The woman lay covered and still on the operating table, while nurses and surgical technicians moved around the room, placing surgical equipment on the tables that surrounded her. When the surgeon approached the patient, a tall man with bushes advanced and cleared his throat.
"Wait time," Steven Ashley said, and the room fell silent.
He read a few words about the woman No one in the room knew, but why were they there that night? He shared personal messages from his family, including some internal jokes, and then pulled a laminated card out of his pocket.
"Remember," he read, "this room becomes sacred when a family entrusts us with one of its most precious objects." possessions. "
The middle-aged woman on the operating table, reminded everyone, was loved by her husband, children and other family members, and a hero." To honor her, he said, everyone in the room should behave like "although the family was present."
Then, there was a moment of silence, bowed heads, low eyes.
Most surgeries do not start with such a preface, but this was not routine surgery.
] Although the woman on the operating table continued to breathe with the help of an artificial respirator, she had been declared dead a day earlier.
This procedure was not to save her life, but to allow her in death to save the lives of others
Much has been written about the dramatic world of transplant surgery, the journey that donated organs take to their new homes, the painstaking work done by the transplant surgeon for a second chance in the life of the recipient. [ 1 9659006] Hours, often days, before surgery, a team of organ recovery coordinators lays the groundwork. This delicate process, which lasts 24 to 48 hours and in some cases more, moves slower, with less action.
This is the story of that prequel.
On a recent spring afternoon, a team of organ recovery coordinators headed west from their offices on the Indiana Donor Network to the intensive care unit at Danville Hospital in Hendricks Regional Health, where the woman had been treated.
Early in the day, a doctor had had the most difficult conversations with his family, saying his prognosis was poor. In the morning, the family met with another team from the Indiana Donor Network, who told them about organ donation. Throughout the day, they decided to donate the woman's organs.
The woman's family agreed to have an IndyStar photographer and the journalist follow the trip to recover the organ. They asked that their name, cause of death and other identifying details not be shared.
Although many people are registered to be organ donors, the circumstances must be adequate for their organs to be suitable for donation. Each year, the Indiana Donor Network receives about 30,000 calls from hospitals about patients who may be candidates for donation.
Of those, around 5,500 lead to references. Last year, 165 people in Indiana became organ donors.
The need for organs is excellent. Around 114,800 people across the country await organs. Last year 34,768 received organs, according to the United Network for Organ Sharing, or UNOS.
The Indiana Donor Network recovers an average of 3.76 organs per donor, more than any other organ procurement organization in the country, the staff said.  "We maximize donor donations and save as many lives as we can," said Luke Jones, supervisor of organ services at the Indiana Donor Network.
Earlier that afternoon, the doctor had administered a final and thorough round of tests on the woman. He had checked if he had a cough or a gag reflex, he noticed that his pupils did not react to the light and that he had no pain reflex. Clinically speaking, he declared his brain dead, which means he had no blood flow to his brain. The respirator ensured that his body would continue to receive oxygen, allowing his heart to beat and circulate blood to his organs.
At this point, their care passed from the hands of the Hendricks UCI staff to those of the Indiana Donor Network.
The woman's family had decorated their sterile room with personal touches, placing pictures and multicolored love messages on a large poster. Three copies of a photo of a mother elephant and her baby caressing also adorned the walls.
With members of her family clustered nearby, the Indiana Donor Network team went in and out of the woman's room, delicately navigating around the family emotional needs. Although their main task remained the organs, they also recognized that they had a role to play in helping the family to grieve.
"We usually introduce ourselves because we are in and out of there, testing," said Anne Kasey, one of the coordinators of organ recovery on duty that night. "This is a process that many people do not know, we want them to know as much as possible, we try to spend as much time as we can, it's a way to educate them about what their loved one is going through."
First, the coordinators of organ retrieval extracted approximately 30 vials of patient's blood. They took samples of urine and sputum, as well as a blood culture. Then, they ordered tests such as a chest x-ray and an electrocardiogram to evaluate the quality of the heart. In some cases, they will request additional abdominal scans to measure the size of organs such as the kidneys or the liver.
A few hours after drawing blood, they returned to the patient's side to biopsy a few lymph nodes near their groin. These will be tested to ensure a good match between the donor and the recipient. Kasey's partner, John Heflin, noticed that the patient's urine was as clear as water, suggesting that he might have had insipid diabetes, a condition common in organ donors due to insufficient levels of a hormone produced in the brain. Following the protocol of the network, the woman received a medication to reverse the condition.
Around 9:30 p.m., a few hours after the organ recovery team arrived, they talked with the woman's family. They recommended that the family go home to rest and return the next day to continue their vigil.
Organ recovery coordinators, however, worked through the night. The recovery coordinators work 24 hours a day, 48 hours of rest. The team here had started at 8 a.m. and I wanted to have everything in order at 8 a.m. the next morning, when another team would replace them.
At one point, six organ recovery coordinators – usually three teams of two – are on duty throughout the state. One team is based in Fort Wayne, but the 24 organ recovery coordinators of the Indiana Donor Network can expect to be called to cases statewide.
"We do this work with the understanding that you can go out to dinner with your family or friends, but you always have bushes in your backpack and you have to leave when they call you," said Kasey, who learned about the race while working as a nurse in an intensive care unit.
As the ICU calmed down By nightfall, Kasey and his team settled into an empty room they used as a base. Most hospitals provide a designated space for staff from the Indiana Donor Network to use while at home.
If the organ recovery team has a medical concern that goes beyond their experience, they may contact one of the Network's medical officers, both of whom are always on duty. The chief doctor, Dr. Tim Taber, has even answered calls while on vacation in France.
An organ recovery coordinator took the woman's blood samples to an Indianapolis laboratory for analysis. Blood is tested for infectious diseases, such as hepatitis B and C, HIV, West Nile virus, CMV, and Epstein-Barr virus. Other vials use the ABO blood type and more accurate tests to determine specific proteins, known as human leukocyte antigen, or HLA, typing that helps determine compatibility between the donor and the recipient.
"All cases are sad but there is a positive result in it is for the family, the patient and the recipient," Kasey said. "When we place organs, because we are assigning organs, we can know to whom this organ is directed, that is the positive part of this, you know that these organs go to receivers that are going to save their lives."  In this case, Kasey and his team did not know where the woman's organs were heading because her shift ended just when the blood returned, around 7:30 the next morning. By then, a new team was heading to Hendricks Regional to take their place.
Two hours later, Steve Ashley, the organ recovery coordinator who read the family's personal messages in the operating room, began the pairing process. He entered the patient's metrics in the DonorNet database, operated by UNOS, and pressed "match run".
DonorNet relies on a complicated algorithm to decide who should receive the organs. The formula takes into account a variety of factors, including the distance that the organ should travel and the health of the potential recipient.
In some cases, said Kasey, this is the longest part of the process. If the medical center of the first recipient on the list declines, the next center on the list is contacted.
Once the team knows which organs will go where, they begin to coordinate the recovery time of the organ. This requires a balance when the hospital has an open and free operating room with the complicated schedules of the surgeons who come to remove the organs. Surgeons can travel from anywhere in the country to obtain organs.
In some cases, up to six surgeons may huddle in an operating room. Doctors work simultaneously but biology dictates the order in which organs are removed. The thoracic organs, such as the heart and lungs, have a shorter time interval in which they can be outside the body to arrive first, followed by the abdominal organs.
Often, organ recovery procedures are performed in the middle of the night, when operating rooms and surgeons are more likely to be free. The donor's family always receives at least four hours notice so they can say goodbye.
On this night, shortly before midnight, the organ recovery coordinators met in the donor's room. Hendricks Regional Health staff and surgeons began the procedure at midnight, approximately 36 hours after the woman's family discovered that doctors could not do anything else to save her.
The family prepared for this moment. Sometime in the last 24 hours, a member of the Indiana Donor Network made a recording of the woman's heartbeat. This goes inside a teddy bear that is a memory for the family.
In the silent ICU, a family services coordinator was close to the woman's husband. The two walked by the stretcher while the hospital staff pulled her out of the ICU ward and into the hospital's operating room through an empty corridor. Only a hospital security guard witnessed the desolate parade. Nobody spoke. Occasionally, the husband contained a sob.
The doors of the operating room opened and the stretcher continued. The husband of the woman could not go further. He left the darkened surgical wing, then left the hospital.
Inside the operating room, the lights shone brightly. An anesthesiologist was already working hard. He supervised the woman to make sure that her organs were well oxygenated and as healthy as possible.
DonorNet and the results of the test determined that three of the woman's organs, her kidneys and her liver, would go to the recipients. They all went to patients in Indianapolis. Only one surgeon, Dr. Burcin Ekser of IU Health, with the assistance of a surgeon, performed the organ procurement surgery tonight. Just around midnight, the two doctors arrived, in a car with an Indiana Donor Network driver.
The organ recovery coordinators of the Indiana Donor Network, the anesthesiologist, some hospital employees and IU Health met under the bright lights of the operating room.
After the moment of reflection, led by Ashley, everyone began to move quickly and efficiently.
At 1:14 a. m. The critical moment of "cross-clamping" occurred, stopping the flow of blood to the heart. This is the moment when the heart would be removed if it was directed to another thorax or investigated.
The pressure would have been even greater if the procedure included the removal of the heart or lungs. Hearts must be transplanted between four and six hours after they leave a body and are packed in a refrigerator full of ice. Ideally, they should sit on the ice for no more than three hours. The lungs can last from six to eight hours.
In cases of long distance, a jet from the Indiana Donor Network will wait at the nearest airport to extract the organ. Once the blood flow to the heart stops, someone in the operating room will send a text message to the pilot, who will start an engine in preparation for takeoff as soon as an ambulance arrives at the airport with the organ.
Abdominal organs have larger windows of time. Livers, for example, have about eight hours. Because the kidneys can be connected to a pump that will send fluid through the organ regularly, minimizing tissue damage, they can last up to 72 hours outside the body. This means that, if necessary, they can travel by commercial plane to their new home, said Sherry Quire, director of organ services for the Indiana Donor Network.
But this donor's kidneys and liver did not take long, only 20 miles back to Indianapolis, where the doctors at Indiana University Health would transplant them later in the day. The team in the operating room prepared to remove the organs, bagging large metal bowls with sterile transparent bags filled with "slush," partially frozen saline solution.
Shortly before the cross-clamp, Ashley made and received a barrage of phone calls. West Coast researchers were curious about the donor's pancreas, but wanted to know the condition and size of the organ before accepting it.
Then the investigators called again and said that, in fact, they would like the pancreas for their study. So another receptacle was prepared for that organ, which would go back to the offices of the Indiana Donor Network, then it would be packed and sent.
At 1:28 a. M., The great violet liver was removed from the woman's body and the large metal bowls were placed in one. Five minutes later, the right kidney came out and three minutes later the left one followed. A staff member from IU Health, who accompanied the doctors to the procedure, removed the fat from the kidneys.
Ekser and his colleague began sewing the patient a backup. Just before 2 a.m., they finished their procedure. Ekser came over to examine the liver closely.
In this case, he was satisfied with what he saw, but it is not uncommon for a surgeon at this stage to decline the organ, fearing that it could be the wrong quality or size for the transplant. . If the staff of the Indiana Donor Network has the feeling that this may happen, they may try to line up a local backup to take the organ.
The IU Health doctors left the Hendricks County hospital almost immediately, crouching in a car that was waiting to take them and their valuable load of two kidneys and a liver back to Indianapolis.
The organ recovery team moved at a more leisurely pace. They packed their equipment, and the woman's pancreas, and moved their belongings through the silent hospital.
Meanwhile, at an Indianapolis hospital, the surgical teams were waiting for the organs that would help them save the lives of three people.
__  Source: The Indianapolis Star
Information from: The Indianapolis Star, http://www.indystar.com
This is an AP-Indiana Exchange story offered by The Indianapolis Star Indiananpolis Star.