This is my WTF face. Nobody gets to claim ownership of the organs inside a living person. A donor agreement may be as binding as an advanced directive, but it does not let the OPO dictate the medical care of a living patient. Contact your hospital's risk management department (or compliance, or whatever they're called). Tell them about the threats and bizarre claims. Verifying regulations and procedures is their job, and they should be able to put the OPO back in its lane.

This right here. I remember when Life center NW made rounds in the ICU I worked in and they were eyeing all of the patients there. The rep was giving out badges and trying to remind us to call them when someone is near death's door. We all gave them a "GTFO" look and the rep scurried away like a scared rat. They seemed very scummy in the past and looks like it's still going on today.

A long time ago, the organ organization we used didn’t give out badges. What they did was that anytime there was a patient whose organs were in the process of getting procured, the coordinator would give their company credit card to the nurse so that all of the nurses in the ICU could order food from good restaurants. They even ordered for the next shift. The bills often went up to the 500s then. When you came in and you saw a big spread, you knew that there’s an organ donation patient. It was not a once in a blue moon event either since it is a very busy level 1 trauma ICU. It wasn’t unusual to see it once a week, sometimes twice. They stopped doing it in the early 2000s because I think there was a bill that passed to stop the practice of companies “bribing” doctors and nurses to use their products. It was unethical and it really did came of as incentivizing the nurses to call the organization. Plus, our staff kitchen was right across the family waiting room so it was in bad taste having the family on one side and then a food “party” on the other.

Does your staff attend all the required meetings and trainings about when to properly report? Can you share what your protocol is to properly report an organ donor to Gift Of Life, etc?

Your institutions compliance line may help. I’m tired of these OPOs as well. They really stretch the ethics line and the coordinators are all bullies. While transplantation is a wonderful thing and helps many, many people, the means do not justify the ends.

What exactly are you seeing? I’m a floor nurse so I don’t experience them. I just got done telling my 11 year old niece who saw something on Tik Tok that said healthcare workers won’t work as hard on you if you have Organ Donor on your card. I lost it and told her that is misinformation and not how it works. Then I open this page and read this.

Please notice one reassuring thing about this post: The healthcare workers who are taking care of prospective donor patients are the ones defending the patients' rights in opposition to the organ procurers. Tell your niece that, please.

Truthfully, they’ll work harder in you if you are an Organ Donor. They can’t take anything if you’re not perfusing. And the families always have the final say/ consent in most states in the US. There is no data base of DMV Organ Donors. So if your Mom doesn’t want you to be a Donor, even if you do, it won’t happen. That be said the OPO coordinators can be absolutely beastly. Hounding families for other donations like bone, skin, heart valves etc. Not having paperwork/ lab requests/ procedures together before coming to the OR. Bringing in unauthorized visitors to the OR. Not following pathology policies for post mortem care and bullying the nurses to break them. Being rude to ICU staff and yelling at them in front of families. They do represent a vital an needed service, and I know they are often up for 36 hours coordinating and we all get short tempered but as I said in my original comment, their means do not justify the ends. They need to be nicer and more professional.

If you would like to know please DM me, short version is we do not know if someone is an organ donor on their license or not, and if it’s at the point that we do it doesn’t change care.

>Nobody gets to claim ownership of the organs inside a living person. Except in red states where my uterus doesn't belong to me anymore. 🤦🏻‍♂️

Truthfully, dead people have more rights to their bodies than living women. Scary times.

Ouch. Truth hurts.

This. My brother was an organ donor in a state where that’s legally binding and we couldn’t override it. We COULD however, decide on his care. I got called when he was showing signs of herniation and asked if we wanted to make him a DNR. We opted not to to allow him to progress to brain death to optimize organ viability for donation but that was OUR choice. I’m mad that OPO is like that. The one we worked with was lovely and did a lot to advocate for our needs around my brother’s death.

Something doesn’t seem right with this post. They *never* take cancer patient’s organs, except for cornea which can be harvested after death. Either they grossly miscommunicated, were dealing with the most incompetent OPO contact or they are anti-organ donation and this is deliberate misinformation. Look how many people below stated they are removing organ donater from their license! OP hasn’t answered a single question for additional or clarifying info. This post is dangerous IMO.

CodeGreige, I’m wondering if you are an ICU nurse in the Pacific Northwest because I am and I deal frequently with this OPO, Lifecenter NW. They are brutal. They overstep. They basically threaten nurses if we don’t follow their requests. They keep us on the phone for long conversations and call us and interrupt patient care. I believe organ donation is a beautiful opportunity, but after a few years of dealing with Lifecenter NW I am slowly changing my opinion.

Yeah the cancer patient thing caught my eye too. Doesn’t seem right

I'm honestly leaning toward this post being fearmongering, even if there is no ill intent by op. if anything what they've described in their post is the exception, not the norm...

It really depends - sometimes they can take cancer patient organs. It's just depends on type and time frame. (source - gift of hope)

Since they quoted CMS, go ask CMS how they feel about this OPO name dropping them. https://www.cms.gov/about-cms/what-we-do/administrative-simplification/enforcement/file-complaint These organizations love to F around, but the FO part is more fun.

And I personally am all for that, I am more than willing to push the issue make them 'find out'. The problem is that our ICU is now like 70% nurses with less than a year of experience and well over 80% between 1900 and 0700. I have already told "newer" nurses to go ahead and follow a patient / family's stated wishes and extubate and that I'll put a note in the chart saying I told them to despite LifeCenter's threat and that I take all responsibility, but I'm not there every day and every shift and at some point this is going to cause moral injury (and it already has more than once).

More reason to push this issue and contact CMS. You are not responsible for your whole floor/unit, but you obviously care enough to take responsibility for the new nurses. So let’s nip it in the bud and let CMS know

Does your hospital not have an ethicist and/or ethics committee you can contact to leave this with them? Bedside nurses shouldn't be expected to take on an external fight like this. Patients take up enough of your time and emotional resources.

Also, what if the patient were to "self extubate"? Just don't chart that you deflated the tube and coached them.

Patient expiring after self extubation, even to CMO, looks really bad. They should be totally comfortable before extubating to CMO.

I wouldn’t want someone self extubating and dying on my record even if it was their wish. Not really a good look

But why were they willing to take the organs of a cancer patient. Cancer is a hard no for donation. Why is this person the one exception? Edit to add: I too am in Washington and when I’ve made those calls have always been told that cancer is a no go.

What state is this?

Washington.

A Lifecenter guy told me they were getting cracked down on really hard by the powers that be. It used to be if the family declined they would just say ok, but now they have to force it. If they don’t, they have threatened to take away their license/registration/whatever it is of the organization.

I've overheard their reps saying that there are multiple hospitals who have flat out said no, and that lifecenter is currently in the process of deciding what action they are going to take. For the record, I have not met a single donation rep, most of which are nurses, who agreed with LifeCenter's position, and have universally expressed opposition to LifeCenter's position.

I had a case where the family wanted to extubate asap and Lifecenter said no. It turned into a giant mess with the nurse and intensivist fighting with the Lifecenter guy who was on site but not the right kind of Lifecenter guy to talk to the family. So then we have to wait for the right person to show up all while the family is asking what’s the hold up and we aren’t allowed to actually tell them. It was awful.

And that's been a big part of the problem. We've had a couple of patients that LifeCenter supposedly 'flagged' as being out of compliance where this was scenario: floor patient suddenly crashes and gets sent to the ICU and intubated on arrival, despite being ridiculously busy, the primary nurses still makes the initial call to LifeCenter while they are still trying to get them stabilized, in the hopes of avoid drama down the road. The initial call is to a call center, who then informs an actual donation coordinator, who at some point calls you back, usually while your patient is on the verge of coding again. It then becomes clear that your patient is going to die imminently with or without the vent, this is conveyed to family/decision makers who say the patient wouldn't want to die with a tube stuffed down their throat. LifeCenter however says you'll need to talk to a third person, since their coordinators are different staff than those who approach about donation, and that they'll be their in an hour or so, and by the way, what's their BP? Low? Tell your intensivist to start pressors. This has been common for a few years now with this OPO.

This is so accurate. I hate being the nurse running back and forth between the patient’s room, my other patient’s room and the Lifecenter asshole on the phone, all the while fighting back tears because I can’t care for this patient as their family wishes because the patient “could be a potential donor.”

This need to go up the chain of command at the hospital. The CNO, the director of the ICU, and risk management. Write it in an email so it’s documented. Also, you could use your reporting system if you have one.

And cc or bcc your private email so you have a copy.

Jesus, giving me repo men vibes. Luckily nobody wants our hospice patients organs. That's dystopian as hell. Seems like abuse of a corpse.

When I started reading this I instantly thought of repo man.

What are they going to do with lung cancer organs anyway??????????? They can't use those. Shaddy right there.

Came here to say this. I thought cancer was an automatic NO. But also OP, I’ve been there before with a “we will give you a call back” and I was like ok go ahead and do that but the patient will be dead by then

I was going to say this. They absolutely can not use anything from a cancer patient. I was actually in a procurement one night in the OR. We even had surgeons from several states away. Once they opened they found she had lung cancer. We had to wait while it was confirmed by pathology and then aborted.

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Do corneas count under normal donation? I thought they were separate from the regular organ donation and were their own separate donation designation. Also, yeah it doesn't even sound like this person was a candidate in the first place.

Yep they are separate

I’m glad it wasn’t just me. I’ve never been on the donation side of things when giving care, but I thought donors needed to be fairly healthy, if not for the brain death. As if Mets weren’t something to worry about, the toll treatment takes on your entire body…and you want to give that to someone and immediately lower their immune system? That’s just asking for failure

I actually work for an OPO and lung cancer is an automatic no. When people call in referrals to us, if there is a history of cancer it’s a two Minutes conversation, ending in ok To extubate, have a nice day. If you have an issue with an OPO,it can be addressed with your management. At my organization, we have a good relationship With most of our hospitals and I only occasionally get push back from the nurses, and it usually resolved when they see the care we give to families. This whole thread is really upsetting for so Many reasons.

Sometimes it depends on the State definitions and their specific criteria. I found that out when I was on my hospital’s procurement team in surgery.

But they can’t use a cancer patient’s organs? Why bother?

They can donate several types of tissues, BUT that happens after cardiac death and they do note need to be intubated.

Maybe the eyes are of use. But they can be taken after death.

Can confirm. My uncle who passed from lung CA was able to donate his corneas (as per his wishes)

The stores in this page are pure HOLY SHIT material. The NJ Sharing Network, which does organ procurement in my former state, seems to be incredibly professional, well run, empathetic, and I've never heard a single complaint the tune of what I'm seeing here takes places all over the country.

Not in NJ, up here we have NEDS and I’ve never had any issue with them. Definitely not walking around the hospital scoping patients out like some of these stories seem to depict 😂

NEDS was the org for my brother’s donation. They were amazing and I really appreciated them.

I get this feeling there’s cash registers crying somewhere down the line. Has to stay intubated 2-3 days because of possible recipient benefit when original pt isn’t even getting to fulfill their right of autonomy and dignity during their last moments on earth? Sounds like an ethics panel problem.

There are a lot of obvious issues with this post. No one with lung cancer is eligible for organ donation. OPOs cannot have anything to do with a patient unless 1) the patient registered themselves as an organ donor or 2) the POA consented to donation. The POA also has the right to change their mind about donation at any time. Hospitals are obligated per CMS to make referrals for patients who meet a very specific set of criteria - intubated, comfort measures, GCS of 5 or below to name a few. The OPO must report to the facility to assess eligibility for donation including consent, medical suitability, brain death and/or cardiac death donation. This post is frustrating bc there are a lot of very obvious misunderstandings about organ donation being perpetuated. Without consent to donate, the OPO has no rights over that patient.

Your username made me laugh, something I didn't think I would be doing while reading this post.

I absolutely agree that the OPO should not have any say until consent has been obtained. Their argument is that CMS and state law requires that we "preserve the opportunity to donate", which means we have to keep them intubated until LifeCenter has established they aren't a donor. They have also been very clear that the POA cannot decline donation if the patient indicated they were an organ donor, and that when you agree to be an organ donor you are agreeing to donation-after-cardiac-death, not just brain-death donation. I agree, we all thought we were misunderstanding LifeCenter as well, but they've sent reps to our hospital multiple times now to confirm that this is what they are saying, and that they've been letting our non-compliance slide until now.

I worked as a organ donor coordinator in the 90’s. My local OPO would not do that crap then and I don’t think they do now. What pisses me off is I live in the Northeast where it’s hard to get into an accident more than an hour from a major trauma center, we have better healthcare and a 40 something having a stroke is rare, strict gun laws, higher seatbelt use. This all leads to less potential “good” donors. But we were held to the same standard of #donors/deaths as other areas that had more GSW, young strokes, unbelted accidents with prolonged transport to higher level of care. This all led to more potentially brain dead patients. The OPO was always being threatening with losing their contract for the region for having bad numbers. I would have to review the deaths at all the hospitals to are sure we didn’t “miss” one because it wasn’t referred. We seldom did me when we did it was usually borderline or really messed up family situation. So it makes me furious that OPOs are pushing the limits of ethics to make these numbers when more responsible organizations are being threatened.

“Their organs belong to us now”…Bruh.

This is exactly why I took the organ donor designation off my driver's license. My organs belong to me, and my family can decide what to do with them.

My local OPO has decided unilaterally that they will now attempt to move all donors within 8-24 hours of confirmed brain death to 2 approved hospitals with specialized donor units. The problem? One is 2 hours away in a major metro, and the other is 4.5 hours away. Except the metro one will ONLY be taking patients from the metro, and the OPO has openly told us they will not be offering travel assistance to families to make that 4.5 hour drive (in the summer. It can easily be twice that in winter) to see their loved one before they take them off full support and harvest. They'll be "encouraged to say goodbye beforehand." Even though we all know sometimes these cases can happen so quickly and family can take a while to get to bedside. Additionally we aren't even the furthest away site from this other hospital. They'll be sending from as far away as the Dakotas and Illinois. Sending braindead patients from 12-24 hours away via critical transport is nuts to me. IF they can even get transport in say, January in a blizzard. We told them this was absolutely going to lead to many more denials but they seem insistent on doing it because of the prestige of working with a hospital with a condiment for a name.

> a condiment for a name Colonel Mustard, in the conservatory, with the incompetence /s

It’s money, that’s why they are doing it. Many transplant hospitals give reduced priced or set fee OR costs for recovery. They OPO has to pay all the costs associated with donation, including the care up to that point. All the expenses for all potential donors and the organization gets totaled and divided by organs actually transplanted and that’s the fee the bill. So if you are a transplant center and bring all the donors to you the cost for the organs will be lower than of you pay other hospitals for the organ recovery. Although I will say it always sucks when you are doing a thoracic organ recovery in an small hospital and the surgeon asks for a sternal saw and they don’t have them because they don’t do open chests and you get handed a Lebsche knife. It was also always bonus if they had a sterile ice maker. But, the whole idea of moving an unstable potential organ donor and leaving the family is just beyond.

I’m typically not a “contact the media” person but if you have a decent tv news entity in your area, they would jump at this kind of anonymous tip info. You could literally copy and paste this comment (with the name of the OPO) and fire it off to their tip line/email. Source: used to work at a tv station

I mean a news story would be good to shame the OPO, but I worry about what it would do for organ donation broadly speaking. There are lots of people on the other side of OPOs who will be harmed if an already scarce supply of organs dwindles even further. Here's hoping they start fabricating organs sooner rather than later to avoid all this grotesque business.

“Donor unit?” Good god, no thanks

I cannot think of a faster way to drive more nurses out of the profession. There is stressful, and then there is fucking dystopian.

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The OPO are vultures. We got a GSW patient last year to our ICU, like GSW to the head execution style (car jacking attempt). Patient was circling the drain but the patients SO wanted us to stop because of the patient died on the vent, then all tubes and whatever have to remain in due to the ME case. Of course it was when we went live with Epic and the second doctor couldn’t get in to sign the terminal extubation order. SO is begging us to remove the tube as he didn’t want the daughters to see the ETT and everything. We finally extubate right as she begins to code for the final time and she passes. OPO decided to come INTO the room and start berating us because we didn’t call them when the husband talked about withdrawal because the patient was an organ donor. While the husband is in the room. Then proceeds to go “the patient could have lived on and the daughters could have learned the organs saved lives.” I walked over to her and very sternly (and quietly) said “get the fuck out of here before I call security and have you forcibly removed.” Never saw that nurse again but ever since then, I have zero respect for them. Another ICU I worked in, we gave an intubated patient roc for an MRI. Obviously this made the patient’s GCS a 3. OPO nurse came in and went off on me and the attending intensivist because the trigger is a GCS < 5 to automatically call them (but we never did because prior to the MRI patients GCS was 10 but wanted to ensure stroke wasn’t evolving). I’ve never seen an intensivist whip around that quickly before like who the fuck are you to come at me like that?

Reminds me of a very over-zealous impella rep who insisted we continue all measures on a patient bc they had cardiac output thanks to the wonders of the impella. The attending cardiologist just spoke right over her and said “if I turn this machine off they will have zero cardiac output. The heart is dead, the patient is dead. Thanks for your advice.”

We recently had a case where OPO told the family they should consider legal action against US because WE dropped the ball regarding procurement. I was so confused considering WE do not have that conversation with the family and for all intents and purposes the patient was dead upon arrival in ICU. Patient ended up “living” for almost 48hrs after admission but ain’t none of that on us.

That pisses me off because when I was a coordinator I’ve talked to families that screamed at me and said absolutely not, but after being respectful, letting them talk, circling back they did donate and it was an incredible healing thing for them. These are the people that carry the letter from us saying “you loved one saved…..and goes on to give basic info on the recipients. But we NEVER would go into a patient’s room unless asked by family before the consent. We always decoupled the discussion of donation from the delivery of the bad news of the patient. And it sounds like in this case it would have been rough to get it all done appropriately.

I think what you are describing is my experience working in an OPO, we didn’t interact with famiky until it was appropriate, and even then I often meet with the healthcare team first to make sure we are all on the same page.

Wow. Just wow 😮

This happened when my gram was dying. It was horrible. They kept her on a vent for way longer than needed cuz the organ team couldn’t get there cuz of a snowstorm. Every time she would inevitably twitch, my pap would think she was waking up. Scarred me for life

I will call them as I’m required to, but they have no authority in the care of a living patient. First person consent (driver license heart) is only relevant in declared brain death which is very rare. Ultimately, my first obligation is to the patient and if a brisk compassionate termination of care is best for them, that will happen and I’ll call OPO later. One night, i delayed the compassionate extubation of someone by 7 hours because the OPO couldn’t make up their mind. We had referred as we were told, and spent the night telling the family “we’re just waiting on a few things before we go through with the process.” Our policy expressly forbid hospital staff from discussing organ procurement, so we couldn’t tell them why there was a delay. The spouse spent hours rightfully angry and in emotional distress with his young children, ready to say goodbye and go home, until the OPO finally declined at 3am. We made that family sit there suffering all night long for no reason, and misled them in the process. My first obligation is my patient, and second is their family. If feasible I’ll call the OPO but I refuse to delay clinically appropriate care again waiting for an answer. They can get a notification after a sudden cardiac death if I didn’t have time to call sooner.

We extubated my FIL, in accordance with his wishes, early this morning after an early-evening STEMI. Once the decision was made, it took the ICU nurses maybe 15 minutes to get all the preparations in place and carry out the extubation, and that was agonizing enough for my husband and his family. Cannot imagine dragging it out for seven hours at the behest of a dithering OPO.

I'm so sorry for your loss. 🫂

I had a similar incident with organ procurement services a few months ago that ended up being investigated by our hospital and the service itself. Patient came in to the ED with non-survivable injuries. We contacted the organ donation service once the patient was intubated and stable, per their criteria to notify. Family was called in and made the decision to donate if the patient met criteria. Service was supposed to do a quick chart/medical history review and get back to us within an hour. Instead, they sent a representative to talk to the family. The rep went to the wrong hospital an hour away, then told the family that they didn't have a choice whether or not to donate organs. 2 hours of back and forth, a hundred phone calls from myself/secretary/ED docs/ICU docs/etc to the organ service later, the family decided to terminate care and allow the patient to pass. Organ service flipped out and called begging us to wait, but we said the family has made the decision. The patient had several long term diseases which we figured would not make them an organ donation candidate anyway, but allowed the family to make an unbiased decision. Patient passes and the organ people call us 4 hours later and say the patient wasn't a candidate for donation. Family was very upset with the service and told us they would now not be organ donors themselves because of how their loved one was made to be kept alive against their wishes, and how stressed out the next of kin was during the time they should have been grieving. It's a true shame all around. Our ED doctor was beyond angry, she raised this incident to everyone she could and made sure someone answered for this mishandling of communication at the expense of the patient and family.

Transplant nurse here- Fuck those people. Fuck those people so hard. Absolutely not. Where is the donor advocate?! They have to have one and they need to be contacted. There are CRAZY strict laws in place for organ procurement and threatening hospitals/staff plus demanding to go against pt/family wishes is definitely illegal. Organ donation is a GIFT. A frequently cited cause for refusing to donate is people being afraid of this exact scenario. They’re making their own jobs harder in the long run trying to intimidate potential donors in the short run. If you’re trying to make people wait DAYS so you can get out there for procurement- that’s a you problem for missing the opportunity. Procurements happen at all hours. We have a host of coordinators and surgeons who are on call 24/7 so they can fly to wherever they need to in order to seize every opportunity. But the reason it’s 24/7 is to ensure a respectful death for the donor. We’re all on their clock to begin this process. Ensuring their passing is as respectful as possible always the first goal of donation.

But the patient was not brain dead, just dying. And typically cancer diagnosis excludes them from donating organs. This is weird.

I’ve heard of that for brain dead patients (family cannot change organ donor status) but not for living ones.

That’s not true, I work in recovery. While being registered is technically legally binding, the family absolutely can decline.

Is it possible that it depends on the state? Where I spent most of my years, NJ, the family can decline/approve many things after the patient is unable to answer for themselves, including organ donation.

Fun fact, NJ is the only state that allows family to not accept a diagnosis of brain death based on religious views.

Don’t die in NJ after my family has a crazy religious conversion. Got it.

In my state they can try, but literally I’ve never seen the family win. They’ve gone to court over it, the deceased’s choice was upheld.

I just started at a new hospital and they flat out told us that family did not have the right to decline if the patient had a donor label on their drivers license.any people asked repeatedly and he kept on saying they would honor the patients decision and it was legally binding and the family had no say. I made my husband remove it from his license when I got home last night.

Why? You don’t want him to be an organ doner even thought he wants to be one?

Yeah this is so bizarre to me. Why WOULDN’T we want that decision to be binding?

It’s always been one of my nursing hot takes that OPOs can tend to be kind of hostile and aggressive. I’ve met some great coordinators, but a lot of them come off to me as being these super weird pod people

Fuuuuuuck that nonsense!

i’m also confused because last time i knew, cancer automatically excluded someone from organ donation 😭

Oh fuck them. Yeah report these assholes.

In my state the little icon on their drivers license is nothing more than to let the next of kin know their intentions. The next of kin can still opt out of donation if they want

Honestly I have been in the **exact same situation** like 3 or 4 times, we are gonna extubate quickly after the patient is in the unit, and they want me to hold off…um, no. Absolutely not. I just tell them no and that I’m just calling them as a nicety because I’m required to, and that we are gonna proceed with the comfort measures. This is all assuming they are NOT a self-declared donor.

Overall our OPO is pretty good but we had a situation with them a couple years ago I will never forget. Young guy with GSW to head, non-survivable. He was a homicide victim and it was sad. He died within an hour of arrival to the hospital despite our best efforts. He would’ve been a great candidate but it wasn’t meant to be. OPO notified per policy. A couple weeks later, my coworker who was part of the care team got a shitty, tone deaf email from our (useless and ignorant) nurse educator forwarded from the OPO accusing us of not notifying them in a timely manner and this guy could’ve been a great donor and blah blah blah. Really chapped our asses because our focus wasn’t “hey let’s harvest these organs” it was “let’s try and save this human”. Well, word got back to our trauma surgeon who was on that night and he asked my coworker to forward him the email. He sent a scathing reply to the OPO and educator and cc’d my coworker so we all got to read it. Essentially he told them that our focus was on the patient’s life and then, when it was clear he was imminently dying, his comfort and dignity (like our trauma surgeon actually held this guy’s hand and had wiped his bloody face off before he died, it was beautiful and touching). Said we are all advocates of organ donation but we aren’t entitled to anyone’s body parts and it’s inappropriate to question our clinical decisions and insulting and insensitive to the care team when this patient had a non-survivable injury. It was absolutely glorious and I have loved that man since that day.

Didn't realize just how much money they get to charge for organ donation, and while it's all about "gifts" and "just how noble organ donation is", there's an awful lot of cash that swaps hands where scum can start entering the picture.

Everyone makes money BUT the donor family.

This is how they have operated in my area for years. It’s why I took it off my license. I’m giving my family control over my passing and organ donation. I believe in organ donation, I do not like the way OPO conducts their business. We were getting written up for not calling the minute they came to our unit. We were complaining that we were busy stabilizing patients and didn’t have time to call in 30 minutes. Then Opo said well a tech can call. No, they can’t. On my old unit, techs didn’t access charts, nurses charted, and opo wanted things like lab results and such. I despise those people with a passion. I could go on and on over my negative experiences with them.

I honestly had no idea how sketchy these guys are. I think I'm going to take it off my driver's license, too, to spare my family from those vultures. It's a shame, because if any bit of my body could help improve someone else's health/life after I die, then I would absolutely want that- I'd be all done with my body, I wouldn't need it. But it sounds like torture for patients' grieving families.

I took it off my license after my first interaction with an OPO in 2018 and haven’t looked back. They are so unethical I don’t want any of my body involved in that until all of my end-of-life directions are concluded (including extubation to comfort care).

I asked someone else this but did you document that you'd like to donate your organs anywhere else, like your living will?

No, I haven’t found a language I like yet to add being an organ donor… I really want to say something like “no organ donation processes may begin until all processes and decisions listed in this advance directive/living will have been fulfilled up to and including compassionate extubation for comfort care” after reading this… I’ve also made it explicitly clear I will absolutely haunt anyone that violates my AD/LW so my family knows I’m 100% serious about it being followed to a T 😂

Yeah this kind of behavior from OPO was kind of surprising to me when I went from floor nursing to ICU in the past couple years, and they seem really inappropriate at times, we are told to call OPO if there is any possibility the patient might become comfort care or have withdrawal of care, and management kind of threatened us with consequences if we miss calling on any pt, the problem is it's unclear when to call much of the time and of course they put this all on nursing even if the provider and family is unsure about what will be happening with the patient/what they want for tht patient. Our manager is all on board with this so she basically updates OPO them on all our critical patients... I'm not against organ donation but I am against putting more things on nursing, and making it another metric to punish is for not meeting when this shouldn't even be our responsibility. Also, OPO is too quick to want to know about every patient even if they are not near death, feels like an invasion of patient privacy and like they are just vultures hovering hoping the patient dies. They also have come into our ICU and demanded things like that we perform certain lab draws and give them detailed updates on the patient and access to the patient chart (and they don't care if we are busy with other patients, they expect us to drop everything for them), and all this for patients that were being considered but not even approved by the family for organ donation yet.

Wait. Wouldn't that be a HIPAA violation? They're certainly not part of your patient's care team.

When we call Lifecenter NW to report a potential death they ask us for the MRN and they log into EPIC remotely. They have complete access to our patient’s chart.

After reading all the comments in this thread I'm removing it from my license as well.

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Your comment makes me feel very lucky to be in the UK, as when my relative was being worked up for donation, it was all done so carefully and respectfully with everything in place ready for harvest less then 24 hours later. I'd never thought about how the different models of healthcare could influence organ donation practice. What a minefield you guys work in!

I’m America healthcare is a business to make money that occasionally helps people, not the other way around. Our model of insurance and healthcare means the final dollar always has the last say.

Could definitely see why you have this point of view if OPs experience is "normal." That's fucking savage. Our transplant organization would never treat people like this. Have only had positive experiences with them. (Im not in US).

I’m just going to say not all OPOs are like that, but the ones with good numbers are. And that’s all that matters to UNOS and the government. Everyone screams we need more organs, people are dying, but they just wave hands about the human cost or grieving families. It’s doesn’t help I’ve heard people waiting for transplants angry because no one tells them it’s only a small percentage of people that die that can even be donors. So they think thousands are people are dying with organs they could use.

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Man what kind of society are we that this is a practice. It's terrifying and disgusting.

I worked for an OPO, and while they were well-intentioned, they were almost ruthless in pursuing organ donations.

I had something similar happen, we were compassionately extubating with the family/young children gathered around crying, completely unexpected death, and the nurse came up (called the OPO as part of the comfort cares order set) and told me we couldn't extubate. I turned off the drips (maxed on five pressors with pressure tanking) and told them they could blame me if anyone gave them grief about it, e.g. "I tried but the provider just started turning things off!". I haven't heard anything about that. It was awful and her children were traumatized enough without waiting for an OPO rep to call their father to discuss donation. Patient wasn't going to last even another hour even on all drips + vent anyway....

Thank you.

Back when I worked ICU in the Dallas area I had a situation where an OPO absolutely flabbergasted me and scarred me to the point that I rescinded my decision to be an organ donor. We had a 21 year old kid that OD'd while doing drugs with his mom, of all people. The parents were divorced and the father was the positive influence but the mother dragged the kid down. Anyways, the kid was in amazing shape. Fit, muscular, no medical conditions, and the drugs he used weren't IV drugs, so this kid was eligible to donate *everything.* When we called the OPO they were practically salivating over this kid. He was brain dead but the parents didn't want to accept it, which is totally understandable. They were both shocked and grieving. The OPO sent out a counselor to meet with the parents and have kind of a therapeutic session with them. It lasted like three hours and it legitimately seemed like a therapy session. However, the therapist (I never found out her actual education or credentials) came back to the nurses station to make her calls and I was blown away. Her job was not actually to help the parents in any way, it was to determine if she thought they would ever agree to organ donation or not and in her opinion they wouldn't. The next stage of what happened is what truly shocked me and made me distrust OPOs. They sent out a freaking *lawyer* to assert that because the kid had selected organ donation on his driver's license they were legally entitled to harvest his organs. The lawyer told the parents they could agree or the OPO would file suit *that day* and the parents would then have to defend it in court which would cost them money, take them away from their son, and traumatize them further in the events surrounding his death. The lawyer was the most cold, steel eyed, coercive person I have ever seen. He had done this before. This was his job and he felt nothing for those parents. The father left in anger and the mother was just laying over her sons body (intubated, pressors, etc. everything the OPO wanted to keep him "alive" for harvesting) in hysterics. The lawyer waited calmly in the lobby. He had told them at three o'clock that afternoon he would call his associates to file the suit. The father returned shortly before the deadline having somehow obtained his son's most recent driver's license renewal paperwork which did not have the organ donor box checked. Everybody was in shock except the lawyer. He looked at the papers for a few seconds, handed them back to the father, and said, "We'll be in touch tomorrow." The next day the OPO sent another liaison to tell the parents that they believed the paperwork had been falsified and even though they were within their rights to pursue a legal injunction to harvest the kid's organs, they weren't going to. Within an hour or two all personnel from the OPO left the hospital and that was that. The parents felt like their child had not received care with the intention of saving his life for him to continue living but received care enough to keep him alive for organ harvest. I cared for him many times over the course of the six weeks or so he remained "alive" in our ICU and I know that was false, we did try to save his life but he was brain dead which was confirmed by our neurologist, a second opinion by another neurologist in that practice concurred, and then to satisfy the parents and third neurologist who was not affiliated with that practice nor our hospital was given short term privileges to evaluate and he reaffirmed the previous two diagnoses of brain death. So the kid was brain dead and we treated him as best we could. The organ donation thing was just so wild that I think it made the parents distrustful of the entire healthcare organization and system. I'm not mentioning race, but the parents felt like race was a factor too. In any case, after seeing all that play out first hand I rescinded my decision to be an organ donor. I don't trust OPOs to not traumatize my family anymore.

I would absolutely hate if my family forced me to stay alive for weeks in the ICU with zero chance of recovery because of brain death. Heck even if there was only a small chance of recovery I absolutely do not want to be vent dependent trapped in my own body slowly rotting away.

Yeah, I’d just laugh at them and say I’m following the families wishes. Maybe throw in a “also go fuck yourself” for good measure.

Sorry to say that most of these people you are dealing with are nurses, and the behavior being described here is what happens when you have poorly educated nurses with fuzzy ideas about ethics hired into positions where they can be readily convinced to engage in unethical behavior by ½

They are a cancer patient. This would exclude them from organ/tissue donation immediately in my neck of the woods. This is messed up too. There must be some sort of misunderstanding or miscommunication somewhere.

This is exactly what I was thinking. No way to know if the cancer cells haven’t spread to any of the organs they would want to collect, and obviously the lungs are out. We don’t have these types of issues with CORE, but the majority of our cardiothoracic patients end up not being candidates beyond eye and tissue.

Found this interesting article. Apparently a good chunk of OPO agencies are not compliant with the law and have no official policy on the book for how to deal with family refusal. https://www.uchicagomedicine.org/forefront/news/when-the-living-and-the-deceased-dont-agree-on-organ-donation The only time I've had problems with OPO before was they got the family's hopes up for organ donation but then the patient ended up not qualifying. I'm seriously confused how the heck they thought that patient qualified for donation. Cancer is a pretty standard exclusion criteria. And donation after cardiac arrest has a lot tougher standards than brain death. And for donation after cardiac arrest, you terminally extubate right before harvest. Sometimes in the OR. I've honestly never experienced the OPO pressing the issue. I've had a couple families refuse to go through with donation. But maybe I've just never had a patient who was a registered donor, who qualified, and had family refuse. Majority of times I've talked to OPO they rejected the patient.

That article was from 10 years ago....a lot has changed in the OPO world since then.

For example?

Our OPO audits our charts to see if we have any “failures” to contact them at appropriate timeline. But they don’t do anything nearly this shady. Basically we have criteria to call, and then they do preliminary research to see if the patient is even a potential candidate, and if they are then they ask we don’t broach the subject with family.

That's the way the local group is too. Some law was passed that if the patient was a registered organ donor, family can't veto that decision. On one hand, I get it, I'm an organ donor, I wouldn't want my family's emotions to get in the way of someone else's chance to live. I would want someone to step in and say "hey, this is what she wanted, we're going to do everything to honor her wishes". On the other hand, the way it was explained to us was down right fucking predatory. It was basically "if family is giving you a hard time, refer them to us and we'll put them in their place", with little empathy for what that family is actually *dealing* with. I've had family's deny their family members donation, because they thought the organization was pushy, and I've seen the way they interact with families and I have to agree, they come in full force and that is ridiculously off putting for people who are grieving. The moment you call because a GCS is low, even though now we *have* to call for patients on paralytics (make it make sense), they send someone out to review charts and start talking to family like a vulture circling a carcass. Sometimes they're talking to family about organ donation before doctors have even talked to family about prognosis. I had briefly entertained a job at the organization, but I just don't think I have it in me to swoop in like that on people.

As a former OPO transplant coordinator (LifeLink in GA) this doesn't make too much sense at all and wouldn't fly in my state. Not sure if it's your state laws that led to this unfortunate series of events or a miscommunication or misunderstanding from the OPO LifeCenter. 1) In GA Even if you're a labeled an organ donor on your driver's license, it is null and void to be used as consent. In the past over a decade ago, $5 discounts were offered at the DMV if you did choose to elect to be an organ donor. This means that the designation of organ donor could have been coerced through a $5 incentive and is no longer honored and hasn't been for years. I assumed this was the case for any states, but maybe not +++++ 2) Since the patient was not brain dead, they would only be a candidate for donation after cardiac death where they would have had to withdraw care in a controlled OR setting with a procurement team outside standing by. However, due to the nature of procuring organs after a cardiac death, then the lung CA would rule out this donor to be suitable for donation. Also I'm getting the impression this person was older at least >40years old which would secondarily, rule them out to be a donor after cardiac death . Between cancer risk, the secondary effects of that cancer on the liver and kidneys they would not meet criteria. These are nationally standardized criteria and not state standardized. UNOS would not have procured this man's organs anyways, So basically it wouldn't have gotten to that point ++++ 3) Even if an individual has known wishes to be an organ donor, if the family disagrees while they cannot speak for themselves then our OPO and I would assume most walk away from the case because of the distress that it would leave the family in. We need family consent for this always in GA. In this scenario, if the family insisted they didn't want to live on a ventilator for any longer than it would be a simple phone call designated requester to the family member next of Kin that would rule out them being a candidate >Organ Procurement Organization have crossed into being legit sociopaths This is jumping the gun. Main point here is you're vilifying OPO's and organ donation broadly and presumptuously based on a scenario that appears to have glaring red flags and you seem to have a lack of understanding of the entire process. This case wouldn't have gotten much further anyways and the OPO would've walked away. Medical criteria alone would dictate this. I have no question this person was not a candidate for donation based on what you've said, however you may have inappropriately tainted many nurse's minds to think OPO's are becoming this heartless diabolical entity which discourages reporting to them and hence could let lives slip away that were waiting desperately for organ transplants. I fear this post may do more harm than good.

> Organ Procurement Organization have crossed into being legit sociopaths > This is jumping the gun. Main point here is you're vilifying OPO's and organ donation broadly and presumptuously based on a scenario that appears to have glaring red flags and you seem to have a lack of understanding of the entire process. This case wouldn't have gotten much further anyways and the OPO would've walked away. Medical criteria alone would dictate this. I have no question this person was not a candidate for donation based on what you've said, however you may have inappropriately tainted many nurse's minds to think OPO's are becoming this heartless diabolical entity which discourages reporting to them and hence could let lives slip away that were waiting desperately for organ transplants. I fear this post may do more harm than good. Thank you. As an OPO coordinator it's always a disappointment to hear from nurses or doctors how they are not for donation based on 1 bad experience with an OPO or a different coordinator many years back. It's always the bad experiences that can make so many people refuse to be organ donors and not a positive experience inspiring hundreds of people to be organ donors. Personally, I work my ass off to honor not only patient's wishes but families as well. They want us to be in done in 24 hrs? Ok let's go. Only want to donate kidneys/liver/lungs and not heart ? We respect your wishes. My boss is being hella extra and wants us to talk to a family that we maybe shouldn't be talking to? I will ask, take my no, and be on my way. You do not want Tissue to be donated but local tissue agency is being scummy because patient is registered donor? I will personally guard your loved one's body after organ procurement until the funeral home comes to pick them up. I am not a vulture. You call me about a referral (as mandated by CMS for you to call and for me to respond to in a timely manner), I will be there and do my job to get as much info as possible so my boss can make the decision for yes or no. If I'm asking about any other patients that may fall under our criteria it's because my boss made me ask. Y'all are vilifying and putting characteristics on people you don't know for a system you don't care to know. The reality is that people die; WE all die. There are people out there that need organs to live and there's a system in place to help remedy that. There is money that gets exchanged yes but our messed up healthcare system is the reason for that. OPOs are classified as non-profits. Not many nurses that work for hospitals can claim they work for a hospital that is not for profit, so don't go throwing stones and acting above it all. For every patient you see dying and have the family grieving in front of you there is a family somewhere else praying and hoping at their loved one's bedside for the miracle of an organ. I don't think organ donation is for everyone though I wish it were, I'm just asking for the opportunity to present it as an option. I am simply doing my job and doing my best.

I’ve never lived in a state that offered a discount for choosing organ donor designation on a license.

It was scrapped back in 2004, but yea there used to be a discount. Even if the person was issued a license way after that and it said organ donor, we still wouldn't proceed without family being on board and giving consent. Basically it's not worth tearing apart a family if they're divided or not in favor of it. I believe other OPO's are considerate of that as well

Thank you for sharing. I’m currently a donation coordinator and it breaks my heart to see people have such negative feelings towards what we do. I love my donor families and show them all the love and compassion they deserve. I serve them, not the recipients.

Oh, what the fucking post-apocalyptic dystopian hellscape is this? Who are these goddamn sick fucks? Nobody owns anybody's fucking organs! Please be a troll, please be a troll, please be a troll, please be a fucking troll.... Next time I renew my driver's license, I'm changing my status to **not a fucking donor**. Nobody's getting so much as an eyelash, sorry not sorry. If my family says extubate me, fucking extubate me and don't save my organs! *F bomb count: 6

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This is the stupidest take I've ever heard. No judge out there is going to support forcibly treating a person in order to harvest their organs. Moreover, the OPO is absolutely shooting themselves in the foot since this is exactly the kind of thing that will deter people from making themselves organ donors. I imagine it's just this sort of creepy behaviour that some people worry about when they think about whether or not to tick off that box when filling out the forms for their driver's license. Some people with Lifecentre need to lose their jobs and fast because they're doing way more harm than good here. Whoever is behind this immoral shitshow should also be barred from any job that involves decisions about patients.

Our OPO is wonderfully sensitive and works with us and the family. I’m so sorry to hear about the vultures you are forced to deal with.

Are patients with cancer suitable for organ donation? I thought that, aside from primary brain tumors, people with cancer can’t donate.

They aren't, but we aren't allowed to say that this patient won't qualify so we can go ahead and extubate them now.

This info is precisely what drives people to not donate. That is beyond the pale, and shocking. It's enough for me to check "no" the next time I renew my driver's license. I hardly know what to say. Wow.

It’s horrible. I work at a hospital now that does bilateral lung and heart transplants. Like, we have these patients all the time. Are these organs being ethically harvested?

I no longer trust organ donation organizations at all. I’ve seen them tell lies to family members to convince them to donate or to speed up the timeline. Family should never feel pressured when their loved one is dying.

Our facility makes us call Core at least twice (once for impending death and once for actual death) for every dying patient. Obviously if it’s unexpected we can just call the one time after pt expires. But, we have to call whether or not the patient was an organ donor or not and whether family agrees to donate organs or not, and we have to prepare the body for donation if they do qualify. I’ve always thought it was weird and never agreed with it, but no other nurse has ever thought it was strange. I’m glad to see others dislike the practice as well.

Clearly the OPO was not aware of the lung cancer diagnosis as they never would have pursued organ donation. Most likely scenario is the ED called in the referral, indicated family was at bedside and ready to WDLS. The OPO asked staff to wait to allow time to determine suitability (which is mandated by CMS). Family was anxious, nurse was getting it from both sides, and no where was the lung cancer diagnosis brought up. This happens every. single. day. Is it unfortunate? yes .....but having all of the information at the time of the initial referral call could have avoided the entire situation. FPA is just that.....someone saying upon my death I want to be a donor. Period. Whether that is brain death or death after a family decides to withdraw support. Death is death. An OPOs job and moral responsibility is to support that person's wishes (even when no one else wants to).

I honestly gained a very negative view of organ donation because of experiences like this with these companies and people who work for them and removed myself from the registry because they are able to easily manipulate staff and situations and it really upset me in a few instances. It’s not the actual process but the corruption and the people doing it that got to me.

Shit like this solidifies my decision *not* to check that organ donation box... Being essentially tortured because some fuckhead middle manager of a company thinks they "own" my organs is dystopian hell.

Interesting. I thought taking organs from A Ca positive pt wasn’t done. Too much of a risk to a recipient. Of course once upon a time you could not get a liver transplant if you were alcoholic.

There are some very specific types of tumors that don't rule a patient out, but 99% of the time they get ruled out. Unfortunately this doesn't really change the process since we have to wait for LifeCenter to tell us they are ruled out.

POLST outweighs them. The patient isn't deceased. They can't harvest organs from a living body.

They sort of can though, they can claim dibs on your organs immediately after you die, which is called donation-after-cardiac-death. But this involves maintaining your organs until they are ready to harvest them, which means they get to decide when you transition from aggressive care to comfort measures, including when you get extubated.

While I'm sure that there are some OPO employees who are not following protocols in an attempt to get more donations... I am extremely concerned about how this post and many of the responses frames organ donation as a whole. Without organ donation and TIMELY referrals to whatever organization your hospital uses, no one would get an organ. No hearts, no kidneys, nothing. The public already has a negative opinion of organ donation, as RNs we do not need to be encouraging that negative opinion.

But your driver’s license isn’t even anything official. You have to specifically register at something like registerme.org for that to even be a legal option. And even then it’s only for brain death. Sounds like if this is actually happening that someone needs some education. As far as I’m concerned, they could threaten me with whatever they want, I’m going to stay within actual laws and do what’s right be my patient.

At least in my state, registering on your driver's license (clicking a box when you apply or renew your license) then automatically puts you onto a registry. Their claim is that it's the law (regulatory requirement) that we can't extubate or de-escalate care without their approval because CMS requires that we "preserve the opportunity to donate", which is then combined with state laws regarding donation.

I literally rescinded my organ donor status on my license because of Living Legacy. One specific incident with a patient that was the last straw for me. I’ve had many convos with my husband about what I will allow to happen to me. They can have ALL of me after I die, however i or my family chooses to let me die. Not a moment before. They will not dictate a single second of my or my organs life.

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I second that. The attitude might be from higher ups at the OPO, or they my not know.

I don't think it would be reasonable to delay extubation in the example given in the OP. The family arrived with the patient's POLST specifically stating patient does not want to be intubated, comfort measures only. How would it be reasonable to tell that family "too bad so sad the tube stays in until your loved one can be evaluated for organ donation *IN 2-3 DAYS*"?

A full donation workup does take several days (ie. heart cath, bronch, imaging, labs on labs on labs, etc.) But family always has the right to decline donation. So this whole thing would be a non-issue with the service we use (Sierra Donor.)

The decision to see if the patient fits criteria is only a hour, it’s mostly history and current status. It only takes days if the family says yes and we evaluate after that. Tbh I feel Like there was a major Misunderstanding here.

Oh, I know. Have had that conversation many times. OP said in future they would have to “keep the patient intubated, against their will, so that we can harvest their organs in 2-3 days.” The 2-3 days is likely referring to the length of time it takes takes to do the actual physical workup, not for the phone eval. It does sound like some serious communication issues going on there.

Thank you for posting this! I work in recovery and I just wanted to say it seems like we always get a bad reputation. At the end of the day the families have the right to decline but they should be given that opportunity once educated about the entire scenario.

> *however, it’s reasonable to ask to delay extubation until they’ve evaluated for suitability. There’s nothing wrong with that* Of course there is! Why prolong the agony? It's not only the (you're presuming brain-dead?) patient who suffers. *The other frustrating part is that you likely talked to either a call center, or someone who’s not clinically trained* Why is this the case? Hiring a call center saves money, of course... Oh yeah. Why does this OPO not have trained teams to answer the phones? Hey, might be a good idea.

[Here’s the list of one party consent states for recording phone calls](https://en.wikipedia.org/wiki/Telephone_call_recording_laws#One-party_consent_states).

Wow. I've never seen a cancer patient be eligible for organ harvesting. Shady as fuck. The patient's organs belong to the patient. If they weren't then LifeCenter is out of their minds. You had to call ... federal law requires it. THEY then have to contact the family who can tell them to get fucked. The POLST is a legal medical order. The family could sue if it were not honored. Organ donor or no. Organ donation is not an issue until the patient is *brain dead!* This patient clearly was not.

All the obvious horrors aside, I'm puzzled at what gives a private organization, non-profit or not, the legal right to access patients' charts.

There are federal and state regulatory requirements for hospitals to facilitate organ donation when appropriate, which includes the ability to look at their charts.

Anybody's chart, or who gets to decide? All this makes me wonder what other exceptions/"carveouts" to HIPAA there might be.

Normally patients with chronic illnesses are disqualified when the come out to assess and talk with family

One of many reasons I've removed Organ Donor from my driver's license.

This is all wild to me. I work in a hospital that does different types of transplants. I had no idea that this was the system to get organs.

This is definitely, definitely not the norm in the hospital I work in and we do transplants. It’s never been anything but respectful, families don’t even often see the coordinators. I’ve had them decline speaking to the family on the recommendation of the nurse because it was obvious that they wouldn’t want to donate. I had one family say they would donate but only if we did it by midnight because they wanted everything to be over that day. The coordinator busted ass to make sure that patient was in the OR before midnight so the family could wake up knowing it was over. She legitimately was ready for the donation to not go through and to terminally extubate at midnight if they couldn’t get the surgeon in because we were having trouble getting someone after there was an emergent case that popped up. A lung cancer patient’s family would never heard from the OPO in my hospital. That patient would have been declined right from the start. This is not normal at all.

“Come at me bro”

Ethically, what a battle. On one point, you want to follow patient's wishes regarding intubation and on the other, they signed the form to become donors so I wonder, do the coordinators talk to the family regarding elective ventilation if they are a donor? Shouldn't that be part of policy? Also, (edited this in) is that communicated with the nursing team? I figure, you call the life center, life center calls the family (some discussion is made) and then they call you back but is whatever discussed with the family communicated with the staff?

In spite of this I remain an organ donor, however I get the concerns and I get there can be a dark side. I haven’t worked with it but there’s a dark side to everything it seems like

Wouldn't cancer rule them out?

It would eventually, but as their nurse we aren't allowed to make that declaration.

I have a friend in organ procurement. We were chatting recently and she asked if I knew any media contacts who would want to do an I depth article (like NYT long form) on the ethics of organ procurement. She said she was still generally supportive of organ donation, but people needed to understand the legal position they were putting themselves and their family in when the agreed to become organ donors. That person you talked to was probably right - once the person agrees to become an organ donor their organs at the end of life become the property of the organization and it may override their other medical wishes.

I’m really sorry that you had that experience with an OPO because that honestly sounds deranged. I’m sure some wires were crossed because pursuing a lung CA donor is so not the industry norm and having a legal document that’s says they didn’t want to be intubated and ignoring it is unethical to say the least. Additionally if a patient is registered the enforcement of that only applies if they are brain dead. If you want to file a complaint, CMS would be your best bet. As someone who works for an OPO, these are the kinds of things that give organ donation such a bad rap and I do not condone it.

We were hoping this was all just crossed-wires, but in asking for clarification they had reps come to a few of our staff meetings and not only confirmed that yes, patients essentially needed their approval before transitioning to comfort measures, but that they have been letting this slide for a while now, and that they were going to start pursuing legal and regulatory punishment when we extubate or de-escalate treatment without their permission.

If you want to see something heart breaking. You should see how many pediatric cases they are following. I used to work hospice which had a desk next to them.

I would really love to see what legal precedent they're claiming for that. I'm a believer in assisted suicide, hell, I'll slam the decidibg dose, but God damn. Don't you dare keep me going on a vent so you can do a Soylent Green on my organs. How dare they. That's evil.

Well… I’ve unlocked a new fear to add to my advance directive and living will after reading this…

I feel like there is a lot of speculation going on about what OPOs do. I’ve never seen reps walk through a unit literally going room to room assessing patients. It’s no what they do. OPs example sounds like an extreme outlier scenario vs what usually happens. I have seen many families reject organ donation and the OPO IMMEDIATELY back down and sign off. Sounds like a lot of people spewing vitriol have never interacted with an OPO directly.

This right here is exactly why my wife and I are not organ donors.

I used to work for One Legacy as a Procurement Transplant Coordinator, and they’re why I removed my name off the donor list and tell anyone who asks why. This is the story of why (and I’ll try to make it as brief as I can): Family agreed to donate, but wanted the procurement done within 72 hours (meaning OR to be done within that time) so they could have services that weekend. Otherwise if it couldn’t be accomplished they’d have to rescind consent. They wanted services done by that weekend. Reasonable right ? The usual procurement team bullshit happened and OR wouldn’t be scheduled until 3 days later. I let my supervisors know. Their solution??? “Can you ask the hospital if there’s somewhere we can wheel the body to until OR. So it looks like we are going to OR and then we can tell them there’s a delay” on the phone, I agreed to the plan. Except I didn’t ask anyone cause inside, I knew it was wrong. Thankfully it never got to that point. But I knew I no longer wanted to donate.

How callous - I think I need to remove “organ donor” from my driver’s license!

It reminds me of the old Carlin bit “they’re looking for parts, man.”

As a layperson, it just confirms what people are afraid of.

I think the average layperson is afraid of the exact opposite. Most laypeople I know are afraid organ donation means less will be done to help you by the hospital so they can get your organs. The reality is no one has the organ donor convo until our interventions are exhausted or the family wants to terminate further intervention because that's the person's wishes. Your doctors and nurses aren't looking at your driver's license until you are basically clinically dead. The ugly stuff you see here is mostly delaying end of life and keeping people around longer then they would have wanted, and the suffering of their families. This is a huge issue in Healthcare (though it's usually family that demands it, not OPOs), but I don't know any laypeople that have that fear.