6 Helping donors pass on the gift of life Receiving a phone call in the middle of the night is nerve-wracking for most people. But for those on the national transplant waiting list, it could be a life-changing moment in which they are told a donor organ is available. And when the call comes, they won’t be the only ones who need to spring into action. The abdominal organ retrieval team at the RFH is one of 10 teams across the UK on standby 24/7 to retrieve organs for transplantation. Although there are more than 20 members of the team, usually only five will go out to a retrieval at one time. Their remit means they have to be ready to travel anywhere in the UK or Ireland when on call – by ambulance van or even plane. But before the retrieval team is called into action, the transplant coordinators at the RFH receive the offer from NHS Blood and Transplant (NHSBT). Dee Sexton, lead liver transplant coordinator, has worked in the team for 30 years. She explained: “We’re the first point of contact for NHSBT. When an offer comes in, we mobilise the retrieval team and contact the recipient, surgical teams and ward staff to prepare for the potential transplant. “Communication is fundamental as we’re always thinking about the clock. The longer an organ is out of the body, the more it’s at risk – and we liaise with many different departments throughout the coordination process.” “When we retrieve an organ, there are scrub nurses, organ preservation practitioners (OPPs) and two surgeons,” explains Carlo Ceresa, hepato-pancreatobiliary (HPB) and liver transplant consultant surgeon. “It’s very unpredictable work – but it’s very fulfilling. If you’re passionate about transplantation, you have to be passionate about organ retrieval.” Jimmy Thalla is a scrub nurse in the team and is usually based in the RFH theatres. He describes his role: “When we travel to help out with retrievals, the scrub nurses prepare the instruments and assist the surgical team with removing the organ from the donor.” When the organ has been removed, it’s then the OPP’s job to help ensure it’s suitably packed and arrange its transport to the receiving hospital, where a patient will be waiting for it. The RFH is one of seven liver transplant centres in the country. There are two ways to keep a liver safe and healthy on its journey: cold perfusion or normothermic machine perfusion (NMP). Cold perfusion uses a cold preservation fluid to keep the organ cool while it’s being removed. Once removed, it’s then put on ice and sealed ready to go. Keziah Crick is the lead clinical scientist for organ preservation at the trust. She explained the alternative option: “NMP machines recirculate the blood supply around the organ to keep it functioning before it’s removed and while it’s travelling. Only when the surgeon assesses that it’s healthy for transplantation will we bring the organ to the receiving hospital.” Scrub nurse Princess April Verganio said: “Sometimes tumours can be found in the organ that haven’t been discovered before, which means it’s not able to be used. Any injuries to the organ will also mean it won’t be available to the recipient, so we have to be very careful when moving it.” “NMP has been the greatest innovation in organ retrieval in recent years,” Carlo said “It resuscitates the organ prior to retrieval and improves its function and post-transplant outcomes. It means we can transplant up to 10 more patients a year and can accept organs from much older patients.” Fulfilling final wishes Chris Bishop is one of the team’s newest recruits. Speaking about his experience as a trainee OPP, he said: “You experience the transition between the end of one life and the beginning of another one – and there aren’t many areas you can work in that encapsulate that.” Scrub nurse Hannah Rosario added: “The most important part of the role is that you’re fulfilling the donor’s last wish and giving them what they wanted. As a team, we take a moment of silence for the donor before we proceed.” “You know the difference a liver is going to make to the recipient and their family – that’s what keeps us going in the middle of the night,” Dee said. “The donor family have made a difficult decision, often in tragic circumstances. They’re still thinking about helping others in their time of grief.” Senior OPP Jenecia Brathwaite reflected: “This job gives you a greater appreciation for life and your role.” Jee Yeon Lee, team leader for HPB and liver transplantation, said: “The team are really hardworking. They cover nights, days and weekends. Behind the scenes, we also have drivers who are the unsung heroes and those working operationally who get us where we have to be.” Flying to save lives RFH organ retrieval perfusionists and team leads Retrieval team “ “ We take a moment of silence “One skill that’s essential for this job is coping with the unexpected,” Blaise Biny, OPP, said. “You have to think fast in an emergency situation but also be compassionate and understanding of what others are going through.” Almira Rairata works at the RFH as the national organ retrieval logistics service manager and has worked in transplantation at the RFL for 25 years. She commented: “As a team, we’re very close. We support each other and often get together outside work. We recognise each other’s achievements and, when we do get emotional, we can talk about it.” The specialty that keeps developing With an ageing population and growing transplant waiting list, organ transplantation is constantly evolving to keep up with demand. Research is a big priority for the team. Keziah commented: “Organ perfusion was only introduced around 15 years ago and now every transplant centre in the UK uses it. We carry out around 170 organ retrievals each year, 85 of which use machine perfusion, and the trajectory continues up. The RFH is also now a liver assessment and recovery pilot centre which also helps increase the number of organs suitable for transplantation.” It was the technology that drew Blaise to the team. He said: “Organ perfusion is very specific and it’s exciting that you get to see this super specialised technology. We’re also very involved in research – we could help develop new technology so patients on the transplant waiting list can benefit.” “Nationally, we’re one of the most active hospitals with regards to clinical trials in machine perfusion,” Keziah added. “The next challenge for us is to initiate our own studies to better determine the quality of certain donor livers ahead of transplantation.” 7 Some of the scrub nurses involved
RkJQdWJsaXNoZXIy NTI5NzM=