Living Through Dying

Organ donation can be a very difficult decision, which could be made easier through increased education and awareness on donating. Through my years as a Respiratory Therapist I have been exposed to the organ donation process. It can be a difficult decision for a patient’s family especially if it has not been communicated to the family what the individual wants. While it is a tough decision for some, the choice to donate a loved one’s organs means a second chance at life for people on organ waiting lists across the country. When patients are pronounced brain dead they are usually being kept physically alive on life support. Life support for these patients consists of a mechanical ventilator, which breathes for the patient as well as intravenous medications that help various bodily functions. The process for organ donation seems pretty clear cut, however the person making the decision is usually under a high degree of emotional distress, which presents the major gap in the debate about organ donation. It may be easier to go through the thinking process while not in mental distress over the loss (or the potential loss) of a loved one. In my experience as a respiratory therapist, I have been witness to families dealing with the sudden shock of losing a loved one traumatically, and there is no denying the emotion. Capacity to make decisions that are logical and precise are greatly diminished when handling the death of a loved one, especially when they are of youth. The urge to cherish everything that constitutes their memory is so powerful that it may be more comforting than the visceral images offered at the thought of them as a motionless, thoughtless tissue factory that sat at your dinner table for years. After witnessing this process as a healthcare worker, it is apparent that the deciding “next of kin” has to have previously established beliefs, be absolutely certain of their dying loved one’s wishes, or possess an incredibly lucid and pragmatic thinking process during the time of tragedy. Debate regarding organ donation can cross cultural, religious, and societal boundaries that are ethereal when not in presentation, but my empirical knowledge presents itself in a way that the majority of decisions made against donation are that of a chaste ignorance or inability to handle the magnitude of stress at the time.
To present more of a realistic picture, there consists a gray area in the process that a family member goes through that has to make the decision to donate in the first place. In our modern world of litigation and medical advancement, physicians don’t give a cut and dry “yes or no” response to the inquiring family member as to whether their loved one is going to make it out alive or not. Even the term “make it out alive” is a giant gray area within itself. There are some family members that would be just fine with their loved one living in a vegetative state on a ventilator for the rest of their life, but that is one extreme end of the spectrum. The other end of the spectrum would be the family member that knows with certainty their loved one wouldn’t want to live if they couldn’t make it to their intramural basketball game next week. (For the latter, it is possible to digress to a whole different subject altogether.) The gray area presented by the percentage outlook given by the physician can have a large influence on how long the family will wait until they decide to stop making the attempt to preserve the life of their loved one, as well as whether the organs in question will be viable to donate. As mentioned before, the prospective donor will have been kept alive by a life support system that is in no way perfect. Inevitable malnutrition, lack of motion consisting of normal life, and risk of hospital-acquired infection has pressing influence as to the timeliness of organ harvest. Even if the patient has a certain level of acidity outside of the normal range in their blood for too long of a time period, harvesting of organs may be rendered impossible, however skin, ligaments, bone, and other more peripheral items may be considered for a longer period of time in comparison. As Rick Reilly illustrates in “Getting a Second Wind”, a second chance at life for others is a huge impact of organ donation. One donor could save numerous lives. The heart for someone with Coronary Artery Disease, a liver for someone in liver failure, kidneys, if they can find a match they will use the organ. The lungs are among the most sought after organs. I have close contact with the Cystic Fibrosis patient population. A lung transplant for one of these patients means not only increased life expectancy, but also quality of life. It is amazing to hear the jubilation of these patients when they get a new set of lungs. In any case, an accelerated process of acceptance is necessary for a person to be a perfect donor, and the short time period available is discouraging to those who are unfamiliar with the options that lay before them. In a preemptive strike to influence donation, government and private programs have been established to educate the public about organ donation have been initiated. Of course, it is still up to the next of kin, but the level of education about the subject beforehand seems to have such a positive influence on the level of donation that these programs often have an overlooked effect on the decisions of distraught family members.