Organ donation

Saying goodbye before organ donation surgery

Doctors must make every possible effort to save the patient’s life. That is their first duty. If, despite their efforts, the patient dies, death is diagnosed by brain stem tests. In the UK, there are very clear and strict standards and procedures for doing these tests. They are always performed by two experienced doctors who are completely independent of the transplant team. Death is confirmed in exactly the same way for people who donate organs as for those who do not. It is around this time that the question of organ donation is raised and the family is given time to come to their decision within medical constraints (see Consenting to organ donation). 
Most organs need to be used very soon after death to ensure they remain suitable for transplantation and the person who has died is not deprived of the opportunity to donate. Once a family had consented to organ donation and accepted that their loved one had died, they said goodbye and then, in most cases, left the hospital. Saying goodbye, understandably, was distressing and traumatic. Added to this was the shock that comes with sudden illness or injury - for this person had been healthy and active only days earlier. Achieving a comfortable and dignified death had been crucial and many relatives had wanted to be present when the patient died. Some people had asked for the hospital chaplain or their own vicar to read the last rites.
The ventilator (life support machine) provides oxygen that keeps the heart beating and blood circulating after death. These donors are called heartbeating donors. Organs such as hearts, which deteriorate very quickly without an oxygen supply, are usually only donated by a heartbeating donor. Patients who die in hospital but are not on a ventilator can, in some circumstances, donate their kidneys, and in certain circumstances, other organs. They are called non-heartbeating donors. Both heartbeating and non-heartbeating donors can donate their corneas and other tissue.
After saying goodbye to her husband John, Linda asked if she could talk to the transplant surgeon.
Switching off the life support machine was traumatic for some people, and a memory that still haunted a few donor families years later. Saying goodbye to their relative felt shocking and unreal because they ‘looked as if they were just sleeping’. Their body felt warm to the touch, they were breathing and their skin was a normal colour. The ventilator keeps the body supplied with oxygen so that the heart can carry on beating and circulating blood. This preserves the organs so they can be transplanted.

When the ventilator is turned off, the heart stops beating, usually within a few minutes. The patient is then taken to theatre for surgery. Some people felt that donor families should be told beforehand that their loved one would still be warm and breathing when they said their goodbyes. Craig and Sandra said their daughter Rachel still looked healthy and pink when they said their goodbyes. Leaving her like that was distressing and Craig felt guilty.
For some people, the image of their relative looking as if they were just sleeping was difficult to reconcile with the news they’d been given by doctors. The brain stem tests had proved that they were dead, yet they were still breathing. Tom, John’s stepfather, said he couldn’t accept the job of switching off the ventilator because, years later, he might still question if he’d done the right thing or switched it off too soon.
After saying goodbye to their relative, some people had wanted to reassure themselves and to see them in the chapel of rest after the surgery had taken place. Most did feel reassured, though a few were saddened when they went to see their loved one and s/he was alone in a room.
Sue wanted to see the funeral director to help her accept that her son, Martin, was indeed no longer alive.
Andrea’s brother, Paul, continued breathing for some time after the tube in his mouth had been removed. She worried that organ donation might not be possible even though that had been his wish.
Some donor families said the specialist nurse (donor co-ordinator) had asked them if they would like locks of their relative’s hair and handprints. They saw this as a sensitive and caring gesture and valued having them (see Interacting with doctors and nurses in intensive care). 

Last reviewed May 2016.



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