Transplant

Transplant Coordinator. That?s my job. I?m on the organ donor side.
I met with the family of a 19 year old gun shot victim. The hospital did what they could, but he was gone. Dead. Brain dead. Heart still beating, on a ventilator. But his brain steam was gone. Luckily, he had registered himself to be an organ donor. The decision was not theirs.
They let out a sigh of relief. We talked about Cooper?s decision to help others. He had a younger brother, he was 13. Due to Covid 19 he hasn?t seen Cooper. His parents talked about what a joyful kid Cooper was. He was a great big brother. We completed all the necessary paperwork. They wanted him buried tomorrow. That would be hard, but I would try. We would try.
You see, donation takes a lot of people. One person with the donor, many others in the background doing tissue typing, infectious disease tests, then we all can make organ offers. Once we find homes for the organs, we have to coordinate the OR (the recovery or ?harvest,? poor term, in my opinion).
I worked hard to keep him stable. It?s tricky to keep the body alive when the brain is dead. On and off drips most of the night but we made it through. Cooper was resilient.
Cooper was exceptional, healthy, very much wrong place at the wrong time. He was a victim of a stray bullet during a riot in a major city. We found homes for all of his gifts in under 18 hours - heart, lungs, liver, kidneys, maybe even pancreas and intestines. I was very happy to relay the news to his parents.
They were tired but wanted to stay for the honor walk down to the OR - you?ve seen them. Staff along the walls, family walks with the bed...very sweet. We were getting ready to roll down. The mom was very upset. She asked if we were moving too fast...I began to speak when the nurse touched my arm.
Cooper gagged.
We stopped everything. I called all the transplant centers and put everything on hold. MD called to the bedside. No response from him.
What the hell?
I requested a repeat brain death exam. Both parents agreed. All exams consist with brain death. It was now noon the following day. The family understood Cooper was gone.
Recovery surgery was set for 1400. I did not participate but stayed with the parents until he went down. As the patient was being prepped to roll down, he gagged...and coughed? Mom and dad did not see this but I did. I asked if they wanted time with their son. They did.
After a few moments they came out and said ?he?s gone, take him. Let him help.? I thanked them and asked if they had any concerns. A prompt no was the response.
I went to him, gasping. Light in his eyes. ?Can you hear me?? Nothing. Can you feel this? I pinched him, nothing. I suctioned him, shone I light in his eyes, touched them with cotton balls, poked, prodded , but nothing. I called the doctor.
?I?m sorry to bother you, but this is a donor case and he has abnormal reflexes . Can you have a look??
?That patient is dead. If you are asking me to bring him back from the dead we have an issue...?. His nostrils flared.
?Sir, he has gagged, twice. I know he has been pronounced but -?
?But what? You want me to bring him back? Tell his parents? Hum?? He scratched his forehead. I was frustrated. ?Sir, can we repeat a clinical exam and an apnea exam? Now?? I ask. I?m tired.
?Why, he?s already dead. Look at him. My brain death note is final. No more tests.? The doctor storms off. I felt out of line. I was not.
We proceed with the honor walk. Cooper has a lot of friends. His parents say a final good bye. We enter the operating room. Cooper is connected to different monitors, a new vent, there is a different transplant coordinator there...I?m only for support now.
Incision - heart rate sky rockets, blood pressure through the roof. He?s fighting the vent...but he?s dead, right? Anesthesia is administering medication, we are trying to stabilize him. He?s going into VTACH. We need to shock him. His chest is open and I get the internal paddles...I notice something, a tear on his cheek. I wipe it away.
?Cooper, honey can you hear me?? A gulp. No, a nod? I check his eyes, no pupillary response, just a gulp.
?Cooper, are you in pain?? Gulp, gulp, gulp
I stop the OR for now. I call my admin.
They ask if he has a pupillary response- no. Pain? He responded to incision. I check nail bed response again. Nothing.
Gag? I suction him. Nothing. Corneal response? No. Cold calorics? I inject ice water into his ears with a doctor present and he doesn?t respond. Dolls eyes? I move his head side to side. They are fixed. He take him off the ventilator to see if he breaths on his own for 15 minutes.
15 long minutes.
Cooper did not breath. He was reconnected to the ventilator and administration was called. I left the room and cried.
Cooper donated his heart, lungs, liver, kidneys, and pancreas. When he was taken to the morgue, he had tears on his face. I called his parents to let him know he how many people he had saved. They thanked me. I sat still for a long time. He had tears. His eyes looked - pained. I drove home that day and turned in my resignation.


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