The Day of the Beating Heart Donor

24/08/17

I observed an eye-opening and mind-boggling event today – something I had heard of a thousand times before, and I knew was commonplace and such a great, great gift to give to someone – yet you never think things through and the details and the minutiae and the step-wise journey that gets you to a certain result sometimes just doesn’t register till you are actually on the other side of the coin. Today I observed an anaesthetist keep a clinically braindead patient comfortable on his journey to giving the greatest gift to a multitude of individuals – through his organs that he donated, the gift of life. I am still reeling, and literally have no words to express how chaotic and inexplicably sad I felt on the inside, and what the whole process entailed and how I came to realise and came to terms with what I bore witness to today – I will surely like to revisit this topic at a later point for a much-needed debrief. But not today. I just felt like I had to share something about this day, and I will. But not today.

RIP.

26/08/17

OK – so here I am, it is the following weekend – and I finally have enough time to do justice to this post
the day began with a pain clinic round – for those of you just joining us, I am now in a anaesthetics placement currently, and aside from all the wonderful cases we are meant to preside over anaesthetics-wise in theatres during various surgeries, we are also required to oversee patients in acute painful crises of any sort, and make a pertinent plan for adequate analgesia, whether it be a PCA pump or varying doses of different drug regimens. It was a cheerful day – not because we saw patients in pain, but because we saw the aftermath of what adequate analgesia does – happy, comfortable, asleep patients – patients with broken vertebrae from falling off horses and post surgery patients and patients with chronic pain issues who had become acutely unwell – all were magically comfortable with the various cocktails measured out to them in various dispensers (epidurals, blocks, PCAs, oral/iv/subcut/intramusc meds) – and to top it off, my consultant was a particularly cheerful, fun person; the ward round was informative and collaborative, and we struck up a dynamic where we bounced ideas off of one another, and she made sure I felt included and did not feel as alienated with the whole deal of being new to the idea of a pain clinic as I thought I would be.
Fast forward to 3 hours later and my consultant gets bleeped about being roped in to performing the anaesthetic for a donor extraction surgery – a team from the nearby major transplant centre were coming in to perform the surgery, and to harvest the organ(s) from a patient currently admitted in our hospital. My consultant asked me if I wanted to continue with the day’s pain rounds or would I like to join her in the theater to see this procedure? I excitedly said yes, thinking I would get to see the miracle of someone donating their kidney to their loved one and both donor and recipient ending up side by side on adjacent beds in the ITU. The reality was far from this very romantic notion.
As I changed into theater-appropriate attire – I realised what was going on as the team from the other hospital introduced themselves and told us the story – this was a 50-something male patient, who had suddenly had a massive stroke, and had been declared clinically brain dead the evening before. He was being kept artificially alive on a ventilator, and the family had said their goodbyes and understood the terminal nature of his condition. All of this however did not prepare me for what this procedure actually entailed: We would be providing anaesthetic to a brain dead patient, in order for him to be as comfortable as possible during the procedure which would entail the team of surgeons harvesting whatever organs had been consented for donation (in this case both kidneys, liver and pancreas) and for us to keep his organs as adequately perfused and optimum physiology as possible till the last possible minute, and at the point of removal of the organs, the blood exsanguinated from his body, at which point we were told ‘your services would no longer be required’ meaning to say the patient would then have been declared officially dead. So we wheeled this patient into the operating theater for what were to be his last few hours of life (albeit artificial due to the ventilator). It doesn’t get any sadder than this does it? It does, in fact. Not with anything else that happened during the procedure – but with the multitude of realisations I had over the next few hours.

I have seen asystole many hundreds of times (I am not proud of it, just the nature of my job) but I have never seen a beating heart become…just a heart. It literally was beating enthusiastically one second right in front of me and then it…wasn’t.

I have attended many surgical procedures which involve trying to get the patient to improve – never to mark the end of their life.

I have seen a heart being jump-started by electric paddles to kickstart it to life – never have I experienced the opposite, cardiac activity ceasing as a result of the drainage of blood from the major vessels entering the heart, and therefore from the rest of the body.

I have heard of so many organs that are transplanted into deserving human beings whose very life depends on the organ(s) being amazingly gifted by someone else who no longer requires their use – but I have never quite registered what it means to actually remove tissue of any sort from a ‘alive-till-the-organs-are-removed’ body so that once these viable tissue are removed, the body will essentially very quickly shutdown.

But I also had one other, very major overwhelming realisation: there is no precedence and no other example I feel of such an amazing, voluntary gift, either on the part of the donor, or on the part of the family who consent to the donation – a gift that may well mean (quite literally) the difference between life and assuredly painful death for so many individuals. While I may have initially felt that the procedure meant the end of a life, I was wrong. The procedure that I witnessed did not just mean the start of a new lease of life for the individual(s) who got those organs, but also their families and friends and loved ones and all the lives in turn they will interact with and influence and touch just by being alive – they may go on to teach, to lend, to help, to protect, to heal, to donate; they may go on to hold someone’s hand, walk someone down the aisle, attend a graduation, a christening or a birthday. They all owe every moment from here onwards to this, the procedure that started it all – thanks to the beating heart donor.

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