Doctors say they can boost the odds donated organs will be usable by restarting blood circulation with a pump after donors are declared dead. Critics say the procedure blurs the definition of death.
Dr. Marty Sellers, wearing a red scrub cap, and his team from Tennessee Donor Services perform a normothermic regional perfusion organ recovery at a hospital in eastern Tennessee.
Sellers and his team recently agreed to let an NPR reporter and photographers shadow them while they attempted NRP organ recoveries. This is believed to be the first time a journalist has done that in the U.S., according to the AOPO.There are two ways someone can be declared dead and become an organ donor. One is when someone is brain dead because they’ve suffered some kind of total, irreversible brain injury, such as from a stroke or motorcycle accident.
But critics say restarting circulation reverses the very condition upon which the person has just been declared dead. Sellers and others dismiss those concerns as overstating the risks and understating the benefits of NRP. Meanwhile, hospital staff silently line the hallway for an “honor walk.” The donor is slowly wheeled past them on the way to a room adjacent to the OR where doctors will remove her breathing tube. Her family quietly walks behind her bed.
"The two nurses will say: 'She has passed,'"Howell says."We’ll utilize the five minutes of observation time to roll in here. The nurses will make sure at that five-minute mark that there’s been no autoresuscitation. And then will move forward with the recovery." It’s well past midnight when the team gets word that the donor’s breathing tube has been removed, starting the 90-minute clock ticking.
The 90-minute mark quietly passes. The organ retrieval is canceled. The patient is wheeled back into her hospital room. "It was a pretty big disappointment. It was very heartbreaking," McDonald, 44, of Murphy, N.C., said afterward."I don't want it to appear that I was disappointed that my mom didn't pass away. I just wanted her journey to be peaceful. And to be able to carry on her legacy through that wonderful gift that she wanted to give. I kind of felt like her legacy just went with her, and she didn't get to leave a piece of herself behind in such a special gift for someone else.
"So as I’m cranking open the sternal retractor, you get ready to hand me the curved mayos," Sellers tells the nurse. "The family’s on hold. And it’s obviously an emotional time for them,” Sellers says. “The recipients are on hold. They were expecting to take the liver recipient to the OR at a certain time today, and now it’s going to be significantly later."
But everyone has to wait a little longer to make sure her breathing doesn’t spontaneously resume within five minutes.Sellers saws open the donor’s chest and quickly takes the first key step. He clamps closed the major blood vessels from the heart to the brain.That’s trickier too because of the donor’s size. So Sellers eventually ends up converting to a version of NRP that attaches the pump to an artery in the abdomen instead.
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