to assess the situation and talk with the family. A family is never pressured, Schulman said.

“Counseling a family (through this process) can take hours and hours--and it should,” Adams said. “Losing a family member is a crisis in the family, and organ donation may be a secondary thing to them at this point. The family needs help in understanding what is happening.”

Adams said families often are concerned about disfigurement (which doesn’t occur, he said), having to postpone funeral arrangements and being faced with additional costs (the agency pays for procedures connected with organ donation).

Families also want reassurance that every effort will be made to save the family member, even if they agree to donate the organs. Schulman said: “Hospitals make every effort to save life first. Physicians and other health professionals exist to save lives.

“Even though we have lots and lots of recipients waiting, being medical personnel we’re as concerned about the donor as we are about the recipient. It’s very important that everyone feel comfortable. We’re dealing with a human life, which is very precious and very important.

“A diagnosis of brain death is not taken or given lightly. It’s very serious and is done by either a neurosurgeon or neurologist in the hospital. The law says there must be irreversible cessation of function of the entire brain.”

Days of evaluation take place to ensure that brain function will not return, and there must be two independent declarations of brain death--one from the attending physician and another from an independent doctor, neither of whom can be involved in the transplant procedure.

Tissue Typing Is Done

Once the family signs an informed consent, and the patient has been declared brain dead, the donor is kept on artificial support systems, and samples of blood and tissue are taken. These samples are rushed to the UCLA lab, where tissue typing is done. The findings are then entered into the computer and cross-matched with the blood and tissue characteristics of waiting recipients. The best matches are then identified.

For kidneys, body size is not a factor since the kidneys will grow or shrink within four to six weeks to meet the needs of the recipient. However, with hearts and livers the donor and recipient must be about the same height and weight because, for example, the heart of a 125-pound female can’t pump enough blood for a 200-pound male. Being of the same sex or age, however, makes no difference

According to Schulman, there are 600 people awaiting kidney transplants, and sometimes there may be two or three best matches. Then the decision will be based on length of time on dialysis or urgent need. For hearts and livers, however, sometimes there is no compatible recipient. In that case, the organ is not removed from the donor.

Once a match occurs, the transplant surgeon is called. When more than one organ is being provided by a donor, several teams of surgeons may be called in from different locations to remove the organ that is to go to their patient. Adams, meanwhile, along with the people at the agency’s main office, helps to coordinate these teams, which range from a minimum of six people to a maximum of 18.

At the same time, recipient coordinators who are nurse specialists in the transplant centers are notified that an organ is available for one of their patients. They, in turn, coordinate with the transplant surgeon to notify the recipient and begin preparations for transplantation.

Coordination Is Crucial

Coordination of the removal of organs and the time it takes to transplant it to the recipient is very crucial. Hearts and livers must be transplanted within four hours of removal; kidneys have a longer “cold life,” but for all organs, the sooner it is transplanted, the better. This means that one team of surgeons may begin on a recipient as soon as the surgeon removing the organ reports that it is a good one.

“It is a high-stress job,” Adams said, “but it’s also high reward. We’re just regular people, but we’re part of a group that can make a difference.

“Almost everyone wants to make a significant contribution, to validate that we’ve been here. This is a way to (do that).”

But, Adams said, leaving instructions about organ donations in a will does not allow for action to be taken quick enough. “People need to communicate to their families what their wishes are when they’re well. It’s a responsibility we have as adults.

“Our hope is that the organ donation may be some positive, humanitarian thing in a very negative experience.”