One of the most challenging jobs in medicine? Asking families for a dying loved one’s organ donation.

One of the most challenging jobs in medicine?  Asking families for a dying loved one's organ donation.
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Jeff Trageser runs a Mission Valley nonprofit that procures organs for transplants from deceased donors in San Diego and Imperial counties. As the only agency in the region authorized by the federal government to do this work, his 85-person team tries to turn death into life.

Some of the results are on display this week at the Transplant Games of America, a biennial gathering of organ recipients, donor families, living donors, transplant specialists and caregivers. About 10,000 people from across the country are expected for athletic competitions, tribute ceremonies and other events.

Traser, 53, was born in Ohio and raised in San Diego. He worked as an intensive care nurse before joining Lifesharing, where he is the interim executive director. Lifesharing sends nurses and social workers into local hospitals for one of the most difficult jobs in medicine: asking the families of dying loved ones for permission to remove organs and tissue.

In 2021, organs donated by a record 146 deceased people in this region saved 413 lives, according to Lifesharing.

The Union-Tribune sat down with Trageser to talk about the challenges and rewards of procuring organs for transplants. The conversation has been edited for length and clarity.

Q: I’m sure every family is different, but is there a common message you bring to all of them?

HAS: If you look at some of the studies out there, upwards of 90 percent of Americans say they support donation either strongly or very strongly. But talking about it with somebody who’s just shooting the breeze is very different from when you are in the ICU and someone you love very much has just died. You’re not in the best place to make that decision.

Our team works really hard to make sure you make the decision that you’re going to be happy with six months from now, even if right now you’re angry, you’re upset, you’re scared, or just can’t deal with it. We try to help them get into the space where they can decide what is going to be best for their family.

Q: What happens when a family says yes?

HAS: Our work is just starting. It’s non-stop for the next 24 to 48 hours straight. Our team works very long nights, in the hospital, taking care of somebody so they can donate their organs.

Finding recipients for the organs is another very difficult part. We make a lot of phone calls to a lot of different transplant centers across the country to find the best match for each organ. And they’re asking questions, pushing us for different timelines — can we go tomorrow, can we go tonight — and trying to make it work for everybody.

All this while taking care of the family, who is still grieving. It’s very complex. I tell the nurses you’re basically wearing three hats at once. You’re a social worker for the family. You are like an ICU resident, doing all the medical care for the donor. And then you’re also allocating organs and you need to be like a business person and wheel and deal to make it work for everyone.

Q: How does this region do in terms of organ donations?

HAS: Actually we’re really successful, both in having a lot of registered donors (almost 2 million people in the two counties have signed up to donate organs) and in having the families of those who never signed up say “yes” when we approach them . Our eligible authorization rate is close to 80 percent, which is higher than the national average of 75 percent.

Q: What does the eligible authorization rate mean?

HAS: One thing to keep in mind is that only about 1 in 300 in-hospital deaths qualify to be an organ donor. You have to pass away in a very specific way. So the agencies that govern us say: OK, of those hospital deaths that qualify, 75 percent of the time when you talk to the family about donations, they should say yes. That’s the threshold. We have been higher here.

Q: One in 300 — you are really threading a needle.

HAS: Everybody’s going to die, but only a very small percentage can be donors. So we have to focus on finding those people, and then speaking to their families. And then because it’s rare, we really want and hope for those families to choose what’s right for them.

If a family says, “Nope, we talked about that and he said don’t ever let me be a donor,” that’s a good reason to say no. And we’re fine with that.

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What we don’t want is a family to say, “He really wanted to be a donor, but we’re really busy right now, we have a lot going on, and we’re just not going to do it.” Because I have met those families, who come up to me six months later and say, “I’m really sorry we didn’t donate. We really wanted to. We wish we had. But we couldn’t see our way clear.”

We need to find out what do they need, what’s important to them? Obviously we’re advocating for donation. We’re not trying to convince somebody who doesn’t want to. We advocate because we know it helps families heal, and of course it helps the recipients. Our goal in that terrible moment is to help people get to that spot where they can make the decision that is best for them.

Q: After families donate, do they find out what happened with the organs?

HAS: We have Family Service Specialists who say in touch. We can’t give out too much information about the recipient to protect their privacy. But we do give basic information. A young woman in Southern California got the heart. A man in his 50s in Arizona got the liver. That kind of thing.

We also have a program where if the family of the donor chooses, we can provide more information to the recipient, and the donor family can also receive information from the recipient.

All the letters come through us. A recipient might write, “Thanks so much for your gift. I’m alive today because of your loved one’s generous donation. I got a new liver and now I’m playing golf, spending time with my grandkids.”

Same thing with the donor family. They might write back and say, “The donor of your liver also loved to play golf and he had a couple of grandkids and he would have loved to know this. So thank you.”

These are really powerful letters. And on rare occasions, if all goes well, the two families can meet in person. We’ll get a stethoscope out so the donor family can listen to their loved one’s heart beating in the other person. It’s really emotional and powerful. Some families have gotten really close after those meetings, attended their kids’ weddings, things like that.

But not everyone wants to do that. Some recipients are very private. They feel guilty because they know someone passed away, and they may not want to write that letter. Some donor families feel the same way.

BY THE NUMBERS

Organ transplants in San Diego and Imperial counties

1,943: Local residents on the national transplant waiting list (as of July 26)
1,694: People waiting for a kidney
165: Waiting for a liver
40: Waiting for a heart
27: Waiting for a kidney and pancreas
10: Waiting for a lung
6: Waiting for a pancreas
1: Waiting for a heart and lung

Source: Lifesharing

Q: What are the biggest public misconceptions about organ donation?

HAS: I think the biggest one that I find frustrating is a belief that if you are an organ donor, and you go into the hospital, they won’t take care of you because they just want to get your organs. It couldn’t be further from the truth.

First of all, the doctors and nurses have no idea if you’ve registered as a donor. They just don’t. People say, “Well, it’s on your driver’s license.” They don’t bring your license into the ICU. Belongings go into a safe. So that’s just a fact: Nobody knows if you’re a donor.

And the second thing is, if they really just wanted your organs, they would need to take really good care of them and try to save your life. What they do to save someone’s life is what the organs need. So to suggest that somebody wouldn’t take good care of you because they want your organs is backwards. It wouldn’t work.

Then there are misconceptions you hear about how rich people can get to the front of the line. They can’t. It’s impossible. You can’t buy your way to the top. It is very egalitarian. It’s like the DMV: You have to stand in that line together, rich and poor.

Transplants are based on blood type, on tissue type — so many factors that have nothing to do with income level. But when a celebrity gets a transplant, there’s always that assumption: “Well, I know how they got to the front of the line.” No, they waited just as long as anyone else.

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