According to the regulations approved by the order of the Minister of Health of the Republic of Lithuania, one of the main tasks of the NTB is to coordinate, control and analyze the preparation of donors, the collection, examination, preservation, storage, transportation, distribution and selection of recipients of tissues, cells and organs. NTB transplant coordinators are responsible for this.
However, the most responsible and important part of the work of the coordinators is to ensure that a smooth donation process takes place at any time, in any city of Lithuania or abroad, if a donor appears. Currently, NTB employs seven transplant coordinators who ensure uninterrupted 24-hour on-call. 24 hours a day, 7 days a week and all year round.
The most important phone call
When the donation coordination process is not taking place, NTB coordinators manage a wide variety of data – they communicate with doctors of different specialties and update constantly changing lists of recipients waiting for organs, register and analyze statistical information about potential and effective donors and transplants of different organs and tissues, monitor foreign the information contained in the donor organ exchange platform and, if possible, organizes the repatriation of the donor organ to Lithuania.
“We also contribute to the preparation and updating of legal acts related to donor organ transplants, donation. We cooperate with foreign organizations and participate in organized meetings of competent authorities of European countries representing Lithuania. In addition, we periodically prepare trainings on the topic of donation”, K. Grigaitė tells about the functions performed by NTB transplant coordinators.
However, for the NTB transplant coordinator on duty, there is nothing more important when the mobile phone rings:
“When the phone rings, information is received about a potential donor who is either already confirmed brain dead, or is still waiting for the final results of tests, but already all the signs indicate that brain death has occurred.
The anesthesiologist-reanimatologist provides the coordinator with detailed information about the potential donor’s state of health, co-morbidities, prescribed medications, results of laboratory and visual, instrumental tests, which are entered into the register of donors and recipients of human tissues, cells and organs”, explains K. Grigaitė.
What happens after registering a potential donor
When it turns out that it is no longer possible to help the patient, and brain death is confirmed, the anesthesiologist-reanimatologist informs the relatives of the situation and asks what their will would be, whether they would agree to donate the organs of the relative to sick strangers who are waiting for a donor organ.
“If the relatives do not object, intensive communication begins – employees of three different laboratories are called, they are informed that it will be necessary to conduct blood tests of a potential donor, at the same time the sending of blood samples to Vilnius (from other Lithuanian cities) is organized or the coordinator himself goes to collect blood samples in one of Vilnius hospitals”, K. Grigaitė tells about the workflow.
NTB transplant coordinators also communicate by phone with transplant specialists – abdominal surgeons, heart surgeons, urologists, ophthalmologists, nephrologists. They are given basic information about the potential donor’s state of health, usually the doctors are asked to conduct additional tests, then the anesthesiologists-reanimatologists supervising the potential donor are contacted again, and additional tests are ordered.
“Lists of recipients are also provided to transplant specialists, and it is decided which recipients are best suited for donor organs. Later, after the transplant centers have decided which organs will be transplanted and to whom, the coordinator arranges for a team or teams of surgeons to arrive at the hospital where the donor is located.
If a heart will be transplanted, in most cases, we organize air transport – a helicopter of the State Border Guard Service or the Military Air Force. The coordinator has to organize the entire course of action with great precision, from picking up a team of transplant specialists from one hospital, transporting them to another where the explantation is performed, to quickly and safely transporting the same team with the donor organs to the hospital where the recipient is already being prepared and the transplant will be performed.” – NTB coordinator tells about the stressful process.
How are recipients selected?
One of the most frequently asked questions to NTB coordinators is how to select recipients for transplanted donor organs?
K. Grigaitė indicates that recipients are first selected according to blood group, then the recipient’s status (active, urgent, urgent) is assessed, which is determined by the attending physician and the waiting time. The anthropometric similarity of the donor and the recipient is very important, so the recipient’s height and weight are taken into account.
“Eligible liver recipients are selected additionally based on a mathematical model based prognostic score called MELD – the higher the score, the worse the patient’s condition and the higher the patient’s position on the waiting list.
“Recipients of kidneys do not have a waiting status, they are all considered active recipients, but the most suitable recipients are selected based on the immunological compatibility of the donor and the recipient, which is assessed with the help of blood tests,” she explains.
You can find more information about the procedure for selecting recipients of donor organs in the following laws: “On the approval of the description of the procedure for the provision and payment of liver transplantation services”; “On the approval of the description of the procedure for the provision and payment of transplant services of the heart and lung complex”; “On the approval of the description of the procedure for the provision and payment of kidney transplantation services”.
Even a blizzard doesn’t stop the donation process
The fact that there are no obstacles to the donation process is also proven by one story experienced by NTB transplant coordinators.
In winter, after one of the Lithuanian hospitals registered a potential donor, it became clear that the NTB coordinator on duty was incapacitated, this responsible work was transferred to a colleague – coordinator Evaldas.
While Evald was going to the NTB office, a careless driver drove into his car and caused a traffic accident. Although Evaldas himself was not injured, another NTB coordinator – Mindaugas – had to take over the coordination process. However, the troubles did not end there.
“Since the relatives of the potential donor lived in another Lithuanian city and could not sign the agreement that they agreed with the organ donation process when they arrived in Vilnius, the coordinator Mindaugas had to travel several hundred kilometers in a raging blizzard.
It was a late winter evening and the potential donor’s condition was deteriorating, so it was time to hurry and the ambulance driver hit the accelerator. The journey was full of stress and tension, as the snowfall intensified and the road was slippery, but the coordinator reached the destination safely, comforted the family members who had lost a loved one and hurried back to Vilnius to continue the coordination process, which ended in 2 successful transplants”, K recalls the happy end of the story. Grigaitė.
There are mixed feelings involved in coordination
According to the NTB coordinator, each organ donation process is unique and requires great responsibility:
“The work is interesting, unpredictable, which makes you feel a burst of adrenaline every time the coordinators phone rings, because you never know when a potential donor will be registered. It is very interesting to communicate with doctors and use the knowledge gained during studies.
Each case, potential donor, his health condition is different, so it is necessary to gradually, as if solving a puzzle, gather all the necessary information, the results of the patient’s tests and, together with the transplant specialists, evaluate which donor organs are the most suitable for the recipient.
Every time a new potential donor appears, one feels sorry for the departing person and his family members, but at the same time, one wants to be happy for the patients whose lives will change for the better after the transplant. The visitor gets a great feeling when the whole process is coordinated successfully, without any problems or unforeseen situations”, says K. Grigaitė.
Currently, 321 people are waiting for a transplant in Lithuania*: 74 are waiting for kidney, 35 heart, 8 lung, 5 heart-lung complex, 51 liver, 148 cornea transplants. Among them – 4 children. The health of these people depends only on the kindness of other people and their willingness to donate their organs after death.
We invite you to express your approval for organ donation – you can do this by filling out an application online on the ntb.lt website or at any “Camelia”, “Eurovaistinė” or “Gintarinė vaistinė” pharmacy.
*August 31, 2022 data