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The Nasty Side of Organ Transplanting.

Chapter 7

Harvest Time

The rush to prepare the ex-patient and now “brain dead cadaver” for harvesting is interspersed with moments of silence. Hospital transplant staff require relatives to bid farewell to the cadaver or patient with the confusing status before he or she is taken into the operating theatre, still maintained on life-support despite being called dead. The transplant teams are assembled and compatible recipients brought to the hospital.

Transplant staff will have injected heparin, a blood thinner used to prevent blood clotting, into the heart-beating cadaver plus phentolamine mesylate to expand the size of blood vessels. Both drugs may increase bleeding inside the skull but it doesn't matter because the brain-injured patient is considered dead. Medical technicians preserve the organs by putting the “heart-beating cadaver” on a high fluid drip and by injecting drugs to increase blood pressure. These procedures arouse no controversy unless they are done before the patient fails the “brain death” test because they further damage the injured brain.

“Brain death” should also be declared before two catheters are inserted into the abdominal aorta and femoral vessels to flush out the blood from the organs with a cold solution. However, all the above may happen when the heart is still beating, “brain death” not declared and the patient still being treated with a view to recovery.

The surgeon slits open the donor’s chest then saws up the middle of the breastbone with an electric circular saw. The surgeon pulls apart each half of the ribcage to expose the viscera and inserts separators to keep the ribs apart. A nurse or assisting surgeon pours ice slush over the surface of the organs. Chilled organs last longer just like chilled meat.

Removing the donor’s liver is particularly difficult and often involves massive bleeding where the “corpse” requires blood transfusions to keep it alive, or viable, or whatever. The liver and pancreas may be removed together and taken to a table just behind the main donor table where they are separated for two different recipients or, if one is not donated or needed, either put back into the body, thrown away or used for research.

The heart will be removed along with the lungs if both are going into the same recipient. Extracting just the heart requires two thoracic surgeons, an anaesthetist, two experienced nurses, one perfusionist and various stand-by staff and students. The donor’s real death is frequently determined when the aortic clamp is applied and the heart paralysed. The excised heart is rinsed of blood, perfused in a cold preservative and put in a picnic cooler filled with ice and coolant and rushed to the recipient’s hospital. It’s a real rush because heart and lungs remain viable for about six hours, which can be difficult if there is a three-hour flight.

Another process is by removing the heart in a block of crudely dissected and cooled tissue from which the wanted organs are carefully dissected outside of the body by the specialised teams of harvesters.

Transplanting surgeons may remove their particular organ and leave with the picnic cooler box on a fast private jet, but usually there are separate harvesters and transplanters. The transplanters prefer to stay with the recipient and wait for delivery by road or aircraft. They may have lunch or sleep while awaiting the organ as transplanting can be a long, gruelling job requiring a high level of fitness while maintaining a subtle touch even whilst exhausted.

The Less Than Desperate Organ Courier

Most people have seen promotional images of harvest surgeons or nurses desperately rushing to an ambulance or aircraft to deliver the organ to a patient flickering on the edge of life and death. One might imagine the nurse sitting in a double seat of an aircraft carefully watching the temperature on an incredibly complex and expensive portable fridge, however, this is not how it is done. Actually, the organ, usually a kidney, is packed with ice and cooling liquid into what is called a picnic cooler or Esky. It resembles those six-dollar Styrofoam boxes used to transport broccoli sprinkled with ice to the morning markets. A courier may take the organ to the airport where another courier picks it up at the destination. 

Hospitals regularly send kidneys across the Nullabor Plain between the Royal Perth Hospital in Western Australia and the eastern states. On one occasion a World Courier (Australia) Pty Ltd courier put a Styrofoam box on the plane to Adelaide thinking it contained a kidney. It didn’t. He discovered the warm, ruined kidney in his van the next day after receiving an unpleasant phone call from the waiting hospital.

Peter Hornsey, the expectant recipient, was waiting in the Queen Elizabeth Hospital in Adelaide. He already had a catheter stuck in his neck and was being dosed him with anti-rejection drugs. Peter was somewhat disappointed to say the least. Doctors pulled the catheter from his neck vein, sewed up the wound, sent him home and back onto the waiting list.^[51]

Reasons for Not Using an Organ

Organs are initially rejected if the donor is considered an infection risk. Disease may be discovered in the body, or the hospital may have fears over the donor’s social history. These may include homosexuality, pituitary growth hormone injections, having being a transplant recipient or from recently working as a prostitute. Further rejections may be due to unusual physical characteristics of the organs, tumour presence, and unforeseen damage during the event leading to “brain death” or by surgical error during harvest. An exception to the above is where organs are being used in some nations from donors with a cancer history.

Organ acceptance varies according to country. Australia prides itself with the world’s highest standards of infection control and won’t accept a range of body products from other places including Europe and the United Sates. Australia’s standards are uniform between states so an organ rejected in one hospital is likely to be rejected in another. This means an organ rejected due to quality is rarely offered to another hospital.

Standards in the United States vary so greatly between states and hospitals that a rejection in one place may be acceptable in another. When an organ is rejected transplant coordinators phone the next waiting hospital, giving them one hour to accept or refuse. This continues until the organ is either accepted or passes the use-by date and is discarded or, theoretically, inserted back into the corpse for burial or cremation. Business is business in the United States and every organ is flogged until rejected by even the most desperate hospitals.

Use-By Times

The Use-By time - after removal in good condition from “beating-heart donors” - is five or six hours for excised hearts and lungs. Livers last up to 34 hours; pancreas' up to 20 and kidneys up to 72 hours. Corneas last ten days and can be harvested twelve hours after circulatory death. The above figures are from the monograph, Using the Bodies of the Dead, by Swedish writer Nora Machado.

In What Every Patient Needs to Know, published by the United Network for Organ Sharing (UNOS), the American organ allocation outfit, it is written that livers last from 12-24 hours. Kidneys last 48-72 hours, pancreas' 12-24 and hearts and lungs 4-6 depending on the quality of harvesting, state of organs, preservation and transport.

Use-by times are being extended worldwide and in Australia one heart was kept 8 hours and 11 minutes between bodies while the maximum (cold) ischaemic time for a liver has been nine hours.^[52]

Donors and recipients usually reside in the same city, but organs are still flown to other states. For example, South Australia doesn’t have a heart transplant unit so their hearts go to the larger states. The trade-off is that South Australia gets a good deal on kidneys and is a good place for those with kidney failure. [A]

Other contributing factors determining who gets an organ are when there is a particularly good tissue match or when an acute patient is sinking fast. An organ may then go interstate despite qualifying patients waiting in the same hospital as the dying donor. Patients awaiting organs may also be left in the lurch if their state owes organs to another state that wants payment from the very next harvest.

Skin and Bone Harvesting

Following vital organ removal there is no longer any doubt the patient is dead. This signals the entrance of new dismantling surgeons who continue a less delicate harvest. They're from the Skin and Bone Banks that rent hospital facilities but may get the bodies for free.

Most body parts are salvaged from those who haven't donated vital organs, especially in the United States. They died before retrieval preparations could begin therefore becoming ineligible for vital organ donation. A body must be refrigerated within twelve hours of death to prevent contamination from decay bacteria. In South Australia, a body must be processed for parts within twenty-four hours even if refrigerated immediately upon death.

Some countries don’t allow commercial harvesting and the following mostly represents the United States practice, which is the most extensive in the world.

The technician, usually a man, cuts the scalp at the back of the head from ear to ear with a knife then, in an effort which requires some strength, pulls it over the face so it fits inside out with the hair on the inside. He saws off the top half of the skull with an electric saw making a notch at the back so when it is replaced for the funeral it won’t slip off and distress the mourners. The skull top makes a slurping sound when lifted from the valuable Dura matter that covers the brain. The top half of the skull is replaced and the scalp and hair pulled back over to reveal the face. Often jaw bones, eyes, inner ears and cartilage are taken making it impossible to display the face at the funeral.

Harvesters dressed in rubber gloves, hats and aprons strip, peel and cut skin from arms, legs, front and back of the torso or anywhere. They remove and wash the major leg veins and the muscle covering called Fascia. They slice through soft, tissue and report that human muscle smells like lamb meat. They remove trachea cartilage, ligaments and tendons. A prized sack called the pericardium, similar to Dura Matter and surrounding the heart, is later used as repair patches that are placed over the brain after surgery. Both fetch high prices though dura matter has been subject to prion disease scares. Pituitary glands are left due to their nasty history of transmitting the terminal Creutzfeldt-Jakob prion disease.

Dozens of valuable bones including the femur, acetabulum (hip socket), hemi-pelvis, humerus, radius, ground humeral, tibia, ulna, osteochondral bone, and cranial plate are taken for what is euphemistically called recycling.

Regeneration Technologies, Inc of Florida toss bloodied bones and body parts into machines that remove “blood, lipids, marrow, bacteria, fungi and spores” and may even remove HIV, hepatitis B and C.^[53]

Junior medical staff get stuck with removing and cleaning intestines that stink of vomitus and faeces. They say you remember the smell of gastric acid to the day you die.

Intestines are rarely transplanted except in combination with livers, but without great success. Rectums are not transplanted anywhere despite rectal cancer being a major killer in affluent societies. One can imagine the public relations disaster if a recipient experienced a Graft-Versus-Host reaction where the transplanted organ rejects the recipient.

Funerals More Expensive

Open casket funerals are problematic when much of the donor corpse is missing or damaged. Some bodies better suit a large bucket with a lid than a coffin. Morticians face considerable challenge to create the image of a gently sleeping, fully intact donor when most of the bones have been removed. They shove plastic piping up the cadaver’s spinal cavity, legs and arms to mask the lack of bones. They do it cheaper in Australia at the Glebe Institute of Forensic Medicine, also known as the Sydney City Morgue. Former employee Simon McLeod said they used a broom handle on an elderly lady after removing her spinal column.

They also belted one murder victim with a hammer. He had a round fracture and staff suspected that he had been killed with a hammer. They wanted to see if the hammer wounds they inflicted were identical to those that killed him a few hours earlier. That corpse would have needed an extreme makeover for an open casket funeral.

The Sydney City Morgue also allowed a plastic surgeon to sneak in and practice nose jobs on corpses. Relatives were not asked for permission. You can imagine their reaction at seeing their newly deceased beloved with a different nose.

Morticians also fill newly created gaps with gel filler, plug the holes, tape and wrap the bodies and put them in a liquid and odor-proof bag with just their faces and hands sticking out. Plenty of scarves, a favourite suit and, perhaps, sunglasses, will disguise the fact that the deceased has been skinned, gutted and boned.

Morticians are artists and the immense challenge of fixing up harvested bodies is matched by their prices. Neither the transplant industry nor governments recognise the extra cost of funerals for relatives of organ donors. There have been suggestions of compensation to the estate of the deceased though some suggest this is a subterfuge to paying for organs.

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