CHAMBERSBURG, Pa. – Celebrated in April, Donate Life Month encourages organ donation awareness and commemorates organ donors and their families.
In observance of the month, a flag raising ceremony was hosted at Chambersburg Hospital. A donate life flag will be flown for the rest of the month to honor organ donors, and to spread awareness about becoming an organ donor.
At the event, Dr. Peter Jablin, pulmonologist at Summit Pulmonology spoke about his perspective on organ donation.
The following are his remarks:
Our world looks solid, but how we see both objects and ideas will change as our perspective changes. What we see as black and white is composed of grey. There are over 500 distinct shades of grey which can be resolved on my monitor in the Emergency Room. Up close you can see the individual pixels, but from my perspective, on that day, I saw an image of Jim’s brain. The CT scan created ultra-thin slices of his brain and I saw the abnormality, the size of a child’s fist within the right hemisphere. Jim had collapsed at home that morning. He was rushed to our Emergency Department. He was in a coma. I was called to see Jim because he was on life support. The images revealed a collection of blood large enough to compress his brain within the rigid confines of the skull. Over 500 shades of grey distilled to ONE black and white perspective. It was already too late. Jim would certainly die. And I had not yet met the family.
The neurosurgeon and I entered the room together where Jim’s wife, his adult children and their spouses waited in shock. We introduced ourselves. We examined Jim. His pupils did not react. The neurosurgeon explained that surgery was not an option. The bleeding was too much and it was too late. And then we spoke some more. I see my role as a guide in these moments. Some words no one wants to hear but how can we move forward, together, how can we accept, if we do not know? I told Jim’s wife that the situation was very, very bad, that there was nothing we could do to change the outcome. That her husband would die. Their son was out of the country, on vacation. They needed time. “Can’t there be a miracle?”
Then Jim moved. His arms drew up over his chest, almost like a monk in prayer but with the back of the hands touching. Everyone in the room saw the movement. “He moved!” “Yes …. That drawing up is involuntary. It occurs when the signals from the brain no longer reach the body. That posturing is a sign of the severity of the injury.” Everyone’s perspective was changing.
Jim was moved to our Critical Care Unit and our staff contacted CORE. CORE is an acronym --- The Center for Organ Recovery and Education. We are mandated by Pennsylvania law to contact CORE when a patient is on life support and might progress to brain death.
Here, we have an “open” critical care unit … family can come and go as they choose. Several family members stayed the night, in the room with Jim. We communicated with CORE regularly. A representative from CORE was driving out from Pittsburgh.
The next morning I talked with the family about brain death testing, a very specific and detailed protocol of examination. The family stayed with Jim and I performed the exact steps, explaining what I was doing and what we were seeing at each step. The pupils did not react to light. There was no response to pain in the legs, arms and face. The eyes did not move. The heart rate did not increase in response to a medicine given by vein. To test for spontaneous breathing, we disconnect the ventilator and deliver pure oxygen. Even without breathing, the lungs remain filled with oxygen and the blood continues to circulate. The oxygen level will remain stable. What we look for is evidence of an effort to breathe and we watch and wait for 8 minutes.
That was 5 seconds, about 1% of the 8 minutes we waited. We talked a little. You can imagine what it was like in the room. It was quiet. Jim did not breathe. “1:22 PM,” I said to the family. “That is the time of death.” We all paused. “We have a specialist in care at the end of life. I would like to bring someone to speak with you.” I stepped out and came back with the representative from CORE. In those minutes, everything had changed.
In Pennsylvania, doctors and nurses cannot bring up the topic of organ donation in this circumstance. That is the law. Years ago, I had felt that I SHOULD be part of this conversation, that I had established trust, that I had been present and supportive and that families expected my support. I contacted CORE and received hours of training on what to say, how to respond, all the places the conversation might go …. And I realized how complicated and thoughtful the responses must be. In Pennsylvania, doctors and nurses cannot initiate the conversation about organ donation while they are responsible for delivering care because we predictably fail, and CORE does it better, much better. Most importantly, in this crucial setting, a conversation about organ donation may create the appearance of compromise of our role of providing care for our patients.
Our CORE representative met with Jim’s family. He was still on the ventilator after he had been declared dead. The family had the carefully written instructions Jim had prepared years ago if he died ---- which funeral home to contact, which hymns and prayers, who would talk from the pulpit. There was no mention of donation in Jim’s papers. The instructions were so detailed, thoughtful and specific that the family concluded that Jim would not have wanted to donate.
My perspective? It’s complicated. Every year, 300,000 people in the US wait for an organ. There are 100,000 transplants. Half of these are kidney transplants, so those patients can live with dialysis while they wait and hope. The other patients will not survive. 75 people may benefit from one donor: kidneys, liver, lungs, heart, pancreas, bowel, corneas and tissue. Jim’s family had thoughtfully considered his wishes and made the choice that they believed reflected his will. And that was as “right” an outcome as we can expect.
Our perspective changes and our understanding will change, from the medical view, to the shock of the family, to the care and support at the end of life and, finally, to the opportunity to donate life. The family asked, “Can’t there be a miracle?” I have heard that Torri, our colleague from CORE, sometimes responds this way, “There can be a miracle, but sometimes the miracle we receive is different from the miracle we request.”
About CORE The Center for Organ Recovery & Education (CORE) is one of 58 federally designated not-for-profit organ procurement organizations (OPOs) in the United States. CORE works closely with donor families and designated health care professionals to coordinate the surgical recovery of organs, tissues and corneas for transplantation. CORE also facilitates the computerized matching of donated organs and placement of corneas. For more information, visit www.core.org or call 1-800-DONORS-7.