When it's time to consider organ, tissue or eye donation in trauma care

May 08, 2021

When you transfer a trauma patient who later decompensates at Mayo Clinic, the impending death triggers an evaluation process for transplant potential of one or more of the patient's organs, tissue, or eyes. In this article, Catherine (Cathy) A. Dudley, R.N., a specialist in the Office of Decedent Affairs at Mayo Clinic in Rochester, Minnesota, and a clinical hospital coordinator for LifeSource, an organ procurement organization, responds to questions often asked by transferring trauma centers about patient organ donation.

What triggers meet criteria to contact an organ procurement organization?

When a patient's life is sustained through mechanical ventilation and he or she has severe neurologic injury, the patient meets the "triggers" for hospital staff to contact the local organ procurement organization to discuss organ, eye and tissue donation possibilities. Also, anytime a death occurs, hospital staff contact LifeSource to report it and see if there's donation opportunity for that individual. Mayo Clinic complies with federal regulations requiring hospital staff to call when a patient meets triggers for organ donation or within one hour after cardiac death for tissue and eye donation.

What does the donation process entail for a trauma patient?

After a patient meets the determined clinical triggers or experiences cardiac death, and the hospital staff makes a referral call to LifeSource, we check Driver and Vehicle Services online records to see if the patient is a designated donor. Individuals can be registered through a driver's license, hunting or fishing license, or an online registry. If the patient is registered and there is donation opportunity, this designation acts as his or her last will. If the patient isn't designated as a donor, legal next of kin such as a mom, dad or sibling may decide for donation. This is why it's important for everyone to have a conversation with family members, a medical power of attorney or both regarding what his or her wishes are with respect to donation.

Once donor designation is made and confirmed, we review the patient's medical record for donor viability prior to a conversation with family. We don't approach the family if there's no donation opportunity. Our job is to offer a family hope and healing, not cause undue hardship during a stressful time.

When considering whether a patient is appropriate as an organ, tissue or eye donor, the patient's organs must be kept perfused and organ viability must be maintained throughout the process to ensure a healthy organ goes to the recipient. When the patient isn't ventilated, eye or tissue donation is still an option. The donation can be made at the time of cardiac death, when discussion with family and procurement planning can occur.

Are there positive aspects of donation?

Yes. For a family losing a loved one due to trauma, organ donation can provide the only positive thing in a time of grief. When facing a devastating blow where there's no other outcome than death of the family member, organ donation may bring a silver lining to the situation. Families can turn grief into focus on helping somebody else, providing comfort. Families feel as if they can participate in saving or greatly improving another patient's life.

It's amazing, the turnaround with these families. I am always struck by their strength, which makes something good come out of loss. It's what we at LifeSource try to do with each family we work with.

One person can save eight lives with organ donation and over 75 others with tissue donation. Eye donation gives the gift of sight to two others and also helps research and education.

Is organ donation designation common in Minnesota?

Compared with other states, Minnesota has a high number of residents opting for organ donation. In Minnesota, the rate is 70%; the national average is in the high 50th percentile. The people of this state are very giving. In 2020, even amidst the pandemic, personnel at Mayo Clinic's campus in Rochester, Minnesota, made over 1,000 calls to LifeSource, leading to 49 lives saved through organ donation and countless others with tissue and eye donation. This is the most lives saved in one year in Mayo Clinic's history.

Surprisingly, less than 1% of those who have agreed to organ donation are able to donate. This is due to many factors and is the reason why we ask people to designate themselves as donors.

Are donors honored in any way?

Yes. We raise a Donate Life flag outside the Francis Building at Mayo Clinic during the donation process. We also do an honor walk with the donor's family and send the flag to the family afterward. In addition, we have Franklin (Kenneth) K. Ackerman, hospital administrator, meet with families to offer condolences on behalf of Mayo Clinic, which provides families comfort.

What ethical considerations do you have to keep in mind with your role?

While we can present organ donation opportunities, we can't coerce families in any way to donate their loved ones' organs.

The relationship between hospitals and organ procurement organizations across the country has not always been ideal, as if we're waiting in the wings for people to die to twist their arms and coerce the families to donate. Rather, I'd want trauma centers to know that ethically, we don't procure organs from anybody who's not authorized. The family needs to sign a designation of gift and must agree. We can't come in and procure organs from people where we've not spoken to the families.

How do I feel comfortable that a patient's organs will not end up on the black market?

Organ trading is not a concern with organizations like LifeSource and Mayo Clinic. It is illegal in every country and is especially mandated in the U.S.

What about the timing of asking a family who's lost a loved one about donation?

The professionals who make family calls are highly trained in communication and sensitivity, and they pick up cues from the families. They collaborate with hospital personnel before the family conversation to ask if staff thinks it's a good time for discussion. LifeSource's authorization rate is 62%.

What if the family has special requests about when the transplant occurs?

We try to work within the family's timetable. Say, for instance, if Aunt Sally is coming in from Arizona to say goodbye to the patient, we can keep the patient ventilated and work with that situation as long as the patient is able to maintain organ viability. The situation may change if the patient's organs are becoming unstable, and then a new conversation will take place with family members to best support their donation decision.

What do trauma professionals at small hospitals need to know about organ donation for their patients?

They need to know when to call, who to call and how to get the family connected to an organ procurement organization.

If I have any questions about the donation process, what resources would you suggest?

If anyone in the trauma field has questions about donations, please see the LifeSource website, email me at dudley.catherine@mayo.edu or call me at 507-293-7800.

For more information

Life Source: Organ, Eye and Tissue Donation.