by David Page
• High serum potassium—results from breakdown of cells; may seriously affect heart function. Easily corrected with medications.
All of these problems must be identified, treated or prevented by the procurement coordinator until organs and tissue are removed.
The Recovery of Organs and Tissue
When the transplant team arrives at the donor patient's hospital, the donor is transported to the operating room with full monitoring of vital functions (vital signs) carried out on the way. This chore is assumed by the donor hospital staff and includes an anesthesiologist, scrub tech and circulating nurse. Intravenous fluid and appropriate drugs are given to maintain circulatory function until the aorta is cross-clamped and special organ-preserving solutions are administered by the transplant team. Mechanical ventilation is stopped at this point.
Organ removal occurs first. Then, tissue is recovered after all support has been discontinued. The body is closed just as it would have been if the surgical procedures performed to take organs and tissues had not followed a life-ending pronouncement. The body may then be sent to the funeral home if no autopsy is mandated by local medical authorities. There is no reason not to have an open casket.
The Process of Performing an Organ Transplant
Before the recovery phase is put behind us, there is a phenomenon called the Lazarus sign you should be familiar with. To help the transplant team, muscle relaxation is induced by anesthesia with special drugs. Despite that, spinal reflexes may persist. The "dead" donor may develop gooseflesh, and the arms may move, flexing and extending at the elbow. This motion is disconcerting to those present and may be quite dramatic as the donor at times seems to be reaching for the endotracheal tube in the throat at precisely the time when all support has been stopped. Try that in your OR scene.
Once the organs have been recovered and placed in appropriate transport containers, they are taken to the recipient hospital (anywhere in the United States or Canada) and transplanted. Airplane travel is most common for long distances, and the organs are accompanied by a member of the transplant team.
The recipient has usually been brought to the operating room while the organs are in transit from the donor hospital. When the organ arrives, it is evaluated for size, function and other technical aspects before being sewn into place. Arteries, veins and other body tubes are reconnected and the organ observed for function. Immunosuppression is begun, and the recipient's blood is tested for the appropriate chemicals that reflect proper organ function.
It's a technical chore from here on in, and only a few glitches might still occur. Prewritten protocols are used to determine what drugs are given and how often. The major concern in the immediate post-transplant period is acute rejection of the organ.
As a writer, you should know that the treasured organ has been accidentally placed in preservative fluid instead of saline on at least one occasion, instantly destroying the organ. More than one organ has been dropped on the floor. And so it goes.
The end point of body trauma is hopefully a survivor with minimal physical and emotional scars. But uncontrolled impact may terminate in death. As you have learned throughout this book, many opportunities present themselves for returning the trauma victim to good health.
Some of those plot twists will have a healing intent. Your characters will thank you for healing them.
