Case Studies from Lynn Cravero,  RN, C.P.T.C
            Assistant Director Organ Procurement Coordinator
            University of Miami

Case #1

Horizon Hospice calls the OPO with a potential organ donor referral. Mr. Herrera is suffering from end stage primary cerebral neoplasm.  He has begun to have mild respiratory distress and is unconscious.  His daughter is asking that he be considered as an organ donor and that his liver be given to his niece who is a status #1 (imminent death within 72 hours w/o a transplant). 

You, the Procurement Coordinator, explained to Mr. Herrera’s daughter that in order to be an organ donor, Mr. Herrera would have to be placed on a ventilator, to keep his organs oxygenated, until he reached brain death.  The time that it would take to reach brain death was impossible to predict. His daughter states that,  “if her father was aware that his niece was so near death, he would do anything to save her”. You consult with the transplant team and are informed that Mr. Herrera is a match for his niece.

Upon review of Mr. Herrera’s Advanced Directives, he had stipulated that he did not want any procedures performed that would extend his life. You inform the transplant physician that you have discovered the presence of this document and he tells you to accept the daughter’s consent and seek an order to place Mr. Herrera on a ventilator, as his family knows the patient better than you do.

Does the daughter’s interpretation of her father’s wishes supercede his Advanced Directives?  If Mr. Herrera was unaware of his niece’s condition, does his family’s assessment of his wishes take precedence over this document presumably signed in ignorance of his niece’s plight? 

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Case #2

Children’s Hospital calls the OPO with the referral of a 5 year old, white male suffering an anoxic incident from a near drowning.  The patient is expected to reach brain death in the next 48 hours but the mother “wants to talk to someone about donation now”.

After you have explained the donation process and the hospital’s  brain death protocol to the mother she enthusiastically embraces donation.  Since the child is not brain dead, it is not appropriate for consent to be obtained and you cannot take any part in his care but you can do a preliminary evaluation from information contained in his chart.  You determine the height, weight and blood group (AB neg), and give this information to the heart and liver transplant teams.   This blood group is extremely rare and may be the only hope of recipients with this same type to get a transplant. You are told that there is a 4 year old female, currently comatose, who matches this patient and needs a liver, small bowel and pancreas. The national list has a priority patient in Alabama, a 6 year old male currently on ECMO, with a matching blood type, critically in need of a heart.

The next day the potential donor reaches brain death and is pronounced.  The mother signs consent.  After a more detailed evaluation you find that the heart, abdominal organs and the kidneys are suitable for transplant.  You notify the appropriate centers and each readily accepts the organs offered.  You convey this information to the mother who appears to receive some solace from the fact that other children are going to benefit from her child’s gifts.  Two hours before the recovery time, the donor’s grandparents arrive and vehemently express their opposition to donation.  The mother takes you aside and tells you that she is going to say her goodbyes to her child and get the grandparents to leave with her after which she wants to proceed with the donation.

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