Don’t Be a Jerk in a Donor OR

—
It is a privilege to work as a guest in another facility

by

Zachary Kon, MD

January 5, 2025

I have always been a “trial by fire” learner. As a resident, my attendings were harsh, relentless taskmasters who demanded perfection. The early days were grueling, but made me who I am as a surgeon and instilled in me a deep sense of accomplishment.

There is certainly debate about if and how learning under extreme pressure and criticism impacts the long-term development of trainees. Does it make them better? Push them closer to perfection? If we become “too soft” on the next generation, will our patients suffer? Does this intensity lead to creating more surgeons who are rude jerks?

Though the debate on how you choose to motivate and shape not only your trainees, but also the staff in your operating room (OR) is an interesting one, I’m not here to weigh in on this. This conversation can be had in your “home OR,” where you are the singular lead.

But, for transplant surgeons, the donor OR is not your OR. In a donor OR, there is only one way to show up: collaboratively, with hubris in check. You are now a part of a team of leads, and a hostile environment can affect the quality and quantity of organ recoveries. While we have a responsibility to our patients, we bear an even greater responsibility to create a respectful environment that honors organ donation. I am by no means perfect, but I have learned from my mistakes in donor ORs and want to see us do better as a transplant community.

Be a Good Guest

Going from being captain of a ship to a member of the crew is difficult. The anomalous nature of organ transplant is such that surgeons often work as guests in hospitals hundreds of miles away where we are no longer masters of our domain. This is because donation sometimes happens at small hospitals that don’t offer transplant surgery. In fact, they may not have any high level or complex surgical services. Moreover, as the recovery process is so critical to the function of the organ, most programs are quite hesitant to “trust” others to recover for them, leading to the need for visiting surgeons. This is a hard transition.

The recovery of organs is a component of the transplantation process that demands no less excellence than the implant. Add to that the fact that surgeons must perform these procedures with other surgeons doing equally important work, in hospitals where they have never been, with OR staff they have never met, during odd hours of the day and night.

It is a privilege to work as a guest in a faraway donor OR. We should all be patient and courteous, and act in a way befitting the hospitality we are shown. Your reputation as a surgeon precedes you and will always follow you.

Be a Well-Prepared Teammate

In one instance, I witnessed a heart surgeon and liver surgeon working on the same donor nearly come to blows — over where to cut a vessel. The vessel of contention: the inferior vena cava (IVC), an important highway that carries blood back to the heart from the liver and the lower body.

The heart surgeon and liver surgeon are the top of the surgical food chain in their own ORs but mere equals in a donor OR. Fighting over who got more of the IVC was like children fighting for a toy. Neither really needed all that much of it, and there was more than enough IVC for them to share.

Battles like this are an embarrassment to our profession. It’s not uncommon to have several surgeons operating simultaneously on a donor, walking a fine line between efficiency and chaos. Oftentimes, they work on the same piece of anatomy. When fellows are sent out on organ recoveries, they should not be told, “Get as much of the IVC as possible,” as though it provides a sense of success and accomplishment. In reality, knowing how much is enough and how much the other team may need are critical things that make you a good organ recovery surgeon.

We surgeons should check our self-interests and our egos at the OR door. The mindset must change from individually setting out to recover my organ perfectly, to fostering a collaborative spirit to ensure that we work as one team so that we all recover our organs perfectly.

Keep Your Composure

In another organ recovery that I hate remembering, the flush to preserve the heart was all wrong and could have jeopardized my recipient’s transplant — and I just lost it. I yelled and cursed at the OR personnel while working on a late-night, out-of-town recovery early in my career.

The heart ended up being fine, but the bad flush put me over the edge and resulted in well-deserved admonishment from the organ procurement organization who showed me a videotape of the whole episode (they filmed it because it was a medical examiner case). I was mortified.

There were reasons for my bad behavior outside of my genuine concern for the organ at hand, but no excuses: lack of sleep, concern for patients I had operated on the day before, donor OR delays … then the flush incident.

What I didn’t see on that night many years ago was a tight-staffed night shift at a hospital that didn’t have much experience with organ donation. They made extraordinary efforts to provide life-saving organs to several people. They were operating under stressful conditions as well. I shouldn’t have lost my composure. In hindsight, it accomplished nothing.

Never Lose Sight of Honoring the Donor’s Last Wishes

Transplants don’t happen without the donor. Never forget it.

The donor (and often the donor’s family) has made the unimaginably generous decision to donate the organs that so many individuals suffering from organ failure desperately need. This can be a gut-wrenching, emotional process, and it deserves the highest level of honor and respect.

We never meet these donors during their lives, and we never meet their grieving loved ones, but we can comport ourselves with dignity in carrying out their wishes and maximizing the impact of their gifts.

Be a Good Steward for the Profession

Medicine is all about practice, especially in the jarring world of the operating room.

We need new surgeons to embrace organ transplantation. We need to show the field at its best. Organ recovery surgery provides opportunities for trainees to be exposed to a considerable breadth of anatomy and surgical techniques, and allows them to make a meaningful contribution to the transplant process.

As transplant surgeons, we are duty bound to nurture the next generation of Christiaan Barnards or Thomas Starzls. We owe them the best versions of ourselves. We owe it to our patients that have put their lives and hope in our hands; and we absolutely owe it to the donor, whose dying wish is to save another life.

Zachary Kon, MD, is the founder and chief executive officer of ProCure On-Demand, a public benefit corporation that is transforming the flawed organ donation system by performing the highest quality thoracic and abdominal organ recovery more efficiently, so more transplants can take place.