10 Organ Donation Practices and End-of-life Care ... 247from sensory peripheral nerve receptors to the spinal column and back,
to a peripheral muscle group which causes these movements. The lack
of visual cues normally associated with circulatory death is clearly and
understandably challenging for families (Long et al. 2008 ). As outlined
in Susan’s story, the use of alternative cues, including the results of med-
ical tests such as X-ray computed tomography (CT) scans, or witnessing
brain stem testing, can be helpful for families to understand the extent
of the damage and therefore the severity of the situation.
After brain death has been confirmed with families, decisions about
organ donation then take place. If families consent, organ donation
coordinators conduct serologic testing and tissue typing to ensure
best match with potential recipients. Organs are vulnerable to ischae-
mic injury,^3 and to minimise this damage they are removed from the
brain dead donor in theatre (McKeown et al. 2012 ). Given that organs
including the heart, kidneys, liver, lungs, and pancreas can be donated,
donation operations can be lengthy (3–8 h) and may involve up to
five surgical teams, although two surgical teams are more frequently
used in New Zealand. In cases where multiple organs are donated,
a substantial incision is made down the patient’s central chest and
abdomen (extended laparotomy and sternotomy) as in Susan’s story.
Neuromuscular blocking agents may be given in theatre to prevent
spinal reflex movements and minimise sympathetic nervous system
overstimulation during surgery. Once the organs have been removed,
mechanical ventilation is discontinued and the incision is closed. Many
families find it challenging to see the body of their loved one leave
intensive care, receiving full treatments, and know that the next time
they see the body, as in Susan’s story, will be when it is being prepared
for funeral.
Case 1: Bioethical Commentary
This case is indeed a tragic one, highlighting as it does the considera-
ble differences between medical or clinical interpretations of death and
dying, and the interpretations of the family who ‘look on’ or ‘bear wit-
ness’. How might this apparent gulf between the medical interpretation