Caroline Lynch has been an organ donation coordinator for about two years. The former paediatric intensive care nurse says that a lot of people ask her if she finds her job sad or depressing.
The opposite is the case. “I feel so empowered working with families who are donating the organs of their deceased relative,” she says.
One of six organ donation co-ordinators working for Organ Donation and Transplant Ireland, Lynch is on call for 24 hours when on duty. During that time, she could be called to one of the 40 donating hospitals in Ireland to organise donations to the three transplant centres in Ireland: St Vincent's hospital, Dublin, for liver and pancreas; the Mater hospital, Dublin, for heart and lungs; and Beaumont Hospital for kidneys. [A small number of paediatric transplants also take place in Temple Street Children's Hospital.]
As the co-ordinator of organ donation, Lynch is responsible for the entire process of organ donation, which includes dealing with staff in the donating hospital, liaising with the transplant retrieval teams from the transplant centres and, crucially, supporting families throughout the process.
Organ donation is still a rare occurrence in Ireland – not least because organs are mainly retrieved from donors who have died from brain injuries including stroke, car crashes or other traumatic brain death. In these situations, the person is pronounced dead by two independent medical teams and their bodies are put on artificial ventilation until the organs – heart, lungs, kidneys, liver and pancreas – are removed and donated to matched recipients waiting in operating theatres for transplant surgery. About 10 per cent of organs are retrieved from donors who die from heart conditions. In these cases, artificial ventilation is also used to keep the organs functioning until their removal.
Tragic deaths
The time spent with the donor families is intense. “In most of these cases, the person has passed away in tragic circumstances – maybe following a car crash – so I’m always blown away by the strength and courage of families who make the decision to donate organs in these situations. I’m humbled and privileged to journey with families at such an intense and dark moment in their lives,” says Lynch.
According to Lynch, it is so much easier for families to opt to donate the organs of their son, daughter, brother, sister, mother or father if the person has talked about the donation process beforehand. “A lot of families will thank you for bringing up the subject of donation because they are often so shocked at the time that they don’t think about donation,” she says.
Before a donation is carried out, a detailed medical history is taken to ensure that a suitable matched recipient is found. There are always more people awaiting organ transplantation than donors so this is rarely a problem. Donors and recipients are matched according to blood group, weight and height.
Blood samples are also taken and sent to laboratories at University College Dublin and Beaumont Hospital to check for specific viruses which would rule out donation. Anyone who has had cancer or had been receiving treatment for cancer is also ruled out for donation.
“We liaise with the recipient coordinator in the transplant centres to give them the detailed medical history and let them know that donor blood has been sent to the laboratories. Ideally, the transplant surgery – specially for the heart and the lungs – should take place six hours from when the blood samples have been sent to the laboratories,” explains Lynch. If a matched recipient isn’t found in Ireland, the organs will be offered to hospitals in the UK.
Mementoes
The organ donor co-ordinator remains with the donor while the surgery to remove organs takes place. “Some families will say goodbye to their loved one in the intensive care unit while others will walk down the corridor to the operating theatre. Each family decides what’s best for them. I always give them my mobile number and say they can contact me anytime,” says Lynch.
Small gestures such as removing locks of hair or taking hand prints of the donor are carried out to give families mementoes. “Some families will contact us and ask about the recipients and while the process is anonymous, we do give them a little bit of information about the recipients,” says Lynch.
Four to six weeks after the donation, the organ donor coordinator will make contact with the donor families to give them follow up information on how the recipient is doing. In 2017, there were 99 donors in Ireland which resulted in 300 transplants of kidneys, lungs, heart, liver.
Recipients and donor families can also write to each other anonymously and these letters are handled by the Organ Donation and Transplant Ireland team. “We get such lovely letters from recipients talking about how children [who have received donated organs] have moved up a class or how someone who had a lung transplant has run a marathon,” she says.
Ultimately, Lynch believes that organ donation should become a normal end of care pathway. “I think organ donation is something that should be offered to everyone as an option. The majority of families will go along with the wishes of the person who has signed up to be a donor,” she says.
The Human Tissue Bill which is currently being drafted by the Irish Government plans to introduce an opt-out register for people who don’t want to be organ donors in the hope that family members will be more inclined to donate organs of their loved ones once they are not on this register.
