Organ donors

thataway

Active member
This is about an experience that my friend had with the death of his wife who was an organ donor. I am looking for feedback from anyone who has had recent experience with donation or transplants--or knowledge of the protocol. I had some extensive experience with this about 45 years ago.
There are also some cautionary aspects of this story for all of us who may want to donate organs.

I was under the impression that the national database was universally used to determine organ donation priority and protocol. This may not be the case.

Our friend was brain dead when she arrived in Memphis about 10 AM Monday morning. Her husband (a dentist) had done CPR for 30 minutes before the paramedics arrived, and maintained perfusion. (They live in a remote area on Pickwick Lake).

The paperwork and interviews for donation were completed about an hour after her admission. She was kept on life support for 24 hours until her daughter (also a dentist) arrived from Seattle area. Some blood was drawn at the time that the family thought that she was going for organ harvest--about 11 AM on Tuesday morning. It is not clear what tests were done before this time.

At 11 PM Tuesday night, both the husband and daughter received phone calls from the organ harvest team, saying that they could not use her organs because she had a positive test for hepatitis C. This was greatly disturbing to the family, who had been without sleep for at least 36 hours, it meant that her wishes for donation would not be granted, and it also raised questions where she had acquired hepatitis C and if other family members had Hepatitis C (intravenous drug use, tattoos, piercings, blood exposure, or unsafe sexual practices are associated with Hep C). The next morning at 9 AM (almost 48 hours after admission) the family was called again, and told that she did not have hepatitis C--there was a "mistake"--and that the organs could have been used either for any recipient or even if she had Hep C, for a Hep C positive recipient....

What I believe happened was that the antibody test was done for Hep C initially--this occasionally gives a false positive. Then the RIBA (recombinant immunoblot assay) which takes longer to do and is more expensive was done, and being negative showed a false positive antibody test. These tests should have been done immediately on her arrival at the hospital.

The husband and daughter were not emotionally able to tell this story until the night before we left Pickwick. Some neighbors were also present (they also have medical backgrounds)--and they had a similar problem at the same hospital with a brother who was an organ donor due to brain damage. They then told us that a commercial team was harvesting the organs. I believe it was Mid South Transplant Foundation which was involved. From what I can find this is a 501C 3 corporation--listing category as "educational" but organ harvesting is its specific purpose. The income is $11,000,000 a year or more.

It is not clear if the national database (UNOS) is used or not at this hospital. It is the same hospital where Steve Jobs got his liver transplant (he had a form of pancreas cancer, and seems to have gotten a transplant a bit faster than the average--and for a condition which is controversial).

So question is does any one have recent interaction with organ donation and what was the protocol followed?

Suggestion: find out what database is used by a hospital where a donation may take place, and be sure that it is the national database UNOS, where over 115,000 people are waiting on a transplant. (Many die because of a lack of organs, and we are appalled that the opportunity for this family to have donated was wasted.) Unfortunately the time of organ donation is an extremely high stress period, and we assume that all of the "right" things will be done. Be sure that the tests for donation are done immediately when the decision is made that there is no chance of the donor's survival.

Thank you for any information--and if you would rather keep it personal, please use the PM or E-mail. The family knows that I am inquiring at some sites.
 
Brent,
I am not sure what confirmatory test was used--and what happened is only speculation at this point. I do believe that RIBA is still used, but there may be some better or more rapid test.

I do have a lot of information on Mid South, including their financials, BOD, 503C status etc. I don't have a copy of protocols. I have sent an inquiry ref standard protocols, which has been forwarded to a transplant surgeon at a center where I trained.

In the distant past all harvesting was done at academic centers. That has changed with over 100 organ harvesting groups in the US. However I am not sure that all use the same standards. (I have found some guidelines)

When I was in the cardiac post open heart ICU one of the patients was an organ donor--and I watched that scenario unfold right in front of me. In that case the surgeons at UAB did the harvesting.

Many organs go to distant recipients--but in some cases there seem to be private databases--and some wealthy patients can be put on a number of these databases, and have a jet to fly them to the center if an organ becomes available. (This presents a bit of a moral dilemma, since the idea was to have a single national database, where tissue match and time on the list were the major criteria.)

In looking at the members of the Association of Organ Procurement Organizations, the nearest Florida harvest team to Pensacola is about 400 miles away. --there are closer teams in other states. There are very few transplants done in Pensacola, because there are no active transplant teams or harvest teams. On the other hand, Birmingham AL, Nashville, TN, Memphis, TN have high transplant numbers because of the academic centers and transplant harvest groups.

Just signing a donor card, does not always guarantee that organs will be put to the best use. Perhaps this post will make others aware of the important issues of transplants and organ donations...
.
 
Bob


I agree with you.

We stopped using the RIBA (was Chiron and now sold by BioRad) b/c of frequent back orders and now using Gen-Probe NAT (nucelic acid test)

APTIMA HCV (Hepatitis C virus) Qualitative Kit for HCV Screening

The APTIMA HCV Assay is an in vitro nucleic acid amplification assay for the detection of HCV RNA in human plasma or serum (HCV Screening). The APTIMA HCV Assay is indicated for use with fresh or frozen specimens

http://www.gen-probe.com/products-servi ... tative-kit


For RIBA (recombinant immunoblot assay)
see
http://www.bio-rad.com/prd/en/US/CDG/PD ... 03.0%20SIA

This test offers improved seroconversion sensitivity, demonstrating sensitivity early in 52 out of 86 seroconversion panels (30 percent) and high correlation with HCV RNA. In a study of 220 HCV RNA positive individuals, 99.5 percent were reactive using RIBA 3.0 SIA [Damen et al. Transfusion. 1995; 35(9):745–749].
 
After our friends work thru their grief, they will be pursuing the issue to prevent this from happening to other families. The organ donor world is far from perfect, and a "cause" is often a good way to work out feelings.

Another close friend lost his son to brain injury, and because of interference by the county coroner there was no donation of organs. This friend worked hard and was able to affect change in the system.

I will give follow up in a few months as we find out exactly what happened. Families are very vulnerable at the time of sudden death of a loved one, and often we don't understand what is happening when there is an organ donor. There are ways to be sure that wishes are followed, and I will try and outline those in time.
 
Back
Top