Story by Joel Swerdlow
Rick Hasz carries a large coffee as he arrives at the Gift of Life Donor Program offices in downtown Philadelphia. Rick, age 38 and a veteran of more than 15 years in organ and tissue donation, looks well rested, but is not. His telephone rang about three times an hour all through the night - he had catnapped on the sofa so the calls would not awaken his wife.
Such nights are normal for Rick, vice president of clinical services at Gift of Life. As people die in hospitals in a three-state area, he helps coordinate efforts to recover organs and tissues. The stakes are high: in the U.S., about 18 people die every day while waiting on the organ transplant list. Each year, moreover, hundreds of thousands of people rely on donated tissue to save their eyesight, make limb amputation unnecessary, replace faulty heart valves and heal burns, as well as for countless other surgical procedures.
But what is happening in this office and 58 other federally designated organ procurement organizations in the U.S. and Puerto Rico goes far deeper. When a death happens, people generally experience grief in five stages: denial, anger, bargaining, desperation, and acceptance. To this, organ and tissue donation has added a new element: whatever stage or stages of grief you are in, you can help yourself and your family by helping other people.
Several of the nighttime calls to Rick concerned 18-year-old Julian Byrd, who is in intensive care at St. Mary Medical Center in Langhorne, Pa., near Philadelphia. Julian had been admitted to the hospital six days earlier. Doctors have declared him brain-dead. Although his brain literally has no blood flow, a ventilator, a machine that pumps oxygen-rich air in and out of the lungs, helps keep Julian's heart beating and blood flowing through the rest of his body.
One call to Rick had been from a Gift of Life transplant coordinator who had been at St. Mary for nearly 24 hours. Julian did not have cancer or any infectious disease, so he was medically eligible to donate organs and tissues. His mother, Susan Deaton, said he had wanted to be a donor and she agreed with this decision, but that she and the family needed more time; to them, Julian was not yet really dead.
Such delays can threaten donation. A brain-dead human body hooked to a ventilator can last at most about seven days, and at any time a number of things, including cardiac arrest, might make organ donation impossible. However, the family always comes first. Rick's advice: work hard to help Susan understand the situation.
At Gift of Life's offices, Rick stops in at the Transplant Information Center (TIC), a large room with windows in its walls so people in surrounding corridors can look inside. At least three transplant information coordinators - many of whom have experience as paramedics, social workers or in some other health-related profession - work in this room on 12-hour shifts, 365 days a year. About 150 times every day, doctors and nurses in area hospitals call with referrals: a patient has died, or is about to die and someone needs to talk to the family about donation.
Each transplant information coordinator sits in front of two computer screens and sometimes has two telephone calls going at once. Time is crucial. When a family agrees to donate, minutes can be the difference between saving a life and letting someone die.
Dominating the TIC is a large activity board listing referrals of potential donors. On it are listed Julian and about a half-dozen other patients at area hospitals. With each is cause of death - mostly strokes and other non-traumatic injuries to the brain - and age: 57, 61, 54 and 36, disproving the popular misconception that most organ donors are young like Julian.
For your name to be on this board means either that you are brain-dead or that you are being kept "alive" only by the most slender thread. No one who reaches this board ever lives. You are beyond life-saving procedures, and one of the only remaining issues is whether you can donate organs and tissues to help others.
To become an organ donor is to join an exclusive club. More than two million Americans die every year, but only about 15,000 die under circumstances - primarily, being declared brain-dead in the hospital - making them medically eligible to donate organs. Of the estimated 15,000 patient deaths, only about 6,000 currently end up donating organs. For most of the remaining brain-dead patients, families often say "no" to donation because they did not know what their loved ones would have wanted. This is one of the major factors contributing to the gap between the number of patients waiting for transplants and the number of organs donated.
Surrounding the TIC are offices in which nearly 100 people work. As the Gift of Life receptionist calls on the office public address system, "TIC, there's a donor referral on line one," professionals organize public education campaigns, conduct grief-counseling sessions, prepare supplies to be taken to hospitals where there are organ donors, and perform other functions.
Built around such activities, organizations like Gift of Life are a community resource; they are not-for-profit, funded primarily through government-regulated fees. Like police, fire, ambulance and hospital emergency rooms, they provide 24-hour-a-day services in life-and-death circumstances. But only the end result of their actions - the dramatic, life-saving transplant - ever receives much attention.
One windowless office belongs to Scott Demczyszyn, a supervisor of transplant coordinators. Professional journals with articles like "Advanced Assessment of Hemodynamic Parameters During Donor Care" cover his desk, and photographs of his twin four-year-old girls smile from the walls.
Scott had been a paramedic for 15 years before joining Gift of Life as a transplant coordinator eight years ago. This profession, which requires certification and continuing professional education, has been in existence less than 20 years. Nationwide, about 1,000 people work as transplant coordinators for organ procurement organizations, and the burnout rate is high. Long hours disrupt family life, and you work with people during the worst moments of their lives: when someone they love has suddenly died.
Scott's office is empty because the TIC had called him at home around 5:45 that morning. Stopping at a convenience store to buy a sandwich that could serve as lunch, he had arrived at St. Mary Medical Center a little more than an hour later. The other transplant coordinator briefed him and went home. After talking with the on-duty nurses, most of whom he knew from previous cases, Scott went to see Julian, who was dead and still in the ICU. It was not yet clear if he would become a donor.