A case for organ donation.

Abstract

A t 6 A.M a 26-year-old man was brought into the emergency department of a 300-bed community hospital, the victim of “the worst head injury ever seen” by the ED physician. Having completed the evening shift at a manufacturing plant, the victim, Mr. M., stopped at his favorite bar on his way home. After leaving the bar at 2 A M., he lost control of his truck and struck a fence post. The post smashed through the windshield, penetrated the frontal area of Mr. M.‘s skull, and continued out through the occipital area of the skull, exiting the rear window of the truck. On arrival at the emergency department the patient had a systolic pressure of 60 mm Hg with agonal respirations. The pneumatic antishock trousers were in place and fully inflated. Brain tissue extravasated from both the nares and the ears. The left pupil was fixed and dilated, and the right globe was obliterated because of the extreme trauma involving the head and face. An indwelling urinary catheter was inserted, with return of blood-tinged urine. A computerized tomography scan of the skull showed no cranial contents. The emergency charge nurse immediately suggested to the attending physician that organ donation might be an appropriate consideration at this time. The transplant team coordinator was called to determine whether this unfortunate young man was a potential organ donor. It seemed likely that his injuries were incompatible with life. Because the patient’s cardiopulmonary system was still intact and his kidneys were making urine, the transplant coordinator recommended that the patient be mechanically ventilated and admitted to the surgical intensive care unit to allow time for a more thorough evaluation of brain death, according to the hospital’s policy. These measures would also allow the trans.plant team to make initial contact with the potential donor’s family, as well as give the family additional time to absorb the severity of the situation. Time for family deliberation would improve the chances for obtaining donation permission iater if Mr. M. did become a suitable organ donor candidate,