What happens in a transplant situation at KEMH?

Two physicians must have declared the patient brain dead. The Intensive Care Unit (ICU) team in Bermuda keep the patient vital through mechanical ventilation.

“We still treat the blood pressure and cardiac rhythms it is just that their brain is not functioning. Everything else is still working,” said Brad Kleinig, Clinical Educator of King Edward VII Memorial Hospital’s (KEMH) Critical Care Programme.

At that time the anaesthetist consults with the family of the patient and asks if they would like any organs to be donated. The next of kin have to give their consent.

“It doesn’t matter if you have indicated on your driver’s licence that you want to be a donor, your next of kin can say ‘I don’t want them to’ and we will honour their wishes. That’s the law,” said Mr. Kleinig.

Once next of kin have agreed, ICU staff contact The New England Donor Bank giving history of the patient and the organs likely to be donated. The Donor Bank immediately send down two representatives, usually a doctor and a nurse.

“While those reps are coming out we have a long list of things that we are starting to test for so that when those coordinators arrive on the Island half of the job is already done,” said Mr. Kleinig.

The extensive work includes testing for malignancies and diseases like HIV. “If we’re doing that and it turns out to be positive then there’s no point in them coming down because they can’t use the organs anyway,” said Mr. Kleinig.

Once on the Island and in the hospital the Donor Bank representatives assume responsibility for the patient and completely take over. They check that all the proper testing has been carried out and that the patient has been kept in good functioning capacity. They also liaise closely with the family.

“They support the families, and they are there to answer questions that the hospital staff can’t,” said Mr. Kleinig. “But they also have to place the organs.”

It is the representatives of the Donor Bank on the ground in Bermuda that decide which patients will receive the organs being donated. In some cases the family of the deceased will request that organs be given to other family members in need. Their requests hold weight and the suitability is determined.

However, in the absence of such requests, the decision lies solely with the Donor Bank reps and their choice is always for the best match irrespective of length of time on the waiting list.

“The better the match the more chance of success” is the reasoning behind the policy.

Local doctors and ICU staff are completely hands off when the Donor bank team arrive but once the decision on where the organs will be going, is made, they are often brought back into the picture.

“New England Organ Bank does not physically take the organs they coordinate everything on the ground here,” said Mr. Kleinig. “If it’s going to Brigham’s (Brigham & Women’s Hospital in Boston) a team from Brigham’s comes. If it’s a team from California then a team from California comes.”

And a single patient may have different organs going to different recipients in different hospitals. This was the case with Carolann Tacklyn whose son Darren had five organs donated after his fatal road accident in 2000. This required five simultaneous operations. Four took place in Brigham & Women’s and one in Massachusetts General.

Timing is important as major organs — heart, liver and kidney — can only exist a short time while out of the body. According to Mr. Kleinig, a heart will last only about four hours from the time it is clamped and removed to the time it is reconnected.

In such instances the recipient patient may have to move closer to the donor. For example, a recipient in California would meet their donor heart in Boston.

“It’s all timed precisely.

“They would start operating before the heart reaches so that the minute the heart gets to the hospital in Boston, it goes right into the recipient.”