“Organ Transplantation: A Gift of Life” was the title of the Nursing Grand Rounds presentation in October. It was prepared and presented by the ICU staff. The speakers included Hannah Campbell, R.N.; Jan Manson Watson, L.P.N.; and Helen Leslie Bottenfield, R.N., Coordinator for the Virginia Organ Procurement Association.
Jan, who has been an ICU nurse specializing in the care of neurologic patients for six years, began the case presentation. She described an accident occurring in the hold of a Coast Guard ship. A 21-year old man fell 60 feet, sustaining a severe head injury. He had cardiac and respiratory arrest at the scene and was transported by Nightingale Air Ambulance to Riverside Hospital. A chest tube was inserted in the Emergency Room for a hemothorax, then he was taken directly to the Operating Room for a laparotomy. An intracranial monitoring device was also inserted. He was then taken for a cerebral CAT scan. The CAT scan showed a subdural hemotoma with a hemispheric shift and a large degree of cerebral edema.
Over the course of several hours in the ICU, his neurologic condition deteriorated. The physician ordered one-to-one nursing care. The patient’s intracranial pressure continued to increase despite aggressive medical and nursing interventions. In the evening hours, the physician informed the nurses and the patient’s family that the prognosis was grim.
By the early hours of the next morning, the patient was totally auflexic, had no spontaneous respirations and had fixed dilated pupils. When the physician made rounds that day, he instituted studies to determine brain death. Once completed, the diagnosis of brain death was verified and Helen Leslie, the coordinator of the Virginia Organ Procurement Association, was asked to come see the patient.
At that point, Hannah Campbell, R.N., who has been an ICU nurse specializing in the care of neurologic patients for three and one-half years, took over. She defined brain death for the audience. She outlined the Harvard Criteria established in 1968, and updated us on changes instituted since that time. From her slide presentation, the audience was able to visualize comprehensively what it would be like to care for the brain dead patient. She emphasized in many ways the importance of caring for the patient as just one part of the family unit. This patient’s family included a young wife and baby. Neither he nor she had family in this area.
During the course of the patient’s illness, the nursing staff was very anxious to assist in supporting the patient’s family as they arrived from North Carolina. They worked with both the hospital and the Coast Guard Chaplains in supporting the family.
Helen Leslie Bottenfield, as the coordinator of the Virginia Organ Procurement Association, then summarized what transpired when it became evident that the patient could not survive. She emphasized how crucial it is that the option of organ transplantation be presented as a positive thing in this time of tragedy. She described going to see the family with the physician after he had initially suggested organ donation. The family members recounted what a kind and giving person the patient had been. She remarked that they had said, “He would give you the shirt off his back.”
Helen also feels strongly that the family needs her support and acceptance. For that reason, she allows them to work through their feelings of loss and death. If through this process they see organ donation as a positive gesture, she will put their desire into action. Helen points out that as many as 20 people could be helped by one person depending on the organs donated. Kidney and eye donations are the most common but hearts, liver, bone and skin can also be donated. She is also quick to point out that this is a true “gift.” It is a gift from the one human being and his family to another human being. It does not cost the donor or his family, nor does it cost the recipient.
Helen recounted that the kidneys were transplanted into a teenage boy and a young man with two children. Eyes and bone were also taken. She told us that she sent the family a letter to let them know this. Sending a follow-up letter like this is a routine she always follows. She feels it will serve to remind them that their loved one did not die in vain.
Hannah Campbell, R.N.
ICU, Riverside Regional Medical Center
Jan Manson Watson, RN
ER/Trauma Center, Riverside Regional Medical Center
Helen Leslie Bottenfield, R.N.
Coordinator for the Virginia Organ Procurement Association (now LifeNet)