At the sharp end of organ donation

Chris Hogan

10/07/2018 11:46:11 AM

Dr Chris Hogan reflects on a transformative experience from his early days in healthcare.

Dr Hogan encourages patients to join the donor registry and inform their next of kin.
Dr Hogan encourages patients to join the donor registry and inform their next of kin.

It is amazing how interconnected our lives are with the people around us.
I recently met a friend after a long absence and I was struck how much her appearance reminded me of her own mother. An Irish phrase stuck in my mind, “Your (parent) will never be dead while you are alive”. I thought of how much that sentiment applied to my other friends and even to me.
Suddenly, I thought of another friend’s mother and the circumstances of over 40 years ago came flooding back as I recalled her battle for life.
I was a resident on rotation from a city hospital in a regional centre, and I was working in emergency and the wards. It was hard work with long hours, but I felt I was making a contribution and learning what I needed to fulfil my ambition to be a good GP.
Some teenagers had been playing stupid games with powered vehicles resulting in fatal consequences. The others involved had died at the scene and this one child was brought in clinging to life. He was intubated and given IV fluids, but his head injuries were too severe to transport him to the city – he was going to die.
At that time, I felt close to my friend’s mother and could speak freely to her. She was in renal failure, on dialysis awaiting transplantation and was anuric.
‘There is little more pleasant than passing urine. How I miss it,’ she said to me.
The child who came to the hospital after being involved in the motor vehicle accident was of adult size and a good candidate as an organ donor.
I mentioned this to the duty surgeon (now dead these many years). He was terrified and refused to have anything to do with it. He would not talk to the family, assist with the donation or even talk to the transplant unit.
‘If you want it, you do it,’ he told me bluntly.
So I did it.
I was not fearless – far from it – but if it meant that my friend’s mother got to pass urine again, I would try. Hard.
I had long phone calls with the transplant surgeon (who had been my examiner in final year) on the logistics of harvesting an organ. There was a strong chance I would have to operate myself. My knowledge of anatomy was good and surgeons had let me take a major part in operations already.
If I had to, I would.
Writing this now, it seems unimaginable that a junior doctor would be put in this situation, but I was.
The first major barrier was to get permission from the child’s next of kin. I had discussed this with the transplant surgeon, who was enormously supportive.
‘How do you get yourself in these situations?” he asked.
‘Wrong place, right time, I suppose,’ I answered in what seemed to be a mantra for the rest of my career.
In spite of all the strategies, the parents were adamant – no surgery, no transplant. They apologised, but felt that they could not allow it.
I had explained that the child was brain dead and could not survive.
‘Take him off life support, please,’ they asked me.
So I did.
I offered to let them sit with the child while they died, but the parents said their goodbyes and left. I felt so sorry for them.
I was married then and we were planning to have children in a year or two. Would I have to watch my own children die?
The nurses and I disconnected the apparatus but left the ET tube in place. The child died without so much as a gurgle and had no need for extra medication.
Eventually, my friend’s mother got a kidney.
‘What is it like to pass urine again?’ I asked her.
‘Simply marvellous,’ she answered, happy to be able to comfortably perform a task so many of us take for granted. She died 14 years later, but I will never forget that smile on her face.
I have subsequently encouraged all my patients to make a will, have an enduring power of attorney, join the donor registry and, importantly, tell their next of kin about it.
I never mentioned this incident to my friend in any detail until I asked permission to write this column.
We live in a different world now, one that is so concerned about not making an error, rather than doing a good job. I marvel at the autonomy I had in my first year out of university but, in those days, I was simply described as a doctor rather than an intern.

donor registry junior doctor organ donor organ transplant

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Max Kamien   14/07/2018 10:36:38 AM

Now I know why you can combine philosophy with history. It is a much better combination than history, politics and media hype