Flowers at a local park. Photo taken by Kate Ota 2019
We’ve all seen the medical show episode about a brain-dead patient donating their organs to save another patient. Maybe there’s a heartbreaking twist, like the donor is the recipient’s father. Every medical show has the organ donation episode or episodes, and they almost always get it wrong.
This post is to help you write your book or screenplay with an accurate portrayal of the organ donation process. At the end, I breakdown how one show did a terrible job portraying organ donation, and why it's wrong. And hey, if this post convinces you to register as an organ donor at your local DMV or at donatelife.net, then bonus!
1. Organ donors get the same care as non-donors.
No one at the hospital considers or even checks to see if you’re registered until either brain-death or after death. Doctors and nurses want to help every patient stay alive and healthy!
2. The hospital’s doctors do not determine donor eligibility.
This is what I see as the biggest problem in medical shows: they always have the protagonist make the call as to if the donor is safe to donate. Nope!
Organ procurement organizations (OPOs) and Tissue/Eye Banks determine donor eligibility. These FDA regulated organizations review medical records for the purpose of preventing disease transmission between donor and recipient. Different organs and tissues have different requirements. For example, because organ donation can be a life or death decision, the organization may ask the recipient family if they’d be willing to accept organs with viral Hepatitis. However, this is never done in the case of donated corneas, as there are enough corneas in the US that the need is met with disease-free tissue.
3. It’s a time-consuming process.
First, the future organ donor must be declared brain-dead, usually by two doctors. Then, the OPO gets the next of kin’s consent, and there’s a lot of paperwork involved recording that consent. The family also fills out a survey of the donor’s history. Then there are blood tests, chest x-rays, CT scans, and even biopsies, depending on the organs deemed eligible for donation. The OPO offers organs based on the UNOS list, who matches the donor, who’s within delivery range, etc.
Then everyone waits for a time-slot in the operating room. This may vary by hospital, but organ donors are not a high priority surgery compared to, for example, incoming traumas. Waiting for an OR time can be a long process, or a very short one.
Something that TV shows get right is that donor families may choose to have an honor walk, in which doctors, nurses, and hospital staff line the halls to the OR when the donor is wheeled in.
Surgeons remove the organs and take them to their recipients. Tissue Banks (which may be the same as the OPO, depending) will remove any donated tissue, like skin, bone, or valves. Eye banks will remove donated eyes or corneas.
4. Donor families and recipients usually don’t meet right away.
Recipients can write letters to the donor families, or vice versa, and they can decide to meet or not from there. TV shows often have these players all in the same waiting room, or meet in the hall. I saw one episode where the donor’s mother waltzed right into the recipient’s ICU recovery room! No!
The problem there is those scenes would violate HIPPA, the act which protects patient privacy. Some donor families may not want to meet the recipient, or vice versa. Especially right away. It’s a personal choice, and no one’s name will be given to the other party unless they write a letter and introduce themselves. In fact, the first letter often goes through the OPO or Eye Bank, so the first letter writer doesn’t even know to whom they are addressing their letter.
5. Remember: consent consent consent!
When you register yourself to be a donor at the DMV or at donatelife.net, you are giving your consent to be a donor. In some states, like Virginia, this consent is enough to donate your corneas without your family needing to give additional consent. But other tissues and organs require your family to consent on your behalf as well. If you decide to register, be sure to let your nearest and dearests know, so they will understand your wishes and honor you through donation.
Now let's chat about how one show got it wrong, so you can avoid those mistakes!
There’s a Law and Order SVU episode that makes me cringe. There was a doctor who would procure from donors if they died on the table without family consent. This doctor, to be clear, was the person on trial. Let’s parse out the episode and see what this character did wrong based on what you read above. And also, what the writers of the episode got wrong.
1. No family consent. And that means no survey of the donor’s history. The FDA won’t like that.
2. The patient’s doctor made the determination to donate, but that’s not their job. That’s for the OPOs and Tissue/Eye Banks to determine. This character would probably not know enough about donation to safely make that determination. In fact, when this happened is the moment the case became unbelievable. Now we move from blaming the character for doing things wrong, to blaming the writers of the show.
3. The character removed the organs themselves and shipped them off to patients at other hospitals. But where was the UNOS list? How did the doctor know if the donor was a match to those recipients? The doctor had no time to run any tests for crossmatching, disease, or size (that’s the X-rays and CT scans).
4. No one caught this doctor for dozens of patients. They were acting alone. And you’ve learned there are a lot of people involved in an organ donor case, from the OPOs and Eye Banks, to the doctors, nurses, and surgeons involved in the tests at the hospital, to UNOS, the FDA, and recipient surgeons. This doctor would never have been successful through one, let alone dozens, of cases like this.
The only thing SVU got right was that the doctor truly tried to save their patients before they were declared brain-dead. And that the family of the donor would sue in that situation.
Did this post help you write your organ donation scene? Have anything to add? Let’s talk about it in the comments!