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Andrzej Baranski - Surgical Technique of the Abdominal Organ Procurement

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Surgical Technique of the Abdominal Organ Procurement
Author:
Andrzej Baranski
Publisher:
Springerverlag London Limited
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Books / Home and family
Year:
2009
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The success of organ transplantation starts with the optimal medical and surgical treatment of the donor. This book guides the reader through the difficult steps during organ procurement. It covers surgical technical mistakes and organ damage.

Andrzej Baranski: author's other books

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Andrzej Baranski Surgical Technique of the Abdominal Organ Procurement Step by Step 10.1007/978-1-84800-251-7_1 Springer-Verlag London Limited 2008

1. Transplant CoordinatorProcurement Team: Bilateral Aid and Understanding, Before and During Abdominal Organ Procurement1

Andrzej Baranski 1

(1)

Department of Surgery and Organ Transplantation, Leiden University Medical Centre, Leiden, The Netherlands

Abstract

Background : Organ procurement is the lifeblood of organ transplantation. A tense competitive atmosphere in the operating room and unprofessional communication skills between transplant coordinator and the members of organ retrieval team(s) may lead to inadequate preservation or surgical injury to the organs. At this stage, all mistakes, which have been made, can make an organ unsuitable for transplantation either due to impossible surgical reconstruction or because of damage leading to serious complications in the recipient.

Successful communication means that you have to fulfil the following criteria: be responsive, engaging, pleasant, patient, clear, positive, realistic, and a problem solver. In the OR never criticize anyone in front of others; if you do so, it will probably cause your colleague to lose face but you will lose the respect of those who view the incident. Focus your criticism on the task and not on the person. This applies to the surgeon as well as the TC.

Conclusion : Organ donation procedure is more than just go and get organs . It is an essential part of the organ transplantation and contributes for at least 50% to its success or failure.

Keywords

Transplant coordinator Procurement team Organ procurement Communication skills

1 Fragments in this chapter have been published earlier in the following article: Baranski AG (2006) Transplant coordinatorprocurement surgeon bilateral aid and understanding, before, during, and after organ procurement. Organs, Tissues and Cells,, 195198.

1.1 1.1 Introduction

The organ procurement is the lifeblood of organ transplantation (). A tense, competitive atmosphere in the operating room and/or unprofessional communication skills between the members of organ retrieval team(s) may lead to inadequate preservation or surgical injury to the organs. At this stage, all mistakes, which have been made, can make an organ unsuitable for transplantation or they can lead to serious complications in the recipient.

The first formal organ procurement organization (OPO) was the New England Organ Bank in USA founded in 1968. This OPO and the 57 others across the United States were founded as medical communities recognized the need to establish organizations that could expedite the procurement, preservation and distribution of organs ().

The first transplant coordinator (TC) in Europe was appointed in the UK in 1979 based upon the idea that originated in the United States (). Most of the TC(s) have responsibility for both organ donation and transplantation.

In some countries this role has been split up for procurement (donor) and recipient transplant coordinators both providing a 24 h service for their specialities ().

1.2 1.2 The Services of the Donor Coordinator

Identification and selection of the potential donor
Review and procurement of the appropriate and prescribed medical, legal and social consent from donor family
Support and advice surrounding donor care in intensive care unit (ICU)
Evaluation of the potential risk for the recipient
Arrangement of the practical procedures involving the anaesthetist, the organ retrieval operation and sometimes pathologist, bacteriologist and radiologist support as well as the donor ICU
Coordination of land/air transportation for the procurement team
Support of the medical and nursing staff in the operating theatre throughout the process of procurement of the spleen and lymph nodes, up to, and including, the packaging and labelling of specimens
Delivery of blood and tissue specimens to laboratories after the removal of the organs
Distribution of donated organs to the appropriate transplant acceptor centres
Logistics concerning the return (repatriation) of the retrieval team
Advice and support to families before and after donation
Feedback to the family, donor hospital staff and to the organ retrieval team(s) ()

During the whole process of organ procurement both the surgeon and the TC have to communicate regularly not only with each other, but also with many other people who are present in the OR. Coordination in such a multifaceted procedure requires high communication skills between people of different status, levels of competence and sex, in order to avoid misunderstandings, errors and medical mistakes ().

There are no standard instructions, nor is there any literature regarding the rules as to how the TC should communicate with the surgeon and the rest of the medical staff before, during and after organ procurement.

There is also no interactive training available for the surgeons to teach them how they should communicate with the transplant coordinator and other people before, during and after organ harvesting in order to achieve an optimal team spirit and to avoid quarrels, medical errors, misunderstandings and scandals.

1.3 1.3 The Most Important Moments of Communication: Priority of Interests

Communication between the TC and the surgeon during organ retrieval can be broken down into the following segments:

Before the initial contact and transportation to the donor hospital
During preparation for and performance of the operation
After paper work, discussion, feedback and support for the family and the medical staff

1.3.1 1.3.1 Before Organ Procurement

The first phone call to the procurement surgeon has to be done after initial assessment of the donor by the coordinator when the authorization of the organ removal has been obtained.

What the donor surgeon should hear and/or should discuss with the TC during the first contact, in most of the cases by telephone are as follows:

Greeting and introduction
In which hospital/country she/he is
Age, weight, height of the donor and the recipients
Reason for brain death or withdrawal of treatment
State and treatment of the donor (stable or not)
Whether the patient has been confirmed or not as having the clinical criteria for brain death or whether withdrawal of treatment is envisaged
All potential risks for the recipient and for the procurement team (infectious disease, surgical operations, usual and unusual medication and treatments)
Which organs have been accepted (heart, lungs, liver, pancreas, small bowel, kidneys)
Kind of procedure heart-beating donor (HBD) or non-heart-beating donor (NHBD)
Approximate time of departure and type of transportation (land/air) to the donor hospital
Distance and destination (whether a passport will be necessary or not)
Time schedule for the procurement of organ(s)
Medical equipment in the donor hospital (retractors, sterile ice, sterile cold fluids, povidoneiodine 2% in water solution, staplers, organ preservation solutions, operating theatre clothing, magnification glasses, sterile organ bags, sterile ice, coolbox, antibiotics, steroids, invasive monitoring equipment, etc.

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