Organ Procurement and What Nurses Need to Know

Kathy Quan RN BSN PHN - 07/10/19

As the backbone of healthcare, nurses are right there at the forefront in the process of organ procurement and transplant. Sometimes they are members or representatives of a transplant team and other times they are the unit or floor nurses involved in the education of patients, family members and even potential donors; often at the time of death under trying circumstances.

Education and open honest communication are key to successful health care, and in this instance, they may be even more important. Every day 20 Americans waiting for organ transplant will die because there was no donor. The waitlist for organ transplant continues to grow (113,000 in Jan. 2019) as does the registration list of organ donors, but the number of donors is still not keeping pace despite the fact that over 95% of Americans are in favor of transplantation. Sadly, only about 58% of adults in the U.S are registered donors and only small number (3 in 1000) actually die in a manner that allows for harvesting of their organs.

One Donor Can Save Many Lives

On a more positive note, one donor can potentially donate up to 8 vital organs and provide other organ, eye, bone marrow and tissue donations to help save or heal over 75 people according to Donate Life America. Organs that can be successfully transplanted include heart, lungs, kidney, liver, intestines, pancreas. Not all donors are deceased. Kidneys, liver, and intestines can be donated by living matched donors. The most commonly transplanted organs are the kidney, liver, heart and lungs. Those waiting for kidney transplants are the highest number on the wait list.

Donors can register online with the Department of Motor Vehicles (DMV) in their state and often through voter registration. Check with state government websites to find more information. After registering, it’s very important for donors to have a discussion with their DPOAHC (durable power of attorney for health care decisions) and family members to help ensure their wishes are carried out.

The Nurse’s Role

Acute and critical care nurses play a central role in the organ and tissue procurement process.” First nurses have to utilize their skills at the art of nursing and develop a rapport and trust with the patient and family members as they provide safe, quality, patient-centered care. They educate the patients and family members in every aspect of restorative care and into and through end-of-life care. Nurses also support the patient and family’s wishes even if they do not choose organ donation. Emotional support is key to the art of nursing.

Then nurses play several roles in the process of organ procurement including:

  • Identification of potential organ donor
  • Obtain consent and support the family (one of the most important nursing roles)
  • Maintaining the patient in a manner that allows for retrieval
  • Successful retrieval, storage and transport of the organ(s)

Once the nurse has identified a potential donor and notified the transplant team, supporting the patient and family through the end-of-life process becomes a major focus. Death may come by means of a cardiac event, or by being declared brain dead. Brain death is usually the result of traumatic brain injury, stroke, or brain tumor. The brain swells, cells die and neurological function ceases. Once it’s determined this has gone beyond a point of no-return the patient is declared brain dead even if cardiac function continues. Cardiac death occurs when the heart stops beating and circulation and oxygenation cease.

At this point, successful organ retrieval is reliant on placing the patient on mechanical life support to maintain oxygenation and blood flow until procurement can begin. Supporting the family through this part of the process takes a turn towards helping them understand that their loved one has passed, and this is just a mechanical process to keep the organs viable until they can be harvested. Understandably, family may feel a sense of hope for revival. It’s important explain that isn’t going to happen, but that this gift of organs and tissue will help heal and save multiple lives.  

Live Transplants

Organ transplant can also be a process using a live donor. This is usually limited to organs such as a kidney or part of a liver. Medical science may soon take us into the realm of partial pancreas transplants or tissue donation. Bone marrow is also a live donor transplant process.

In the live process, nurses are involved in the direct patient-centered care of recipients as well as donors. Patient education in risks and informed consent are key issues.

Dispelling Rumors

Patient education and dispelling myths are also part of the role nurses play in the transplant process. Donors don’t need to worry about pre-existing diseases, age, or costs. They can continue to sign up to be donors and at their time of death, transplant teams will determine the possibilities. Even if organs cannot be transplanted, corneas, skin and other tissue may be deemed to be quite useful and there are no costs to the donor.