The stories of the nurse who collects organs for donation – 08/24/2023 – Health

Nurse André Ramos Carneiro was in the first year of his career when he came into contact with the case that would mark his professional life.

At the time, about 14 years ago, he needed to talk to a woman who was going through one of the most tragic moments in her life.

Days earlier, the house where she lived with her family in São Paulo was invaded by thieves – who, after an unexpected reaction, ended up shooting her father in the chest and her brother in the head.

The father succumbed to his injuries and died shortly afterwards. The brother was taken to a hospital and was admitted but, after two days, his brain death was declared – which qualified him as a possible organ donor.

As an organ transplant service employee, Carneiro then called the victim’s sister.

She asked him to go to the cemetery where she was watching over her mother — who, given the series of misadventures, suffered a heart attack and also died.

“I remember that scene like it was yesterday, the children running outside and the smell of the flowers in the coffin. The woman took two chairs for us to sit and talk, so I was able to explain the whole situation”, he reports.

“And she said to me: ‘I buried my father yesterday, I’m waking up my mother today and you came to tell me that my brother died now. But he is the only victim of this whole tragedy who can still help someone, so I authorize the donation of the his organs’.”

At the age of 41, the nurse continues to work in the organ collection system for transplants.

In the meantime, he worked at Hospital das Clínicas de São Paulo, Hospital Israelita Albert Einstein, Hospital Geral de Guarulhos and today works at the Mobile Emergency Care Service (Samu) at a public hospital in Grajaú, a neighborhood located in the south of São Paulo. capital of São Paulo.

Specialized in thanatology —the scientific study of death—, Carneiro performs a difficult and delicate job every day: talking to family members who have just lost a loved one, to find out if they authorize the donation of organs that can be used in transplants.

“In many cases, death occurred abruptly and unexpectedly, such as a stroke (Cerebral Vascular Accident), a traffic accident, a fall from a slab, a gunshot…”, lists Carneiro.

In an interview with BBC News Brasil, the nurse tells how he decided to pursue this career — and what are the steps and criteria for organ donation in Brazil.

Life’s only certainty

Carneiro understands that health professionals themselves have a wrong expectation about the work they do.

“Generally, we see hospitals as healing places, where people are cared for and recover. But the reality is that, in a context where death was institutionalized, hospitals became the place where the individual dies”, he says.

“It is very rare, nowadays, for someone to die at home, surrounded by family members and loved ones. Death happens at the hands of health professionals, who do not accept and do not always understand that they are facing such a sublime moment.”

Upon realizing this, the nurse saw that organ donation was something unique, that it makes a tremendous difference in the lives of people waiting in line for the transplant.

He decided to specialize in identifying people who have just died and who have the potential to donate organs.

As part of this work, Carneiro needs to talk to the deceased’s close family members, who are legally responsible for authorizing the removal of tissues that may end up being transplanted into other individuals.

“At the beginning of my career, I heard several nicknames like ‘angel of death’ or ‘vulture’.”

“That impacted me, so I came up with a very strong phrase for myself, which represents what I do: ‘I see life where death prevails'”, he says.

To be more prepared to deal with such a delicate subject, Carneiro decided to specialize in thanatology —the word refers to Thanatos, the personification of death in Greek mythology.

“Understanding the subject is a process of self-knowledge, of humanizing death and, of course, goes a lot against what you believe, your spirituality”, he points out.

“That’s why, in conversations and lectures, I always like to ask: what would you do if you had six more months to live? What would be your priorities? Usually, the answer is the family and the legacy that will be left.”

a sensitive conversation

But what is it like to talk about organ donation with individuals who are going through a moment as painful as the loss of a loved one?

Carneiro says that, even though there are formal protocols and guidelines, the main recommendation is to have a humane and respectful approach.

“The first impact after the news of the death is usually shock, anger and revolt. The person complains to God, to the hospital, to the universe, and tries to find answers to explain why he lost the person at that time.”

“Then comes the stage of bargaining or despair, of wanting to see the body or not believing that it actually happened.”

In Carneiro’s assessment, this is not the ideal time to talk to family members about organ donation.

“At that time, the best thing we can offer as professionals is silence”, he says, who also highlights the importance of a welcoming attitude and trying to understand who that person was and the story he built in life.

“When family members enter a moment that is a little calmer, of acceptance, we have a greater openness to talk.”

“I always try to understand who that individual was in life, to find out if he saw himself as an organ donor or not.”

Another mission at this time is to make it clear that the person is really dead and there is nothing more to be done —death is always declared by two doctors, who are not connected to the transplant team, and with the help of three protocols different (two clinical evaluations and an image exam to prove that the brain stopped working).

“We need to make sure that the family members truly understand that the individual has died.”

“This is particularly important in a religious country like ours. If there’s any doubt left, there’s always hope that the loved one will come back”, he adds.

The nurse reinforces that his work and that of other professionals in the area does not involve convincing relatives to authorize the removal of tissues.

“Our role is to clarify how the donation process works and resolve any doubts that may arise.”

According to Carneiro, many are afraid that the removal of organs for donation will leave the deceased disfigured — which is not true.

After the process, the body is released for the funeral rites completely preserved — and, even when the corneas are removed, the space of the eyeballs preserves the same proportion, with the eyelids duly closed.

In times of health crisis

The specialist points out that, during the Covid-19 pandemic, the work became even more difficult.

“I worked in a tent set up to absorb the demand of patients who arrived infected. And there we saw four, five, six deaths every night”, he recalls.

“And worse, we couldn’t do anything in terms of donation, even if the family authorized it, because we didn’t have studies to guarantee that those organs were safe for transplantation.”

With his experience in thanatology, Carneiro was often asked to talk to and welcome the families who received the news of his death.

“Everything was psychologically very heavy for health professionals. Some no longer wanted to work in Covid units, because it was death all the time”, he reports.

“And many began to realize that the risk of death did not only affect the patients, but also themselves, who were in contact with the virus all the time.”

The specialist believes that having previously studied the subject helped him to deal with such a complicated situation.

“I have my faith and, when an individual died, I had the privilege of closing his eyes and saying: ‘God, receive this person’. And here I am not talking about the body, which is just a vessel that will be burned or eaten by the earth.”

Faustão and national commotion

The nurse believes that stories like that of the presenter Fausto Silva —who recently disclosed a diagnosis of heart failure and the need to undergo a heart transplant— help to debate and explain the subject.

“But our society is so plagued by cases of corruption that many believe that the organ donation process is also corrupted. There are those who think that the rich and famous manage to jump the transplant queue”, he reports.

“But that’s not how it works. I believe in the queue and the prioritization criteria for transplants that we have in Brazil. I put my trust in that and I don’t see signs of favoritism”, he confirms.

Carneiro recalls that, under Brazilian law, authorization to donate organs from someone who has been found to have brain death is exclusively up to the family.

Therefore, it is important for everyone to talk about the topic – and make it very clear to close relatives if they accept (or not) that some body structures are removed after death and used in transplants.

“I need the signature of first and second degree relatives to carry out the removal of the organs. I cannot carry out the donation if I do not have this, even if the person has made a video while still alive saying that he would like to be a donor”, he points out. .

Soon after the relatives are released, health professionals begin a real race against the clock.

After a series of exams, which include the health history of that individual and some laboratory tests, the surgical teams that will perform the transplants are activated.

“Each organ has a time of ischemia, or a period in which it remains viable after death. In the case of the heart, for example, there are only 4 hours from the moment it is removed from the donor’s body”, says Carneiro.

It is worth remembering that this entire process is anonymous — and neither the donor’s family nor the recipient know where (or who) the transplanted organ came from.

In this decade and a half as a human tissue collector for the national transplant system, the nurse learned that it is not necessary to face death as an enemy.

“We must understand that death is part of a process, and this acceptance makes this inevitable moment more peaceful for everyone.”

“In this context, organ donation means doing good to others. And this is the greatest act of altruism anyone can have”, concludes Carneiro.