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The Gift That Heals


[Apr 21 2009]


A pediatric emergency room is not a place for the squeamish. Children come in who ran in front of a car on the last day of school or fell off a bicycle or drowned while their parents went to answer the doorbell. These are not children who have suffered from a chronic illness where death could have been foreseen. The shock is total.

“The parents hurt so much. Some of them seem to need help just to survive,” says Mindy Zoll, a transplant coordinator with TransLife, the organ procurement organization in central Florida.

Yet these are the parents that some nurse, like Mindy, is going to ask to donate their child’s organs to help complete strangers. It must be one of the most difficult questions in the whole of medicine. But the need is urgent and the supply of organs is very limited so it has to be done.

My seven-year-old son, Nicholas, was shot in a botched robbery in Italy in 1994. My wife and I donated his organs and corneas to seven very sick Italians, four of them teenagers. Almost fifteen years later all seven of them are living productive lives. Having met them all and seen the agony they have gone through and knowing what would have happened to them if we had made a different decision, it’s inconceivable to me that we could have turned our backs on them.

More than 100,000 people in this country are on the waiting list for a transplanted organ. Twenty years ago it was 20,000. It is not that organ donation rates have gone down – there has been an upward trend for years – but as the techniques improve and more and more patients become candidates to receive a transplanted organ so the list grows month by month.

In a real sense, then, transplantation is the victim of its own success. That, however, is no consolation for those 100,000 people, 18 of whom die every day because of the shortage.

Nor is there any magic wand to dramatically increase the supply overnight. In the great majority of deaths, where the heart stops beating, the organs deteriorate too quickly to be of use to anyone else. Most donated organs come from the small number of people whose brain has stopped working – and so are truly dead – but who are on a ventilator that is keeping the blood flowing and the organs viable for a short time.

April is Donate Life Month when the year-round, unremitting push to encourage people to sign donor cards, put their names on state registries and talk to their families goes up another notch. A good starting point for those thinking about what to do is the Donate Life America website www.donatelife.net

Being prepared is crucial. A transplant coordinator told me she was on duty one night when a small boy was brought in, dying from a road accident. When brain activity stopped, she took a deep breath and asked the parents if they would donate the organs. They refused -- angrily -- at what they saw as a crass intrusion on their sacred moments. She said she understood, the bottom had fallen out of their world. But all she could think of was that on the third floor of that same hospital was another little boy who was also dying that night, and did die, because the heart that could have saved him never arrived.

I often think of that family and how close they came to being saved and how, in all probability, they would have been saved if that other family had only had a brief conversation about organ donation months before while death was just a distant concept.

The average decision to donate produces three or four organs as well as tissue such as corneas, skin to cure burns and bone to straighten spines. Anyone faced with the choice then can either save three or four lives and relieve many others of pain or shrug off their problems as none of their concern. With that much at stake, I often wonder what possible debate there can be about what is the right thing to do.



Reg Green’s New Book

The Gift that Heals, a new book by Reg Green, tells the stories of 42 families at almost every stage of the transplantation process. Some are recipients, among them, a GI blinded in World War II who fathered five children, none of whom he had ever seen, whose sight was restored after 48 years by a donated cornea; a man who was so short of breath that he couldn’t walk and talk at the same time but, after a transplant, ran a marathon alongside the father of the girl whose lungs saved his life; and a police officer, shot at close range, whose wounds were so large that his rescuers had to put their fists in them to slow the flow of blood.

Others are donor families who, though numb with pain, put their grief on one side to save the lives of complete strangers or living donors, people who undergo an otherwise entirely unnecessary operation to donate a kidney to someone they have never met, because "they need it more than I do." Still others are on the waiting list, like the woman in the prime of life terrified that unless a donated kidney comes soon her son will be left without a mother. Professionals also tell their stories, such as the transplant coordinators, who have to ask bereaved families if they will give something more at the worst moments of their lives, and the pilot of the aircraft racing to deliver organs to dying patients.

An excerpt from "The Gift That Heals":

Transplant Team Copes with Child’s Tragedy Amid World-Shaking Event

At 10 p.m. on September 10, 2001, Bruce Zalneraitis, then clinical director of Life Alaska Donor Services, was called to Alaska Regional Hospital in Anchorage to help with a tragic case. A 13-year-old boy, Will Dean, had just shot himself in the head and seemed likely to die at any time. When Bruce arrived, the emergency room team was still giving the boy large quantities of fluid and blood products to replace the blood lost from the wound and had placed intravenous drips in both arms. But it soon became clear that not only could they not save him but also that, in his highly unstable condition, they would have a difficult time just keeping his heart beating. Will’s mother and father, Jill and Tim, are divorced – and at the time she was in Saipan and had to be reached by telephone -- but when told their son was a candidate to be a donor both said they were in favor. It was something they had discussed while they were still married. It seemed fitting that a boy known for his patient and gentle touch with small children and pets should at the end still be helping others. At 2:30 a.m., no brain activity could be discerned and Will was given the full range of tests to put all doubts to rest. Bright lights were shone into his eyes and sharp pins were used to prick his arms. He was given a gag test and taken off the ventilator for 10 minutes to see if he would breathe spontaneously. There was no response to these or any other tests and at 3 a.m. he was officially declared dead. By 5 a.m., Bruce was telling his organ donation colleagues at LifeCenter Northwest in Seattle, the organ procurement organization that covers Alaska, that potentially seven organs and two corneas had just become available from a boy weighing 140 pounds and blood type O-positive. At their end, the Seattle team accessed United Network for Organ Sharing’s computer system to match the donated organs to the sickest candidates with the best genetic matches. Once the organs were allocated, calls were put in to book the two corporate jets that are always kept on standby at Boeing Field to take the specialist surgeons to the hospital where the donor was. The long distances between Alaska and anywhere make time even more critical than elsewhere. For livers, kidneys and pancreas, timing is always a concern but for hearts and lungs everything has to go right. Bad weather or even a slight mechanical problem can unravel the donation and everyone’s hopes. Arrangements are dovetailed to save seconds. While the planes are in the air, bringing the transplant surgeons, the organ procurement team is providing them with updated information about the donor. When they are on their way back, the crews are reporting progress to their own hospital: “30 minutes out, 15 minutes out, we’re in the ambulance.” Even before they land, the operation on the heart and lung recipients is under way – their chests are opened and the lines are in. In Bruce’s words, “the recipient is placed on the bypass pump when the surgeon comes through the OR door carrying the heart in the ice chest.” On the day of Will’s donation, the donor team at Anchorage was doing its part, maintaining the oxygen supply and blood pressure and reducing the dependence on drugs, to make sure the organs were working as normally as possible. But at around 5 a.m. they were interrupted by a nurse who came in to say that a terrible accident had happened in New York. It was four hours later on the East Coast on the morning of September 11 and a plane had just crashed into the north tower of the World Trade Center. Two hours later, word reached Bruce that the FAA, acting on orders from the military, had grounded all civil aircraft in the United States. The schedule put together with such speed would have to be scrapped and, with it, the donation itself. Among the confusion and disbelief of that day, Bruce still remembers the special pain he felt hearing that news. “Here we were, witnessing the enormity of one of the worst things that has ever happened to this country and yet struggling, in a small way, to bring some good out of the terrible loss of a child,” he says. “We decided that, even if we couldn’t move Will’s organs by air, we would at least take his kidneys to Seattle by van, because they can last longest outside the body. It’s 2,300 miles but we would have saved something.” A hectic series of phone calls from Alaska and the clinical director of LifeCenter Northwest followed and, in the end, the FAA granted a special exemption for the jets to fly. At 6 p.m. they took off from Seattle into eerily empty skies – the first civilian planes, Life Alaska was told, allowed to fly in all American airspace since that morning. At 9:15 p.m., the surgeons were in the operating room in Anchorage. At 12:22 a.m., the cross clamp went on and Will’s blood stopped flowing. Minutes later, his heart and lungs were removed and the first team left, while the second team continued its work to remove the other organs. Twenty minutes later, the first team was in the air and all was going well. As they approached Seattle in the black of night, however, fighter planes that had apparently not been informed of the exemption intercepted them, declined to accept their explanation and forced them to land at Bellingham, Washington, close to the Canadian border. There they were surrounded but, to their great relief, quickly established their identity. But now another worry took over. They were 90 miles from the University of Washington Medical Center and already dangerously close to the time when the organs would no longer be viable. Conveying the urgency of the situation to the base commander, they were bundled into a helicopter and flown directly to downtown Seattle. As the new day began, Will’s young heart was transplanted into a 21-year-old man and both lungs into a 52-year-old. His liver and a kidney went to a 29-year-old man, his pancreas and another kidney to another 29-year-old, a father of two, and the corneas to two other patients. Back in Anchorage, the team completed its work, carefully suturing Will’s chest and abdomen, just as if he were still alive, applying dressings to the incisions and washing his body, returning it as much as possible to the state it was in prior to the donation. Then Will was put gently into a shroud, having just saved the lives of four people it’s hard to imagine he would ever have met...

The Gift that Heals: Stories of hope, renewal and transformation through organ and tissue donation, which is published jointly by the Nicholas Green Foundation and United Network for Organ Sharing, can be ordered online at www.authorhouse.com or through booksellers.





Reg Green is the author of The Gift that Heals, and heads the Nicholas Green Foundation. His family’s story was the basis for a made-for-television movie, starring Jamie Lee Curtis, called “Nicholas’ Gift,” for which she was nominated for an Emmy and has been shown worldwide.

A seven year-old boy from California, Nicholas Green, was killed by highway robbers in 1994 while vacationing in Italy with his family. His parents agreed to donate his organs and corneas, which went to seven Italians waiting for transplants. Reg and Maggie Green spoke openly to the media, with no bitterness, about their loss and decision. The world took the story--and the Greens--to its heart. Organ donations in Italy have tripled since Nicholas was killed so that thousands of people are alive who would have died.

The world's response to the Green's personal tragedy is called "the Nicholas effect." No matter their nationality or calling, people respond from the heart--presidents, movie stars, schoolchildren, grandmothers, Boy scouts, soccer players, surgeons, and organ recipients. Organ donor cards are signed. Poems are written, pictures painted, parks dedicated, scholarships established, medals given, children hugged.





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