Page 4 Working to offer quality care to our colleagues and families... Lifeline Monthly Update March 2o10 Donors Pancreas Organs To Call or Not to Call… That is the Question! Hospital Kidney Liver Intestine Heart Heart Lung Double Heart & Valves Lung Lung for Research If you’re in healthcare long enough, you will eventually have some form of interaction with a staff member of the Alabama Organ Center. If you are a clinician in the critical care setting, this interaction becomes a routine part of JOIN US ONLINE … www.alabamaorgancenter.org UAB 5 7 3 2 2 1 1 1 1 your clinical experience. At the AOC, our staff is charged with a responsibility to consistently collaborate with our clinical teammates to maximize donation opportunities for donor families and transplant recipients, alike… a process Eliza 1 2 1 1 commonly referred to as dual advocacy.Huntsville 2 2 1 1 1 1 For many clinicians, placing a call to the AOC during aHospital time of intense emotional distress can introduce some uncertainty... In addition to providing quality patient care, Baptist 1 2 1 1 nurses nurture the spirit by offering compassion and com- South fort to grieving families—walking hand-in-hand with them as they begin the difficult journey to emotional heal- ing. In an effort to avoid compounding a families grief, We would like to take this opportunity to clinicians may be reluctant to place a call to the AOC that In the month of March, there were nine recognize our “teammates”. We value the remark- could provide valuable opportunities for organ donation consented donors from four hospitals in Alabama. and transplantation. At the AOC, we have identified this able contribution that you have made. Thank you The generosity of each donor family, coupled with the hard work and dedication of our clinical colleagues, for your commitment to the gift of life! as an area of angst for many of our clinical colleagues. In resulted in 40 life-saving organ transplants. an effort to provide additional support, we have imple- Multiple factors can affect the mented the role of the Family Support Services Coordina- outcome of a case; including the medical tor (FSSC) to assist clinicians and families with the diffi- and social history of the donor, the cir- cult transition to end of life care and decision making. cumstances surrounding the death, and organ function. Unfortunately, not all The Family Support Services Coordinator is professionally trained in the psychosocial aspects of grief. 500 22nd Street South consented cases result in opportunities for Their role is to provide a bridge of support. As the clinician walks hand-in-hand with the family, the Suite #102 transplant. Our objective at the AOC is to FSSC offers an additional source of compassion while providing for the needs of both the clinical staff and Birmingham, AL 35233 honor each donor by maximizing the po- grief-stricken family members. The FSSC responds personally when a patient is being evaluated for clini- tential of every gift. Optimizing an outcome requires cal brain death and/or when a family has made the difficult decision to withdraw life support.Phone: 1-800-252-3677 teamwork. In a relay, multiple athletes work together in a concerted effort. Com- The FSSC is intended to work as an extension of the healthcare team and collaborates with on-site clini- Fax: (205) 731-9250 pleting the race, requires dedication and cians to determine legal, medical, and emotional suitability prior to introducing or discussing options for participation from each member of the donation. When you are challenged by end-of-life patient care, give us the opportunity to help… CALL. team. Likewise, opportunities for organ donation are realized when each “member “Coming together is a of the team” identifies their role in the beginning... Keeping to- process and actively participates in the TRANSPLANT TALK! t case. We cannot do, what we do, with- gether is progress... out you. Working together is success.” W e’re listening! The Alabama This story can fit 75-125 words. Organ Center would like to invite Common Causes of Neurological Damage Clinical Triggers you to getheadline is anask clinical Your involved... important ~ Henry Ford questions, voice concerns, and newsletter and part of the offer suggestions! should be considered carefully. Anoxia (cardiac arrest) Unresponsive to verbal / noxious stimuli We will select a topic for detailed review in each Head Trauma Pupils non-reactive to light edition of lifeline. In a few words, it should accu- Transplant Talk is a segment Cerebral Vascular Accident Absence of cough / gag that will reflect the interests of our clinical part-of rately represent the contents the story and draw readers into Brain Tumors Absence of spontaneous respiration on vent/ ners. It’s a privilegethe work with you. Thank you to story. Develop the headline We’re on the web! for your commitment to life—we welcome your before you write the story. Thiswww.albamaorgancenter.org participation... E-mail usthe headline thoughts, Always call when a patient is being considered for withdrawal of life-sustaining measures ! way, with your will help you questions, and suggestions: story focused. keep the 1-800-252-3677 Christina.Pippin@ccc.uab.edu
Page 2 Page 3 LIFELINE - A PUBLICATION OF THE ALABAMA ORGAN CENTER LIFELINE - A PUBLICATION OF THE ALABAMA ORGAN CENTER Nurturing the Spirit ( An interview with Janet Shaw, FSSC ) Home Sweet Homeostasis the permanency of the situation is What exactly do you do? realized, the family begins to in- management is to keep the cells “happy “As a Family Support Services quire about the next step. By mak- and healthy”. Imbalances in the homeo- Coordinator with the Alabama ing these inquiries, the family is static environment of the cell will result in Organ Center, I offer support to starting to display a readiness to make end of life decisions. This cellular damage… cellular damage is tissue families in whatever manner they provides an ideal opportunity to damage… and tissue damage is organ need. On the surface this seems like an over-simplified statement discuss options for organ donation. damage. but when one considers the circum- If the family expresses an interest in Simply stated, any factor that compro- stances surrounding the situation, donation, the process is explained and additional questions are an- mises the integrity of the cell will compro- this interaction can become pro- swered. I always make certain that mise the integrity of the organ. Some foundly important.” the family knows what to expect, organs, such as the liver and kidneys, are including the timeframe associated more resilient and have an increased likeli- When do you meet families? with the process. I remain with the hood of rebounding from cellular insult. family throughout the case to pro- Other organs such as the heart, lungs, in- “I meet families during their dark- vide emotional support, including Homeostasis is one of the most re- testine, and pancreas are extremely vulner- The human brain is a complex, est hour… during the difficult time updates on organ allocation and markable properties of the human able to environmental variables, and read- amazing organ with countless func- when they are being told, or are about to cepts the finality of the situation would be a placement. Witnessing the life-saving body. It’s the biological ability to be told, that someone they love is not ily suffer irreversible damage... tions. When examining the goals of cruel invasion of their grief.” contribution that their loved one will achieve and maintain physiological going to survive the tragic circum- make frequently helps to relieve some equilibrium, regardless of environ- donor management, we must take a stances of their hospital admission. What is the next step? of the grief that they have been experi- closer look at the effects of brain Often, this news is delivered on the mental variables. I offer to speak with additional family mem- encing. It’s a wonderful thing to see death and the factors that interrupt same day that the tragedy has occurred. bers and friends who might be waiting on an the hopeful expression on their face A classic example of homeostasis is biological homeostasis. These circumstances leave surviving update. Often, family members are too when I explain the Donor Family Pro- demonstrated each time we eat. Af- family members with precious little time overwhelmed to have these discussions and gram and how they may have an oppor- ter a meal, blood glucose levels rise. In future editions of Lifeline, we for emotional preparation, resulting in a appreciate this offer. In some cases, I have tunity to meet the recipients of their will examine various clinical mani- devastated state of grief and shock.” This elevation in blood sugar triggers been asked to speak with the children of the loved ones life-saving contribution. festations of brain death— including patient. This is a particularly difficult thing Donation offers hope to a family that a series of biological events that re- sult in increased insulin production. metabolic disturbances, hemody- for me but I realize that it is important for has been devastated by hopelessness.” namic instability, and electrolyte How exactly do you help? Likewise, a decrease in glucose trig- children to understand what has happened to imbalances. These factors have a “While the doctor explains the patient’s their loved one. After speaking with the What about those who choose not to gers a reduction in insulin produc- prognosis to the family, I stand in si- children (in the presence of their legal tion . The ability of the pancreas to direct impact on organ viability and donate? lence. This is not the time to speak. guardian), I offer to take them to the bed- “Donation is an intimate decision. It’s respond to variations in glucose is a utilization. We will discuss specific After the physician leaves, I stay with side. Some children choose to go while not for everyone. Some families, for classic example of homeostasis. goals of donor management and the the family and serve as a resource for others do not…there is no wrong decision. I various reasons, choose not to pursue associated implementation of clini- emotional support and education. I am provide families with information on ser- options for donation. As a Family Sup- Organs are composed of tissues and (A—Acute cellular swelling, B—Normal cal interventions. available to answer any questions that vices that specialize in grief counseling for port Services Coordinator, my role is to tissues are composed of cells. It’s Cells, C—Swelling and rupture) the family might have as they struggle to children. I feel this is important for both the ensure that all families receive emo- simple—the golden rule of donor comprehend, and come to terms with, adults and children impacted by the loss. tional support, regardless of their deci- the finality of the situation. Frequently, sion. All families are entitled to com- the family is in shock and unable to absorb detailed information. If their I offer to escort additional family and friends to the patient’s room. I serve as a passionate care.” Don’t Carry it Home! loved one has deteriorated to brain protective barrier for the family, meaning How do you cope with the emotional death, or if they are expected to progress that they tell me who they want to see and aspects of your job? Stress Management hour, Ill have an ache in my for a while and rest before hold- Sooner or later to brain death, I ask questions in an who they want to visit. I make sure visits “Because of the nature of my work, I right arm. If I hold it for a day, ing it again. When were re- effort to assess the families understand- are limited to these people. With permis- deal with tragedy on a daily basis. A lecturer, when explaining youll have to call an ambu- freshed, we can carry on with the burden will ing of the prognosis, then offer addi- sion from the family, I explain the equip- Many families have asserted that I have stress management to an audi- lance. In each case, its the same the burden." tional information through a compas- ment in the room, why certain things are the hardest job in the hospital. I am ence, raised a glass of water and weight, but the longer I hold it, become too sionate explanation of brain death and being done they way they are, and offer quick to explain that I love my job asked, "How heavy is this glass the heavier it becomes." "So, before you return home how it is diagnosed. Everything I say is reassurance that their loved one is not suf- because I have the honor of working of water?" Answers called out tonight, put the burden of work heavy if we delivered in what I call “compassionate fering. In short, I work as a liaison between with families who, during their darkest ranged from 20g to 500g. The He continued, "And thats the down. Dont carry it home. You plan talk”. I always begin with an apol- the medical staff and the family.” hour, make the decision to embrace lecturer replied, "The absolute way it is with stress manage- can pick it up tomorrow. What- don’t allow ogy… “I’m sorry that I have to say such life… despite death. The most reward- weight doesnt matter. It de- ment. If we carry our burdens ever burdens youre carrying difficult things about someone you When do you introduce options for organ ing part of my work comes with the pends on how long you try to all the time, sooner or later, as now, let them down for a mo- ourselves to love.” At this point, unless the family donation? hope that I have helped a family hold it." the burden becomes increas- ment if you can. Relax; pick initiates the conversation, organ dona- “Support measures can go on for hours. through a horrific time in their lives and ingly heavy, we wont be able them up later after youve put it down. tion is not discussed. Introducing op- During this time, family members begin to helped place them on the path to heal- "If I hold it for a minute, thats to carry on. As with the glass of rested. Life is short... Enjoy tions for donation before a family ac- face the reality of what is happening. Once ing.” not a problem. If I hold it for an water, you have to put it down it!"