Hello and welcome to the Get to Life podcast where we have conversations about organ tissue and idonatiate. You can always find us at thegiftedlife.org. Today we're celebrating February 14th National Donor Day What a Day to Make Life Happen. Here's what we're talking about on the show.
Laura, not only are we celebrating National Donor Day, we are celebrating today for our first DCD heart donation ever in the United States. And since it's Valentine's Day as well, we're going to talk about how conflicts can benefit your relationship. Okay, that's a twist. Didn't see that coming.
Maybe you did. We're going to talk about all that and more. Alright guys, here on the Get to Life we want to bring you the most cutting edge information when it comes to donation. This is it.
So hold on to your hats. We want to learn. We want you to learn too. That's why we partnered with Lifeline of Ohio.
Yes, today we bring you an old friend of mine and colleague from Ohio, Andrew Mullins. He's a chief operating officer there at Lifeline. Welcome in Andrew. Thank you very much for having me.
So you guys were involved and you obviously were one of the ones that spearheaded one of the landmarks in the donation process and donation at the circulatory death to be specific. So can you tell us a little bit about how you guys lives have changed and what you did to change the donation world in the last couple months? Yes, actually on Sunday, December the 1st we had two milestones in the field of organ donation again all thanks to the decision of a registered donor and those two landmarks or two milestones that we had was one was the first BCD heart to be transplanted in the United States and also the first five sticks organ DCD donor where we are able to recover heart, lungs, litter and kidneys all successfully transplanting. That is quite amazing and of course being a clinical guy myself.
That's always been something that's been out there. We've talked about it. It's been a possibility but we never really had the technology, the equipment and of course there were other challenges that were brought over time as well. So can you talk us through some of the challenges that you guys anticipated when in addressed ahead of time and then maybe some of those that you didn't anticipate that kind of caught you off guard that you didn't have to deal with?
To be honest it was a pretty straightforward process for us. So there were really any surprises in this we addressed everything in real time with the hospital staff and make sure that we were communicating fully with all the surgeons that were going to be involved in the recovery process to make sure everyone was on the same page and tried to get ahead of any possible concerns or challenges or issues that we were going to potentially run into. It's unfortunate that everything was very smooth and we ended up with a very successful recovery process. So one of the things I never thought I was going to see DCD hard in my lifetime.
I didn't think it was even one of the possibilities based off of what was happening over in Europe. But I didn't know that I would see that happen here in the United States. So we went about our normal process and the family prior to a couple of days before December 1st it may be the decision to withdraw ventilator support based off of injury that we got into the hospital of cardiac arrest and at that point our family services coordinator went in and had a discussion with the family. Just for the listeners just to clarify and I know I mentioned DCD the two ways that one can become a donor well three ways.
One is a living donor. The other two are our donation after neurological death or brain death or donation after circulatory death. And roughly nationwide around 90% of the donations are when someone has suffered a brain injury, a neurological injury which is caused brain death. And with donation after circulatory death the donors become donors only after circulatory death and usually this happens after someone has suffered a brain injury not always but almost always where they've suffered a brain injury of some sort whether it be from a traumatic brain injury whether it be from a stroke hemorrhagic stroke or bleeding stroke or an anoxic injury from some other means.
And this was someone that would have either lived in a persistent vegetative state or decided themselves from an advanced directive or their families wanted to withdraw support because that's not how they wanted to live. And those are the patients that can become donors through donation after circulatory death. On the right note he was already registered so he'd already made that decision so it was really helping them sort of walk through the process. And then at that point we started going into our allocation.
We didn't even know anything about DCD hard at that point in time. We even know that again it was happening here in the US and we had heard a conversation from one of our ordinary care coordinators that was in with our program that particular day and found out that he had heard that there was a couple of programs in the US that were getting ready to start a DCD hard transplant. And so based off of that information there's a discussion that was had with our team lead and about the opportunity to even look at this as a potential. And so we had an echocardiogram down that showed a very strong ejection fraction which in our field we know is a good sort of standard of good potential for the hard to be used for transplant and at that point you ran the list and there's two patients that came up on the list.
And I was blessed and surprised. I would have never thought to even we haven't even looked at the hard list when we're running our match runs to then say okay well there are patients on there. So for you guys to get that notification and to look that was very fortuitous and it was really a nice job from you guys to actually then go out and seek that. Thank you.
It was an opportunity to present it to us and we didn't think twice about not looking at the opportunity to save another life and thanks to new technology and things that are out there. This is now an option and it's really this has such an impact on so many lives moving forward when you look at the hard list and look at the number of patients that are currently waiting for a transplant because the number of patients that are dying each day waiting for a hard transplant that doesn't come in time this will provide the opportunity for more lives to be able to be saved just through this new option. So I think that's what it's all about and we all know that it all starts with the donor and none of this happens and transplantation doesn't happen without the donor. So thanks to our donor 26 year old justice Yoder for making this really this landmark even an opportunity for patients.
And obviously it started with him saying yes to donation obviously well ahead of this time and to be that thoughtful of others through death and leave that legacy is definitely an indication of his character. You talked about technology and the change in technology. Can you share with us a little bit about some of the changes that have enabled us to take place now? Sure.
I feel that this sole reason that DCD part is now an opportunity for patients based off of the trans-medical CS part system that's in existence and that truly is what was able to resess the heart in this machine to keep it in a state that's clinically able to be transplanted during the flight back to Duke from Columbus, Ohio. And we've had technology in the preservation space for years to be looked back at kidney preservation. The pulse out kidney perfusion machines have been around for decades. And now you look at new things such as liver preservation machines, perfusion machines you look at longs now, DCD longs if you go back a couple of years that wasn't even something we were talking about.
And now with new technology, one of the patients of the donor, the option for longs to be able to be recovered, placed on this machine in trans- medical care. And just to make one quick point, so the big difference in why technology is needed in this situation is with brain death, that person is declared dead and the recovery takes place while the heart is still beating. And so the time that the, what we call the ischemic time, the time that there's no perfusion is limited. It's almost nothing.
Where the time for a circulatory death, after death is declared by circulatory death, there's a time period that everyone has to wait to make sure that there's no auto resuscitation by the heart, by that person. So that's the actual time of death. That's where the time the heart stopped and it's no longer going to resuscitate itself. So I just want to make a quick point that it's important to note that the heart doesn't get resuscitated there.
It's only after it gets put on to this trans-medic machine in transportation that the heart starts to break. In the justice situation, we look at the in the ordinary recovery process. There is 13 minutes of time of warm Athena time where there's no blood or oxygen perfusion to the heart. And then you look at the time that once the heart was recovered and getting prepared to go on to the trans-medic machine.
When you look at that, I think total around 45 minutes of time that the heart was not beating whatsoever and then the heart was able to be resuscitated once it was placed on the trans-medic machine. So about 45 minutes in general. That's what we saw in this particular scenario. We always say, you never know what's going to happen tomorrow.
Well, you guys are doing it and living it. And I guess just from my perspective, so all these amazing things are happening. I hear Joey and he's very excited about the possibility of saving more lives than what you guys are doing. And then we have this change, education when it comes to those working in the hospital setting and the community.
Are there new things that you guys are pushing out to help people better understand? What is it you're doing? I know it was a big media story. People were following it.
That's one of the reasons we have you on the podcast so we can all learn. So is there any other ripple effects changes within the organization and outside to help with this? We continue to think about the same as far as our messaging and what we say and what we'll continue to say. First, it starts for everyone to listen to this podcast and anyone that even hears anything about donation is to make a decision to be an organization or to register your decision to be a donor.
That's the first thing you can do and encourage everyone to do that and also to share that information with their family. As far as what we go, that would be the public aspect and ask that we have the second component. We look at the hospital literally about the hospital making, again, the opportunity to win the referral should be made to the organization. For instance, one of ours is when we know that the family has made the decision to withdraw support, that is an opportunity for the hospital to call us and to call us in a time remayner to let us know about this referral or other clinical triggers we have of Glasgow Como Scale of five or less.
Be hard on the ventilator for those referrals to come in and that allows us the time to determine is there suitability for organization to exist and at the right time to be able to have that conversation with the family. Like I said for the case of DCD, once the family is made that decision to withdraw, is when we're having the conversation about the opportunity for the potential of donation. It goes back to that early referral and ensuring that the hospitals are calling in a time remayner, making sure that there's a close partnership between the hospital and the order to come an organization to continue to build upon the strong relationships that already exist and just continuing to have a very supportive positive culture of donation in that hospital environment that can lead to identifying opportunities or anything to happen. So we work with obviously a lot of families and what we hear is their excitement over wanting the heart to be transplanted specifically, not that one gift is greater than the other because we know they're all lifesaving and equal.
It's probably due to a lot of media exposure when you see someone listening to a heartbeat and so it used to be that for our DCD donors, the heart wasn't an actuality and out is I'm wondering if when you spoke with your donors family members, how excited they were that their heart was transplanted and I'm sure just in the future there's going to be so many family members who are so happy that now a heart is a possibility for our DCD donors. It's just interesting and when they heard first of all they were excited that the option for donation was going to be able to exist and then when they found out about the heart because we all know, like you said about the heart, the heart is special. Like you know a lot of families connect immediately just anyone in the public connects to the heart of there's something special about the heart, not that it makes it more important than any other organization, there's some special about the heart and so when they heard the information about not only was there something in Oregon, but he was also going to pave the way for the future and really about this new landmark opportunity, they were also beyond excited to know that their son justice was going to be able to initiate this entire process that's going to change the field of donation and transplanting for our future in safe countless lives. So, you know, multiple factors there but they were just beyond excited to be able to know that their son, their son at a hero of donation was going to be able to impact so many lives and impact so many generations of lives to be forward.
Andrew, I'm so excited because you know this is very much a copycat type thing because it's not like there's a heart bypass surgery that takes place in almost every bigger hospital or other surgeries, a bone fracture and things like that that get fixed through surgery. These things happen so often whereas transplants in general aren't that frequent, you know, it's not as frequent as we would like. So of course we always look to each other, to colleagues and when we read something, you know, in the transplant world, when I'm reading something about the procurement world, you know, I get excited and of course I want to do that. That's some of the conversations you and I have had before, you know, how are you all doing this and how can we do this, you know, as well as you guys are.
So because it's a copycat type thing and we have so limited information to learn from, I see this spawn so many others, other transplants just like it. In my mind, I can imagine a lot of other heart transplant centers starting to list their patients. Now that they've seen this, you know, you and I have seen this with HIV donation in the whole pack, you know, and you know, once you've had a few transplant centers on board, all of a sudden, you know, now you've got 50 on board and I see the same thing with this where a lot of patients now and from the patients themselves, you know, transplant potential recipients that are there waiting for a heart saying, hey, why don't you guys, you know, taking the DCD hearts, I would be interested. I see this having a huge ripple effect in the very near future and in fact, and we talked about it just for a second.
But so you guys were the first on December 1st and all of a sudden there's roughly, we haven't gotten the official numbers in, but between four and six others or that, well, four and five others that have happened just in December alone after you guys pioneered and made the first kind of leap of faith there. I don't know the official numbers, but I know there's been several programs. I would say at least five or six successful DCD heart transplant that have taken place. So we think close contact with the Duke Surgeon that I was in operating with in our team was and just the see how the recipients are going and just the things are going and you let me know yesterday that his center, Duke's transplant center has trans or they're going to be transplained and transplained and time and manner to really impact their life moving forward.
So that's before I know I do for sure and I know there's a couple of other centers including MassGen and I believe in Wisconsin and I can't recall the centers, but I know this is a clinical trial and I believe there's four or five centers that are a part of the trial at this point and I believe they're ultimately trying to get at about 221, 222 or so if memory is certainly correctly for the trial and so they're well underway. So when I read the story, the first thing I thought about was whether you all had any ethical considerations to take into account. Yes, our take on this was a standard DCD process and we were not going to make this a week communicated to stakeholders involved in the process but we were not going to be in a standard DCD, we're not going to make this a bigger issue than it was an issue, it didn't need to be anything made big of this and so what we did was we communicated to the stakeholders in real time of what in the hospital of what was going to happen and this was going to be the first and that in this case the heart was after death had been declared and we went through the waiting period and once the decision had been made there was going to be a waiting, you know, there was going to be the heart was actually going to be removed from the body before it was placed on this machine and so as you said Joey, there was a very clear black and white line there, very delineated between or their neatrical concerns, et cetera and in this case there was zero ethical concerns because of the standard process the patient was pronounced dead and at that point we were by the attending physician, we waited the five minutes and the decision was made, the heart was recovered and placed on this machine so there was zero, the scenario we faced and what's currently taking place in the clinical trial in the US right now is that the death has been declared the heart has been recovered and in place on the machine, right, but the body. And obviously with the success so far with the trial with at least in obviously it's a small sample size but with the few that have been recovered and transplanted and all being successful immediately and not having a delayed graph function or a delayed in the heart function or poor function, you know, if you got if it's successful, I can't imagine that anyone would want to change what's going well so that's my time.
And I believe if I remember correctly, it's very comparable to the liver when you look at what are the parameters of warmest you made time that they're willing to look at and I think it's 30 minutes and so we were 13 minutes but so it's very comparable to what a lot of the transplants are looking at in the DCB space for liver sugar for transplant. I'm a family advocate so I approach for donation so I'm wondering too what y'all have done on the front in there. Yeah so it's about first of all it's about honoring the decision to donate and so we've been working diligently to make sure that we're navigating that in the right context and making sure that our staff are trained appropriately to be able to feel like they're comfortable and confident in having that conversation with the family. We're hearing more and more that we've had family said unfortunately have said when they made the decision to withdraw they're ready to withdraw now and so they're telling us I wish I would have known yesterday or two days ago I would have loved to have donated and I would have loved to have honored my loved decision to donate if I would have known that at this point we're just ready for it to all the others.
So we're really our family services team and our hospitals and others are really trying to navigate that particular aspect. Yeah timing time down. Yeah timing and how can we continue to get better at what we're doing and make sure that we're able to provide this opportunity to these families. Right, well that's what's all about working together to make life happen.
We talk about this on the podcast all the time so we appreciate you joining us to share the story. If folks want more they want to learn more they want to follow you guys see what's next. Where do we send them? We send them to our website at lifelineofohio.org there's plenty of information about our organization there and we're happy to answer any questions that anyone may have whether you know they're in the OPO world or just someone wants to know more information about this we're happy to answer any questions as we as we move forward.
So thank you all for the opportunity and I also want to say thank you two kudos and thanks to your program the Louisiana Working Procurement Agency for all that you guys do in the field of donation and transportation we've learned so much from you and we're very appreciative for all that you guys are currently doing and have done we've learned a lot and continue to learn from you. So thank you. Well Andrew we will be here for your next landmark and donation so please stay in touch with the Get to Life podcast and thanks for sharing today. Thank you all thanks for having me I appreciate it.
In the podcast we take a moment for mental health that is now. That is now and somehow Sarah's going to convince me or try to convince me that conflict actually benefits relationships. You're on. That's right guys.
Happy Valentine's Day. Okay so first of all yes we're going to talk about how conflict definitely benefits relationships but the first piece of the puzzle is we're going to have to redefine it. So that's how she got you. That's how she got you.
That's right to Joey. So really I want us to think about conflict as not fighting but as a healthy conflict. So what is healthy conflict? It's being able to communicate with your partner about something that you disagree on and it's not just romantic partners either this could be friendships, family, just any relationship.
So conflict is just discussing things that we disagree upon or things that make us uncomfortable upset anything like that. So it's good though because we need to keep open communication with those in our lives so that we can get three things correct. So I know you said it's not about like it doesn't have to be romantic partners but I'm thinking okay like it takes a blanket so we're going to go to dinner like those. Yes.
So how do we fix that? How do I fix him is what I'm talking about? Oh you'll need to seek him in a horta. So I just want everybody to be less afraid of conflict too because it really just gets you going and it gets you to a place where you both can agree or you can compromise which is really healthy.
So first of all you just have to make sure that when you're going into conflict with a person in your life you make sure your energy is correct so you're coming at it very open and very non-blaming, non-defensive. You're ready to have a conversation that a little bit could affect you negatively as well. Yeah and I can tell you that is a challenge. It's different.
So from I have so many conflicts at work and even with not in a bad way just differences of opinions and decisions that have to be made and it's so much easier to match my energy to where I need it to be in my work relationships than it is in my personal relationships if that makes any sense. Just on your lacks like I'm always in tune to those things. I try to make sure I'm projecting and I don't it's not an emotional thing to me. It's a lot more cut and dry some of the decision-making and differences in opinions whereas when you bring it into the personal realm you see a lot more emotions being involved and then of course when emotions are thrown at you it's hard to keep your energy and emotions and everything in check to be where it should be.
So just know too that you can always take a pause if it does feel like it's rising in emotion and it's getting more negative and angry and defensive. It's okay to take a pause and to let that person know we need to take a pause and come back to this when we're both ready and have the right head space for this. When you check your tune and use your work. It's true.
It's true but it's hard. It's easy things. It's easier than I can do it. But that's exactly right.
Check your attitude. Take a deep breath and come back to it. Another really good way to do this is to share about yourself too. To share using I statement so I feel this way.
It's a really good way to start the conversation so that it's non-blaming as well. You don't want to make who you're having this conversation with feel blamed or defensive. And then own your own contribution to the problem. Okay now this is getting crazy.
You're never wrong, Laurie. But as I say there's two people in everything. So if you lead with I was wrong when I did this, instead of you did this, you did this, when you start with I did this or I might have contributed in this way, it opens the door and it creates a more trusting conversation so that they don't feel so blamed and it isn't as emotional. Sorry it's hard to say sometimes.
It is. It is. That's good. Yeah.
And then just follow it up with what can we do differently in the future? So what are some actual actions and behaviors that we can change so that this conflict doesn't keep happening? So you and I need to talk then. Okay.
Yes. Those are good. All right. Anything else, Missyra?
If you hurt someone and they hurt you, as long as you are on the same page with making it better, it can really open up the door to a more meaningful relationship. You don't take a note, Joe. I'm always more confident about it than I love it. Challenge.
All right. We like that. Maybe you have a question you'd like Sarah to tackle? You can email us here at infillall interconnectedlife.org.
Earlier in the podcast, we spoke with Life Line of Ohio about the first DCD heart donor in the United States. As you know, in every episode, we honor a hero. Today's hero is that very amazing donor, Justice Yoder. Here's more about justice.
During his lifetime, justice cared for developmentally disabled individuals. Through his death and decision to be a registered organ donor, he saved the lives of recipients, ranging in age from mid-20s to mid-60s. This young man was the shining light and beacon of hope for his family and friends, said the donor's family. He supported, loved, and lived fiercely.
Even though we will miss him, we know a part of him lives on. This truly provides us comfort. He was an extraordinary young man. And now we pause and say thank you to Justice for the gift of life.
In our question and answer segment today, what is a living will? What is DNR? Are they the same thing? Joc, can you jump in here?
Yeah, so we have spoken this in a prior podcast a little bit about living wills. And living wills are kind of usually the term living wills, interchangeably with advanced directive or advanced medical directive. It's a legal document from a decision that a person makes for the time that they become too ill to make the decision for themselves or incapacitated. So it encompasses all areas of health care, everything that you would need in those situations.
A DNR, it can be part of a living will. DNR is do not resuscitate. And that's just basically says that when your body's failing and your heart is shutting down, that the health care team doesn't do CPR and advanced cardiac life support. So it can be part of the living will, but they certainly aren't interchangeable like living will and advanced directives.
If you want to learn more about end of life decision making, you can listen to our episode 99 with Paul Rabela. And if you have a question that you want us to answer on the podcast, go ahead and email us at info at thegiftedlife.org. And you can also call us at 504-648-3477. Episode 128 of the Gifted Life in the Books.
Yeah, thanks to Andrew and his team there at Lifeline of Ohio for pushing the envelope and allowing the rest of us to follow. And hopefully see a lot more hard donations through that. Incredible story. And you, you right there, you listening, thank you so much.
And hopefully you are inspired to register as an organ tissue and eye donor. You can do that anytime, register me.org. And remember, you can always find us at thegiftedlife.org. You can listen there or on Apple, Google, Spotify, our radio, wherever you listen to your podcast.
If you do listen on Apple podcast, go ahead and give us a five star rating and subscribe so that more people can find us. Or if you're on social media, like our page on Facebook, the Gifted Life podcast, and follow us on both Twitter and Instagram at Gifted Life Pod. And we do hope that you go out and do something you would normally do to help us make life happen. We do appreciate you listening and hope that you share the Gifted Life podcast in this new year.
Have a great day. This is a production of LOBA, or the Louisiana Organ Procurement Agency. The Gifted Life is hosted by Lori Steele, Joey Bubro, and Sarah Blakemore, our executive producer is Kirsten Heins, producer Ishelon Caraway. Intern is Rebecca Rannam, and we are recorded, engineered and mixed in our Covington, Louisiana studio by Troy Perez.