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MARIAN MACKINNON: Resilience of our donor families demands respect and admiration

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Asking about organ donation can be difficult. Think about it, make a decision and share it with your loved ones.
Asking about organ donation can be difficult. Think about it, make a decision and share it with your loved ones.

Living with organ failure is hard. Hearts, kidneys, livers just not working properly, leaving individuals dependent on drugs, oxygen or machines to live.

There are people in our Highland communities facing this harsh reality. Transplantation remains the single best treatment for many patients, often lifesaving and life-changing allowing an independent, productive and fulfilled life.

There are far fewer organs available than people in need and some will die waiting.

Living donation is clearly not an option for all. This leaves many waiting for a phone call saying there’s an organ available. That call which signifies such hope for one person and their family, is, however, inescapably bound to tragedy and grief for another.

I am a consultant intensivist working in the department of critical care at Raigmore Hospital. I’m part of a dedicated team of doctors, nurses, allied specialists and support staff, caring for the sickest patients in the hospital. Working in intensive care can be exhilarating, often challenging and rewarding, but also sometimes desperately sad.

I meet families at their most vulnerable, often after an accident or sudden illness has left their loved one critically ill. I can only get to know my patient through their family and friends. We assess, use sophisticated machines and drugs to support life, and many of our patients fully recover, but some patients are too broken to heal.

I then have to use the trust built through honesty, shared at the outset of illness, to gently take away false hope, helping families to understand that their loved one is now dying. Making promises of kindness, comfort and dignity, I explain withdrawal of our now futile life-sustaining interventions. I’ve been a doctor for over 25 years, a consultant for 13 and these conversations don’t get any easier.

Only around one in 100 people will die in a way that allows organ donation. This happens in an intensive care unit. This happens in our intensive care unit in the Highlands. Once a family comes to terms with and accepts that their loved one is not going to survive, I ask about organ donation. This can be difficult, but it is my duty to discern what my patient’s wishes were in life to be able to honour them in death.

Readers will know that the law changed recently to an opt-out system. This allows organ donation to be “deemed” if an individual has not formally opted in or out on the organ donor register. Safeguards within this new law mean an individual’s views are still always sought from those who knew them best.

A registered decision can bring clarity to that difficult conversation, empowering families with the knowledge that they are respecting their loved one’s choices. Registering your decision is easy (organdonationscotland.org) but making that choice for someone else when you are newly grieving is not.

It is a privilege to care for all critically ill patients and their families. The particular resilience of our donor families demands respect and admiration. At a time when their hurt and loss is so raw they are able to imagine the hope and joy they can give to others so desperately in need.

I am in no doubt of the benefits of transplantation for an individual, their family and wider society. I also acknowledge that opting in or out of organ donation is a deeply personal choice.

This organ donation week, I would, however, appeal to everyone to think about organ donation; decide to opt in or opt out and share your decision with friends and family as well as registering your choice on the organ donor register.

Marian MacKinnon is a consultant anaesthetist at NHS Highland and clinical lead for organ donation.

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