My day with Donor Alliance

June 9, 2009

My Day with Donor Alliance

Now instead of talking about each day in a week I am going to jump to just talking about interesting things that I do. Today was one of those GREAT days! This morning I was filling out the information for a death certificate when Ed came and told me that we had been called out. Ed, Mark, and I jumped in the vehicle and drove to Lander. It was a fun ride over to Lander because it was a car crash we had our lights and siren going so we could get to the scene quickly. Mark ran the siren so that it only went off when we were in town or near other cars. This is because the noise can become incredibly annoying to houses that we pass, businesses, and us.

It was neat to see how many people actually know or obey the Wyoming laws about what to do when an emergency vehicle is running lights and siren. Lots of people pulled over- kudos to any of you if you are reading this. As for the rest of the population please remember to pull over when you see or hear sirens. When traveling on a two lane highway both lanes of travel are required, by law, to pull to the side of the road. When traveling on a four lane highway the two middle lanes need to be clear. Best advice I can give is to pull over every time and remember to check that it is safe before you begin to pull over.

So we drove very fast into Lander and out to the crash. There is not a lot to say about this incident except everyone should always wear a helmet when riding their bike and those who drive semi-trucks need to check their surroundings before pulling out into an intersection. Bicyclists and pedestrians do not do well when hit by a semi. As for everyone else please be careful on the road because anyone can be effected whether you are a state champion bike rider or a mother out to ride bikes with her children. When you die those who loved you have to endure the pain, not you.

Anyway, so we arrived at the scene to learn that the individual was Dead on Arrival. What we also learned was that this woman was adamant about having her organs donated. For that reason the family insisted that we call Donor Alliance so they could come and receive her organs to donate to others. Donor Alliance said that they would be in that day to do a recovery and made a time to meet with me at the Lander morgue. This will be the first time that I get to watch a team of doctors recover organs from a donor and I’m very excited to see how the procedure is done and talk to the individuals about their jobs and the process of organ removal.

So I drove over to the Morgue and met the Donor Alliance team. This opportunity was incredible. It is so neat to think that these people get flown around on planes to travel all over the mountain west to save people’s lives. It is a very honorable job and the group that I worked with was great and very attentive.

Since they weren't collecting organs, the team was able to do their recovery in our morgue. Their first step was to make the room, by their standards, sterile. They did this by taking blue sheets and taping them over vents and other objects near the center table. They also put some at the foot of doors to prevent air from entering the room, which made the room warm and by the end the men were sweating profusely and had to leave at times to get some air. They got dressed into blue scrubs, hair covers, gloves and the typical face masks that cover the mouth and nose. Because I was in the room with them the whole time they gave me a hair cover to wear and a face mask.

The body was removed from the cooler and taken into their newly made surgery room. The body was analyzed as to what areas had cuts or other damage which could have allowed in bacteria so as to contaminate the body parts. Coming to a consensus they decided only one leg was in good enough condition to recover donations from.

They began by having two of their group clean the leg with brushes and squeegees. Then they used other squeegees soaked in a strong alcohol solution to sterilize the leg. One of the members held the leg while another helped the two other doctors get sterilized so they could perform the extraction procedure. To sterilize themselves these two doctors washed their hands and arms, and then, with a well learned technique, they put on their operating gowns. Not letting their hands leave their sleeves they put on one pair of disposable gloves and then a second heavier, pair on top of that. The assisting person buttoned their robes in the back and with the use of a tab on the strings helped them wrap the string belt around their waist. It was interesting to watch the techniques they use to get dressed. Finally, they opened their tools in a similar manner to insure they too stayed sterilized.

They turned their attention to the leg itself, placing sheets that were cut and had sticky tabs on the back around the leg. By the time the sheets were placed the individual holding up the leg was getting tired and was asking them to move a little faster. After the sheets were in place the two individuals that were sterile started their tasks. One was to perform the surgery. She was the only female and the newest person to join the team, which meant that she was constantly being questioned and given advice by the other doctors. This was good for me because the whole procedure was explained to me through their questions and her answers. This was an intensive anatomy review. The second individual that was sterile was in charge of the making sure the tools remained sterilized and available for the operating surgeon. He was also in charge of packaging the recovered parts. When the operating surgeon removed a muscle or bone she took it to this second person and he would package the organ up and label it for transport. At times he was asked by the other two men, to help the operating surgeon.

I was allowed to stand next to the woman doing the extractions and watch the whole procedure. The men how were not sterilized were beside me and helped by instructing the operating surgeon. At times they would explain things to me, probably because I looked so fascinated. I was told that from the leg they would be removing the fibularis brevis, fibularis longus, tibialis anterior, a portion of the soleus, calcaneal tendon, semimembraneous, semitendinosus, gracilis, tensor fasciae latae, and part of the rectus femoris. They did move the Sartorius but just to move it out of the way so they could reach the deeper muscles. They told me that they are currently doing research into what the sartorius could be used for and then they will begin removing that as well.

They also took connective tissue because they now have a procedure where doctors can remove the cells from the connective tissue and then, through surgery, place that connective tissue into patients that have had abdominal surgery, cleft palates, etc. This is interesting because the tissue doesn’t have the donor’s cells so the recipient’s body doesn’t reject the foreign tissue. Instead the recipient’s body does what it always does when connective tissue is being made; it puts its own cells into the connective tissue helping that area to heal in a very natural and safe manner. There are a variety of different surgeries that benefit from this procedure in helping patients heal. It is amazing what the medical community keeps coming up with to help patients.

The first cut was made at the foot and then made vertically up to near the hip. Then, using a scalpel, she cut at the fascia to separate the skin and the muscles. At this point all of the doctors commented on how athletic the deceased must have been because the muscles were so well defined. The extracting doctor had to know a certain set of steps as to which muscle to extract first and how. It was neat so see how she had to move around the different muscles looking for the target muscle she was looking for.

I watched as all of the muscles were cut at certain areas and how the tendons were followed to find the muscle's place of insertion. Then the muscle was carefully cut at that area and removed. Sometimes it was hard to find the muscles because the individual was so muscular, and at other times the other doctors had to give the operating surgeon tips on how to get to the insertion point of a muscle by cutting certain fascia that was holding it in place. This procedure is not easy to perform due to how compact the body is and how easy it can be to cut or hurt one of the muscles you want to extract while cutting fascia to get another muscle out. They told me that it is hard to get all the muscles that are donated out in good condition. In fact the company keeps a running total of how successful a doctor is at retrieving certain body parts and keeping them in a condition conducive to transplantation. All of their doctors have to have a 90% success rate to continue performing this kind of work. This could be incredibly difficult in light of the fact they told me that they commonly put in over 70 hours a week during certain times of the year.

Some of the muscles had their insertion points on the bone that was going to be removed. These muscles were not removed from the bone but instead stayed attached. The femur, the fibular, and the tibia were recovered. After all the muscles and bones were removed everyone was cheering about the new surgeon’s accomplishment.

The last step with the body was to make it presentable. To do this they took a long wooden rod and placed it in the leg cavity. Then they took out small sterile sheets and began wading those around the rod and filling the leg cavity as they moved from the hip to the foot stitching the skin back together. This process, they explained, was done as a courtesy to the family so that their loved one wasn’t just a big mess when they saw them again. I was told that this is done every time, even if the family would not be seeing the body ever again. They commented that this leg was easy for them to make presentable. Sometimes when they have recovered organs from all parts of the body they have to take these rods and crumpled sheeting to the whole body because the only parts that aren’t taken are some of the abdomen, feet, hands, and some of the head. Then they have to “rebuild” the whole body again, but it all depends on what the family is willing to give and how death occurred.

The last step was to clean up the morgue. They washed off all the counters, sinks and gurneys, placed all their trash into the dumpster outside the door . They took some last minute photos of themselves inside the jail cells and then gave me a survey to give to the funeral home to evaluate how their job was.

A pretty neat experience overall and I was lucky for having a boss who goes out of his way to allow me to experience all that I can, while staying within in ability and interest zone. When an opportunity arises, I am allowed to decide how much is too much. I have begun to realize that my job is to learn as much as possible- which makes my job pretty amazing. What makes it better is that I am learning from a man that I am repeatedly told, “is one of the best men to learn from” because he is patient, constantly looking out for others, encouraging of questions, has knowledge in law enforcement and EMS, and is a genuinely nice and gentle man. I really am blessed to have Ed as he is such a great mentor and boss.