LEILA FADEL, HOST:
There have never been enough organs for everyone who needs a transplant. So many surgeons are turning to a new way to retrieve more organs, and it's controversial. NPR health correspondent, Rob Stein, got an unprecedented chance to shadow a surgical team as it attempted this procedure. Before we start, a warning - we're going inside an operating room as a potential organ donor is monitored after life support has been withdrawn.
ROB STEIN, BYLINE: It's late on a Friday afternoon at the Nashville International Airport. Dr. Marty Sellers, a transplant surgeon, strides towards a small jet idling on the runway.
Hi. I'm Rob Stein from NPR.
MARTY SELLERS: Hi, Marty Sellers, Tennessee Donor Services.
STEIN: Sellers and his organ retrieval team are flying to Chattanooga to try to recover a liver and two kidneys from a donor. We quickly board the plane. Once we're buckled in for the 15-minute flight, I ask Sellers about this new procedure he calls revolutionary.
SELLERS: We're doing an NRP recovery for liver, kidneys.
STEIN: And what does NRP stand for?
SELLERS: Normothermic regional perfusion.
STEIN: Normothermic regional perfusion? That's when the surgeon uses a special pump to restart circulation, and sometimes the heartbeat, right after the donor has been declared dead because their heartbeat and circulation have ceased permanently.
SELLERS: The biggest difference is that it's better because it replenishes the oxygen deprivation that the organs incur during the dying process.
STEIN: And what's the advantage of that?
SELLERS: Well, if we recover the organ and put it on ice in an oxygen-deprived state, it's not as healthy when it gets into the recipient. And this way, it's actually recovered in a healthier state and so that when it does get to the recipient, it's more likely to work.
STEIN: NRP is generating a lot of excitement as a way to get more good livers, kidneys and even hearts. But NRP is also very controversial. Why? Critics say that NRP essentially reverses the basis upon which the person has just been declared dead. What's more, the surgeon also cuts off blood flow to the brain to try to prevent any brain activity from returning. But that raises big questions, too, including whether some blood may still be getting to the brain. Alexander Capron is a lawyer and bioethicist at the University of Southern California.
ALEXANDER CAPRON: I believe the procedure raises very major ethical and legal issues. And, yes, I find it disturbing.
STEIN: We'll get into that more later. Right now, we're about to land. When we arrive at the Erlanger Baroness Hospital in Chattanooga, there's a snag. The operating rooms are full with emergencies. The 7 p.m. organ retrieval's been delayed by at least 4 hours. Finally, it looks like an operating room will open up soon. But first, hospital staff silently line the hallway for the honor walk. The donor is slowly wheeled past to where her breathing tube will be removed. Her family quietly walks behind her bed.
Karen "Susie" Phillips, a 66-year-old great-grandmother, suffered a head injury in a car accident about 10 days ago. Her family just decided to withdraw life support and honor her wishes to donate her organs. The transplant team heads into an operating room next door to where life support is being withdrawn. Nurse Karen Howell with Tennessee Donor Services gathers the Nashville team with hospital staff.
KAREN HOWELL: This means a lot to this family. They are very supportive of this patient's wishes to be a donor. We will keep you informed with what's happening over there, should she pass within the time frame, to allow her to share her life with others, which will be 90 minutes.
STEIN: If the donor can breathe on her own for more than 90 minutes, her organs won't be usable. If her breathing stops in time, everyone will wait another five minutes to be sure.
HOWELL: The two nurses will say she has passed. We'll utilize the five minutes of observation time to roll in here. The nurses will make sure at that five-minute mark that there's been no autoresuscitation, and then we will move forward with the recovery.
STEIN: Autoresuscitation, when a patient starts breathing again on their own, which would also cancel the procedure. Another member of the transplant team, Preston Lambert reads an I-want-you-to-know message from the family.
PRESTON LAMBERT: (Reading) Susie was a very spirited spitfire lady that always spoke her mind, no matter what; a lady that loved her children, grandchildren and great-grandson with all her heart; a lady that lived her life the way she wanted without caring what anyone else thought. Her granddaughter, Eleanor, loves her very much.
STEIN: Next, Dr. Sellers briefs everyone.
SELLERS: When we restore blood flow to the liver and the kidneys, the heartbeat will resume - doesn't mean that the heart is coming back alive. It just means that what we have done is actually working. So it doesn't mean that you guys were wrong when you made your declaration, but I don't want anybody to be alarmed when you see the heartbeat resume.
STEIN: It's now well past midnight when the team gets word that the donor's breathing tube has been removed. The 90-minute clock's ticking.
LAMBERT: The patient has officially been extubated at midnight 40.
SELLERS: Midnight 40.
STEIN: Lambert starts announcing updates.
LAMBERT: First set of vitals at time of extubation. Heart rate 115, blood pressure, 150/65, MAP 93.
At the 13-minute mark, heart rate is 116. Blood pressure is 103/47, MAP 66. Respirations 30, saturating at 78%.
STEIN: Everything seems to be going as usual.
SELLERS: Blood pressure is steadily going down. It's noticeably lower than it was when we started. Death will be when it's zero. Yeah. And if it's going to get to zero, the sooner, the better because that's the less total amount of time that the organs are deprived of oxygen.
STEIN: The team mills around, checking equipment, chatting.
LAMBERT: Minute mark, heart rate 106, blood pressure 84/40, MAP 55, respirations 33, saturating at 76%.
STEIN: But then the vitals start to plateau. Another hour goes by. The donor is still breathing on her own. The 90-minute mark quietly passes. The operation is canceled. The patient is wheeled back into her hospital room.
What happened? Why couldn't she be a donor?
SELLERS: She had enough cardiac function to be able to withstand the withdrawal of the life support. So she was able to breathe some on her own, and blood pressure was good enough for long enough to where, you know, we exhausted the time limit that she could be a donor.
STEIN: This happens about one-third of the time.
SELLERS: For us, it's disappointing, but for the donor family and particularly the recipients who were expecting to get a life-saving organ, you know, it's more devastating, I think, for them.
STEIN: The patient did eventually pass, but it took another week. This case illustrates just how hard it is to get enough organs for transplantation and why some doctors are trying everything they can and why Sellers defends the use of NRP.
SELLERS: We don't do anything until the donor has been declared dead by all acceptable medical and legal standards. We certainly would not be doing anything if we thought it was unethical. NRP does not cause any additional death, and not doing NRP causes many, many unnecessary and avoidable deaths. We are saving lives. NRP can eliminate deaths on the waiting list. That would have been science fiction just a few years ago.
STEIN: Rob Stein NPR News, Chattanooga, Tenn.
FADEL: Later today, on All Things Considered, we go inside another operating room as the organ recovery team tries again.
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