Donor transplant coordinators
In Scotland, there are donor transplant co-ordinators based in Aberdeen, Dundee, Edinburgh, Glasgow and Inverness. Liver recipient transplant co-ordinators are based in Edinburgh and heart recipient transplant co-ordinators in Glasgow. In some units the donor co-ordinator has a dual role of kidney recipient transplant co-ordinator. This is the case in Edinburgh and a team of four cover Edinburgh, Fife and Borders, also working an on-call rota with the Dundee donor transplant co-ordinator. Most transplant co-ordinators are registered nurses.
One of the main problems we still face in transplantation is the shortage of donor organs. There are presently 5734 people in the UK awaiting a transplant and last year there were less than 800 organ donors, with almost 400 people who died whilst waiting for a transplant. Every person who donates his or her organs has the potential to save at least 6 lives.
The role of the donor transplant co-ordinator involves:
- Asking families permission to donate the organs of their loved one at the time of death.
- Giving family information as regards the donation process.
- If a family agree to donate, then we organise the donation process, working with UK Transplant to ensure the organs are allocated to the most suitable recipients.
- After organ donation we provide follow-up to the family and to the Intensive Care and Theatre staff.
- We are an important resource in Education and have a large commitment to the teaching of other Health Care Professionals and members of the public.
Many people carry a donor card or place their name on the organ donor register but it is also very important that this information is discussed with close family members.
Increasing publicity as regards organ donation is very important to us. The demand for donor organs is constantly growing and we need to look to the future for ways to either increase the number of donor organs for transplantation or until such times as alternatives either biological or technological become available.
A Day in the Life of a Transplant Co-ordinator
A typical day in the life of a transplant co-ordinator may include:
08.30 hrs: Kidney/Pancreas Transplant Unit ward round. This involves the multi-disciplinary team that includes surgeons, physicians, nurses, dieticians, pharmacists and transplant co-ordinators. Each patient on the ward is reviewed and their progress, including blood results and anti-rejection medication are discussed with the patient. Today a mother and son are reviewed following a living kidney donor transplant the previous day, when the mother donated one of her kidneys to her son. The other patients reviewed include a 35 year old man who had been waiting for a transplant for six years, and finally received a call two weeks ago. He is hoping to be discharged home soon, looking forward to leading a life free from dialysis.
09.30 hrs: Following the ward round, paperwork is attended to from the transplant yesterday. It is important that all the legal documents are completed and sent to UK Transplant.
11.00 hrs: Education is a significant part of the transplant co-ordinators role. Today the talk is to a group of medical students about brain-stem death and organ donation. All health professionals are involved in transplantation, and for new doctors and nurses it is important they are informed about approaching bereaved families and discussing organ and tissue donation.
12.00 hrs: The hospital media department have contacted the transplant co-ordinators asking for information and volunteer patients to talk to the press about transplantation. Most of the transplant recipients are willing to do this – without organ donors they would not have received a transplant, and it is important to highlight this to the public. An interview is organised with one lady who is entering the Transplant Games this year – an Olympic-type event for organ recipients.
13.30 hrs: Transplant Assessment Clinic: Patients who are reaching end-stage kidney failure attend this clinic to review their suitability for a transplant. This involves an in-depth discussion and examination by the transplant surgeon, and information from the transplant co-ordinator concerning life on the transplant list, the operation and the care following a transplant.
15.00 hrs: Whilst in clinic an anaesthetist from one of the local intensive care units contacts the on-call transplant co-ordinator. The first set of brain-stem death tests had been performed on a 28 year old man who had been in an accident. As the first set of tests had shown the man to be brain stem dead, the transplant co-ordinator was requested to attend the unit to discuss organ donation with the family following the second set of tests. Already the family had mentioned that the man had carried an organ donor card and had previously discussed his wishes with them.
The co-ordinator leaves the hospital immediately, to drive 50 miles to the intensive care unit in the referring hospital. On arrival, the anaesthetist informs the co-ordinator the second set of tests have been completed, confirming brain stem death. The family was willing to speak to the transplant co-ordinator.
16.30 hrs: Along with the nurse who has been caring for the patient, the option of organ donation is discussed with his family. This is perhaps the most important part of the role of the transplant co-ordinator and the family are assured that the operation is performed with dignity and respect by the transplant team who will attend the hospital. This is followed with a detailed discussion concerning which organs will be donated, his past medical history and the follow-up provided.
17.30 hrs: The next two hours are spent gathering information about the potential organ donor, taking blood for tissue-typing and virus checking, and supporting the family. When all the information is complete UK Transplant, a special health authority based in Bristol is contacted. The duty office will take details and inform the co-ordinator which transplant centres in the UK to contact for organ allocation. UK Transplant holds the names of everyone in the UK who is waiting for a transplant. The system in place can immediately work out which centre or patient should be offered an organ. As there are no super-urgent patients (those patients who are so ill they need a transplant within 72 hours), the liver team in Edinburgh and the heart team in Glasgow are called to offer a life-saving transplant to someone in Scotland.
19.30 hrs: The recipient transplant co-ordinators for the liver and heart teams are contacted, they organise for their transplant teams to come to the hospital to remove the liver, kidneys and pancreas, heart and lungs. The family also kindly agreed to corneal (eyes) and tendon donation, so the tissue co-ordinator is contacted who will arrange for an opthalmologist (eye surgeon) and orthopaedic surgeon to come to the operating theatre. The anaesthetist and donor hospital theatre team are also contacted to make arrangements for the operation.
21.00 hrs: The family say goodbye to the patient, and arrangements are made to meet the next morning when the operation will be completed and they can visit him in the Chapel of Rest in the mortuary. This is a very difficult time, and the transplant team are always aware that it is due to the kindness of families at a time of acute grief that transplantation can proceed.
21.30 hrs: The donor is still on a ventilator, which provides oxygen to the organs. The anaesthetist and operating theatre assistant arrive in the intensive care unit to transfer him to theatre. The operation can take from 4-6 hours, and is performed under sterile conditions like any other operation. The organs are perfused with a special preservation fluid, as they will not have a blood supply until transplanted. The heart and lungs are quickly transferred, as the recipients are already in another hospital waiting and they must be transplanted within four hours. The liver and pancreas are transplanted with 12 hours. The kidneys are allocated by the best tissue match, and are usually transplanted within 24 hours.
03.30 hrs: The surgeons have finished the operation, and along with the theatre staff the transplant co-ordinator performs ‘last offices’. This involves washing and dressing the patient, in preparation for transfer to the mortuary.
04.30 hrs: One of the kidneys has been allocated to a local patient, and the surgeon, kidney doctor and transplant unit are telephoned by the co-ordinator. At 0500hrs the recipient is phoned, who has been waiting for three years for a transplant and asked to come into hospital.
10.00 hrs: The co-ordinator meets with the family of the gentleman who died, and takes them to the mortuary to view the body. There is a brief discussion about which organs have been donated, but this is a time for their grief. Within the next few weeks they will receive a letter and a visit if they wish, giving them information about all the people who received a transplant today.
There are many different people involved in the transplant process, and all work with the awareness that a grieving family have given their permission for organ and tissue donation. Due to this act, others live and enjoy an improved quality of life.
Further information about transplantation
See the links at the foot of the Kidney Transplantation page in EdRenINFO. We produced the Transplant booklet, Photo-story, and other information.
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