Gift of Life Michigan: Richard Pietroski, Executive Director

by HCE Exchange on August 19, 2010

In the state of Michigan, there are currently 3,004 people awaiting organ transplants. There are more than 100,000 on the list nationwide. For 38 years, Gift of Life Michigan has been working to live up to their name. As the second oldest Organ Procurement Organization (OPO) in the nation, Gift of Life gets donor organs to the people for whom transplants are the only promise of life left.

Gift of Life Michigan is one of 58 OPOs in the nation designated by the Secretary of Health and Human Services to facilitate organ donation. The not-for-profit organization has approximately 200 employees working within the geographical boundaries of the state of Michigan. They coordinate with the national donor registry based in Richmond, Virginia, to allocate organs. In recent years, Gift of Life has seen record-breaking numbers of donors and transplant recipients. In 2008, they had 327 organ donations and 922 organs transplanted, according to Richard Pietroski, Executive Director of Gift of Life. Pietroski comes to the position after more than 25 years with the organization, serving in many key roles such as transplant coordinator, public education director, tissue program director, clinical director, and operations director.

The Organ Donation Process

Last year in the state of Michigan about 15% of organ donations were derived through first-person consent. This means that a person had designated prior to death that they wanted their organs to be donated, usually by means of the state organ donor registry or through advance care directives. The remaining donations were upon consent of the surviving family members. “We really have to thank the families who have looked beyond their own grief, to support either an individual’s prior decision to be a donor, or to make the decision for them in the absence of a documented consent by the individual who has died,” says Pietroski.

When a person is declared brain dead, meaning their body is still being supported by a ventilator or medicines, but their brain is beyond all ability to recover, Gift of Life coordinators are dispatched to the hospital where they work with the physicians and nurses caring for that patient. The coordinators approach families with first-person consent documentation in hand, or they explain to a family the options for organ, tissue, and eye donation.

Once consent is confirmed, tests are conducted to determine the eligibility of each organ for transplant. This information, as well as a donor’s age, height, weight, and blood group is entered into the national organ transplant database, which electronically sorts the patients awaiting transfer by best fit for each particular organ.

“That list gets shuffled every time there is a new donor in the system, so no one is effectively ‘at the top’ of the list,” Pietroski says. “There are some exceptions for medical urgency, but generally the list gets reshuffled every time there is a new donor.” Each organ has its own number of variables to determine how best fit it is for those awaiting organs. An organ from a 200-pound donor might have a completely different priority list than an organ from a 100-pound donor, for instance.

Once the computer determines the closest matches, Gift of Life begins the process of contacting the physicians or care centers involved with each potential recipient so that they may review the donor data in detail and decide if they want to accept the donation offer. Pietroski says even as recently as two years ago, these contacts were made almost entirely by phone calls. Today the database software is set up so that notifications of a donor organ’s availability can be sent out electronically. Once a recipient center indicates interest, they are in direct contact with the donor program from that point forward.

The job of Gift of Life then becomes surgical coordination. There may be as many as five different surgical teams from different areas of the country in the same operating room. Timing is critical since there is a very short amount of time that each donated organ can be outside of the donor’s body before it begins to deteriorate.

A Critical Decision Every 2 to 3 Minutes

Working for Gift of Life, therefore, requires an entirely specialized skill set. Pietroski is looking for physicians or nurses who can be available at a moment’s notice, be able to walk into an entirely new hospital and operating room each time they are called, and make difficult decisions in as rapid a manner as possible. “If I had to think of one single word – it would be extraordinary,” says Pietroski. “We have to be an extraordinarily fast and reactive organization.”

As well, healthcare professionals have to relearn much of what they know about caring for live patients; though many of the procedures are similar, when a brain-dead patient is a candidate for organ donation, there is a whole new set of rules and therapies to be applied.

Pietroski says the organization currently has a very low turnover rate in staffing—well under 10%—but he considers the future of maintaining the necessary level of staffing as potentially problematic. “As nurses and doctors decrease in number compared to the general population, our ability to recruit from the same pool of healthcare professionals will become more difficult,” he says.

Increasing the Numbers of Organs Available

One answer to maintaining quality staff and affordability is in moving to a centralized donor surgical center. Gift of Life is currently building a $5-8 million surgical center. Benefits of moving donors to a central location rather than sending surgical teams out to procure the organs include freeing up intensive care space in the hospital where the donor is located and assuring access to all services necessary for best results. A small hospital might not have a pathologist available 24/7, for instance, and sharing such services with an already busy hospital can be difficult. Pietroski predicts that a centralized center will increase the number of transplants that become available.

Another change, in the broader sense of healthcare, is that organs are now being recovered from patients after cardiac death. In the year 2000, the organization recovered one organ using this method. Of the 327 organ donors in Michigan last year, 90 were from patients whose organs were recovered after cardiac death. “Let’s say a patient has a severe brain injury. They are not brain dead, but because of advanced directives or a family’s decision, they turn off breathing machines and all medications. Once a patient has died a cardiac death, we can still do a rapid recovery of kidneys, liver, pancreas, and sometimes the lungs,” Pietroski says.

Looking to the Future

Pietroski sees the future of organ donation including a process he calls organ reconditioning. “You can take an organ out of somebody that may have tested non-transplantable, but then if you treat that organ with certain solutions or supplements or medications, you can potentially make that organ a better organ,” he says. “I think the science behind organ reconditioning is something that is being worked on. There is always new research going on about how to manage organ donors better, how to manage brain dead patients and how to prevent other organs from diminishing in function while you are trying to place them for transplant.”

The stories of the people who have been given a second chance are the real future, however. A single organ and tissue donor can affect the lives of up to 50 people. Everything from major organs to heart valves, veins, tendons, bone and corneas can be used to allow another person to survive or maintain their quality of life. It can be hard “to work with a family that is deep in their grief, maybe the lowest point in their life,” says Pietroski, but the return is worth it. Another person will receive renewed hope for a healthy life, and that knowledge can be a comfort to those who are grieving.

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