We're living in an age with very few taboo subjects. Even
death is more openly discussed but remains an uncomfortable subject
even when, or possibly especially when, the discussion is with
loved ones and family members.
One of the consequences of this is that if the unthinkable
happens our loved ones can be left to make decisions on our behalf
as well as coping with their loss.
Only around 1% of deaths occur in circumstances where organ
donation is possible and at County Durham and Darlington NHS
Foundation Trust, Lisa Adair, specialist nurse for organ donation
and former intensive care sister, provides expertise to colleagues
and families so that, when appropriate, families are approached to
discuss the possibility of organ donation.
Lisa explains, "First and foremost, the role of doctors and
nurses is to save lives. They do everything they can to save
their patient. It is only when there is nothing more they can
do, and end of life planning begins, that the possibility of organ
donation is raised with the family.
"It's incredibly important that we have these conversations,
both for those patients who are waiting for transplant but also for
the families of potential donors.
"Around 6,000 people are currently waiting for a transplant and
three people in need of a transplant die every day. At the same
time, many donor families say that doing something so positive
gives them comfort and hope at what is otherwise a tragic
"In the three years I've been with the Trust I've worked closely
with our intensive care teams at University Hospital of North
Durham and Darlington Memorial Hospital. In particular, encouraging
them to let me know when they have a potential donor and the good
that can come out of organ donation. I run study days, giving
colleagues a chance to hear first-hand from a donor family who
comes to speak about their experience. They explain how they
understood nothing more could be done for their loved one and the
comfort they took from donation. They also hear from someone
whose life was saved by a transplant.
"It's important I get involved early so I can check the
patient's medical records and sometimes seek advice from the
transplant teams and we now have a second specialist nurse for
organ donation, Francesca Herrera Lee.
"The Trust was recently highlighted by a NHS Blood and
Transplant Northern Region report as 'exceptional'. This came as a
result of the potential organ donor referrals we make to them and
in recognition of the effectiveness of the partnership we have with
medical teams in approaching families to discuss organ
"The report noted that at County Durham and Darlington NHS
Foundation Trust, there wasn't a single missed opportunity to offer
and explore organ donation in appropriate end-of-life care
situations between April 2018 and March 2019. In that year
the Trust had 12 whole organ donors, which enabled 30 people to
receive life changing transplants.
Lisa explains, "A single donor can save or transform the lives
of up to nine people. In addition to major organ donations
such as the heart and lungs, a donated cornea can help someone see
again, a replacement heart valve can treat a heart defect and
tissue transplants can also significantly improve a person's
quality of life. Donated skin can transform the life of someone
with severe burns. Science is constantly expanding the
boundaries of what is possible.
"When there's agreement to go ahead, I register the organs
for donation and the organ donation team look at placing them. I
then stay with the patient and their family until the patient is
taken to theatre, when a specialist regional retrieval team
attends. We always stay with the donor and their family through the
whole journey from the decision to donate, during and after the
theatre process. and supporting them throughout the process."
People are encouraged to join the organ donor register, however,
in Spring 2020, the law around organ donation will change from an
'opt in' to an 'opt out' system. From then, all adults in
England will be considered to have agreed to be an organ and tissue
donor when they die unless they record a decision not to donate or
are in an excluded group - such as those under 18 and people who
lack the capacity to understand the change.
Lisa Adair, said, "When the change in law is implemented, the
family of a potential donor will still always be approached to
discuss organ and tissue donation and their wishes will still be
respected - so with the 'opt out' system, it will still be really
important to tell those closest to us what our wishes. Gordon
Harrison was an hour away from having a double-lung transplant when
the surgery was cancelled as despite the potential donor being on
the register, their family chose not to consent. Fortunately
for Gordon, another donor was identified.
Gordon was diagnosed with idiopathic pulmonary fibrosis in 2012,
when he was 55, which carries a five year average life
expectancy. Without the double lung transplant he had in
2017, doctors told Gordon he would have died within a month. "I was
filled with relief when the call about the transplant came - I was
so ill I had to be carried to the ambulance. Life now is
fabulous, I get enormous joy in the ordinary day to day things and
am able to live a very full and active life, just as I did before I
became ill. "
You can find out more about organ donation, and register your
decision, at: https://www.organdonation.nhs.uk/
Published 10th June 2019
'Every aspect of my emergency care was dealt with quickly,
efficiently and professionally with full explanations and
compassion from all staff involved'.
Patient, Emergency Department, Darlington Memorial Hospital