A day in the life of a Donor Transplant Co-ordinator
I work primarily in one large Critical Care Unit and am responsible for providing professional support to the families of potential organ donors and to my medical and nursing colleagues. The aims of the role are to ensure the identification and referral of all potential donors and a skilled professional approach to all families where the option of donation is possible. Every day has been different since taking up the post.
07:45: I arrive on the unit and liaise with the nurse-in-charge regarding any potential patients. On this day I am informed about a patient’s deterioration overnight and who is now presenting with fixed, dilated pupils with no further planned neurosurgical input. The nurse explains that the family is not present but her brothers and sisters are expected at the unit midmorning – they have been informed overnight about their sister’s deterioration. The patient is divorced with two young children and her ex-husband has been in touch but is not planning to visit. I take the opportunity to review the notes and await consultant review of the patient. At this time I also inform my DTC colleague on call of the potential donor. I defer any planned desk-work until another day.
11:00: I join the ward round, where it is decided that the patient fulfills the criteria for brain stem testing and that tests will be carried out this afternoon. The consultant is happy that we speak to the family together regarding the tests. The nurse asks for advice about patient preparation and we discuss routine blood tests and the equipment required for testing. At this point I also suggest contacting the NHS Organ Donor Register, which the nurse does, and we discover the patient has recently registered when changing her GP.
12:00: The family arrives and the nurse gives a brief update on the patient’s condition and introduces myself as a specialist nurse. Following introductions, I prepare the counseling room and the consultant. I and the patient’s nurse begin the process of reinforcing the prognosis and introducing the subject of the proposed tests. The family is understandably upset but appears to grasp the gravity of the situation and the implications of the brain stem tests. The consultant takes his leave, having given a time for the proposed tests. I remain with the family and reinforce the information. At this point, they express their concerns about communicating the information to the patient’s ex-husband and their young children, as family relations are strained. I offer to speak to the gentleman over the phone and the family gratefully accepts.
13:00: Telephone communication is difficult and although the husband understands what the outcome will be he does not wish the children to see their mother again in these surroundings. I offer some simple suggestions on breaking the bad news to the children and suggest they may want to send some personal keepsakes to be with their mother. The husband thanks me for taking the time to call and will consider my suggestions. I relay the outcome of the conversation to the family who are relieved at the effort that was made. Time for some lunch, to recharge the batteries.
14:30: The first set of tests is completed and confirms the clinical picture. The consultant and I break the news to the family and state that the next set of tests will be undertaken shortly. The family is distressed and wishes to spend some time at the bedside.
15:30: The second set of tests are done and we again approach the family. I have informed the consultant that the patient is on the register and he plans to use this to direct his conversation. The coroner is informed and raises no objection to donation. The consultant then sensitively explains that the tests have confirmed death and we wait while the family absorbs the information. After a few minutes they then ask what happens next. At this point the consultant explains that organ donation is an option and in our care for these patients we routinely try to ascertain what the patient’s wishes were by accessing the register. He confirms that the patient had recently registered with a wish to donate all her organs. The family is not surprised and says it was in her nature to be a giving person. They wholeheartedly concur with her wishes and want donation to take place. The consultant thanks them for their consideration and offers my services in an explanation of the process. The family listens to the detail and asks specific questions regarding timescale and when the patient’s body can be released home.
16:30: The family return to the bedside and I take the opportunity to contact my DTC colleague on call. She has been awaiting the call and will be on site within half an hour. The family is exhausted and keen to return home to break the news to the patient’s mother. The patient’s sister is the nominated next-of-kin and she takes time to complete the consent form and offers further information for patient assessment. My colleague arrives and I introduce her to the family, explaining her role for the rest of the day.
17:30: The family says their last goodbyes and thanks the staff for our support before taking their leave. As my colleague reviews the patient information I return to the bedside, offer advice on donor management and complete the assessment.
18:30: The patient is registered with UKT and the offering process begins. My colleague continues the process and I go off-duty, reflecting on a sad day, but satisfied that the protocol in place had worked in managing this patient and her family.
A fascinating and detailed account of a day in the life or a Donor Coordinator; why not share this with friends and family to give them more of an insight into what happens behind the scenes?