organ viability

Allergic reaction makes me think that he went into anaphylactic shock, which means his throat closed up and his body was getting no oxygen. I'd be surprised if that alone would kill him, because it's easily treated (with a shot of epinephrine) but it's very possible that there are other issues compounding the situation.

Do you want his organs to be viable for transplant? I can honestly see it going either way.

I believe that some organs could be used, bu, depending on what kind of allergic reacton, some organs would not be useable. The allergen, the reaction, and the organ would have to be known, and the potential recipient would also be a factor. In some cases no organs could be used.

Here's a scenario that really happened. Guy was in a minor fender bender and transported to the hospital by ambulance. He's cleared by the doctors, and released. On his way out of the ER, his aorta, which had been damaged in the accident, but not observed by the doctors, ripped and he dropped to the floor, dead. Emergency surgery brings no luck, and they ended up transplanting several organs.

I have the same problem with anaphylactic shock that Miranda does. It's easily treated in the hospital by epi, intubation, or a trach.

Other then poison, there's very little that will kill a healthy person quickly and without any signs. But for organ transplants, you need a cause of death that can be quickly ascertained (usually from trauma). If you don't know the cause of death, the organs cannot be used.

Best of luck,

Jim Clark-Dawe

Cyia said:

If there's internal trauma, would the heart be viable? What about an aneurism?

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I don't know, but here are my thoughts. Most organ donors are accident victims. Matter of fact, the nickname for motorcycle riders, especially the ones that don't ride with helmets, is "organ donor." So the organ donor commonly has been through extensive trauma, with the most common cause of death being brain injury.

So most organ donors are definitely shaken, and probably stirred as well. Viability of individual organs is taken on a case-by-case basis. In the case I mentioned, I don't know what organs were specifically transplanted (there are levels of confidentiality in medicine).

The aorta, in the best of circumstances, is not the strongest of designs. It's not part of the heart, although connected to the heart. Aortic aneurisms, from what little I know, do not seem to be connected to the heart as far as problems go. I would think, but am not sure, that the heart would be able to be transplanted in an aortic aneurism. Biggest issue I would see is the lack of blood, but the treatment for an aortic aneurism is surgical repair. I can see the surgical repair being finished, but not in sufficient time to get the patient back. I can see the heart being viable at that point.

It's not a probable result, but that's because very few aortic aneurisms occur in a hospital.

Best of luck,

Jim Clark-Dawe

I am not a medical professional by any means, so you can take this with a grain of salt, but...
If the patient had a rare blood type and/or there was a patient in desperate need of a transplant ASAP, I would imagine the hospital would go to greater lengths to make sure they got a viable organ. (i.e. there's a patient on the fifth floor who needs a heart within 24 hours or he's dead, and this organ would be a perfect match. For added urgency, the fifth-floor patient is a dad with five kids under the age of 10, and/or some kind of VIP in the community.)

The most common cause of death leading to organ donation is a massive intra cerebral bleed. This may be caused by trauma, as suggested previously especially those who ride motorbikes but also those who play sport. Some one can get a knock to the head on the football field, appear to recover, and then collapse a few hours later when the bleeding begins again. Sometimes these people have an underlying anatomical abnormality at autopsy, sometimes it's just bad luck.

Anaphylaxis seems an unlikely path. It's either going to be treatable, in which case not a donor, or refractory, in which case there will likely be such catastrophic organ damage that the organs aren't worth taking.

There's a very strict protocol around organ donation. It's a tragedy if people die from something that could have been fixed by donation, but it's even more of a tragedy if they die because of their organ transplant, because the donor had an infection, or a cancer, that got transplanted too. For that reason medical staff wouldn't be rushing the process, no matter how important the VIP is upstairs. Cause of death needs to be clear. If there is suspicion of foul play, I don't think a surgeon would take the risk of transplanting the organs into someone else who might then die the same way. (I'm thinking here about someone suggesting poisoning as COD.)

I'm not a medical professional, but I would steer away from having cardiac arrest involved. Someone close to me died of a sudden, massive heart attack and could not be an organ donor because of that (meaning, cardiac arrest != healthy).

Cyia said:

If a patient dies of a massive allergic reaction, but is otherwise healthy, would his organs still be viable for transplantation?

This would be an in-hospital death. The guy gets to the ER on foot, but doesn't make it any farther. He goes into cardiac arrest on the spot, and is card-carrying DNR / organ donor.

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Is it really necessary to your story that the reader know where the donated organs come from? Is it enough for the audience to just know that the character was saved via an organ donor? Most of the time, these small details are not as important as the author thinks, but its your story, only you know that.

The organs from a person that suddenly died, will not be immediately used in another person. There are waiting lists, there are ethics, there is a pathology protocol, there is processing and there is tissue typing. The organs have to be flushed to reduce possibility of graft vs host disease, clots and crap and the organs must be packed to keep them from perishing in the event that they can be used as soon as testing is completed.

Even though the deceased person holds an organ donor card, doesn't mean their organs will be used for organ donation. That is just a permission slip to harvest. The medical history of the person may be consulted, the tissues must be screened for infectious diseases & tox, and they must be tested for compatibility. Not all hospital systems have the credentials to perform this type of testing, or the staff to perform it.

Keep in mind, just because an organ is deemed a 'perfect match' = 6 out of 6; this doesn't mean the transplant will work, it just means the data support that it should work. The organ can reject the patient, just as much as the patient's body can reject the organ. Another thing to consider is age of the patient. You cannot put an infant's heart into a 40 year old man, or vice verse.

Good luck to you & your story!

Cyia said:

The discovery of the donor is actually the linchpin of the story, so it's not a detail I can excise.

It's what I guess you'd call light fantasy or magical realism where everything is in the "real" modern world, but there's a single, fantastic element to it rooted in the idea of shared blood and tissue.

I had considered keeping it a living donor situation, but I find myself needing the donor's heart for the plot, so he's got to go. I guess I could always have him being a living donor, and then die in the course of a harvest. Maybe he's giving a kidney and bleeds out.

That way he'd already have been cleared as a donor, and he'd already be in the donor/tissue registries.

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The ethics of that are pretty mind blowing. One out, all out, is not quite the same thing.

"So your loved one agreed to give a kidney, of which he had one to spare, but now that we've botched the job completely, what say we take out the rest of the organs? He won't be needing them anymore and I know just the person for a new heart."

Just as an aside- http://articles.cnn.com/2004-07-01/...donor-rabies-spread-rabies-tests?_s=PM:HEALTH

For something that doesn't leave an external mark but leaves the organs viable - a brain aneurism does the trick.

A man in my church died this way. He went to the doctor with a massive headache, was given migraine medication and sent to the hospital for a CT scan, but he died on the way there.

Some of the people who received his organs came to our church one Sunday at the invitation of the man's family to show what a gift of life really is - including the teenage boy who got his heart.

Cyia said:

If there's internal trauma, would the heart be viable? What about an aneurism?

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Yes, people who die of an aneurysm are viable organ donors. Including the heart, I'd imagine.

Agree with the brain aneurysm bit.

My father had four. It presented initially with amnesia - he drove home from work, but had no idea if it was his home and who my mother and I were. He had no idea who he was, either. He had massive migraines as well. The doc at the hospital diagnosed him as drunk and sent him home with painkillers.

A few days later, my brother arrives from another city to take him to the hospital in the nearest city, where he's finally diagnosed accurately. Another week or so wait for the swelling to go down before they can operate. He survived with brain damage. He lived another 32 years after that, but he could easily have died at any point along the way - in fact, the docs kept telling us to prepare for his passing the first few months. They were *certain* that there was absolutely no way he could survive more than 24 hours...

If you want to add another kink to it, in my father's case, the aneurysms were caused by Ehlers Danlos Syndrome, which is a genetic collagen defect. The collagen defect is not necessarily easily discernable without looking at the cell structure, but it can show its ugly head at any time.