Danny McMahan unfolds his 6-foot-2 frame from his silver pickup truck and pauses.
He's been driving fast to get to the hospital. Now he needs to slow down, to center himself. He takes deep breaths as he walks slowly into the hospital, pausing to don a white lab coat. Then he enters the waiting room.A woman sits on the edge of her chair, a few family members around her. As he enters, their eyes lock.
"Hi. I'm Danny McMahan from Intermountain Organ Recovery," he says. "I'm so sorry about your son."
McMahan, 46, was a critical care nurse when, a decade ago, he made a career change to become one of five transplant specialists for the IOR, which coordinates transplants for Utah, western Wyoming and southeastern Idaho.
"It was an opportunity to learn new things but still utilize my skills and training," he says, absently stroking his mustache as he speaks. "It has different rewards than working in the ICU, but it is rewarding."
He's not there to "get" organs. Rather, he hopes to comfort the family and let them know they have the option of donating organs - something that has usually already been explained by the hospital staff.
"Whatever they decide is the right decision," he says.
"In my opinion, organ donors are heroes and families need to know those heroes are going to be treated with respect and dignity."
So McMahan steps into an emotionally charged atmosphere. "I get to share such difficult, sad, tragic and oftentimes senseless moments," he says. "If only he'd worn a helmet . . . If he'd put his seat belt on . . . If . . . If . . ."
On this day, a 12-year-old boy has been terribly injured in a car accident that killed the driver. After he's flown to a local hospital, it's clear to medical staff that he didn't survive, although his heart continues to beat and his small chest moves up and down in time to the ventilator. Tests have indicated the brain is dead, neither sending or receiving signals.
More tests will be done later. But McMahan is here to help the mother, explaining her son's condition in less clinical terms than she might have heard thus far.
From the time he received the call from the hospital about a potential donor, McMahan's moves have been carefully choreographed. Even his clothes - slacks and a neutral-colored shirt and tie - have been selected with the grieving family in mind. He doesn't want to jar this fragile woman or add to her pain with anything as silly as too casual clothing or a wild-print shirt. He wants to blend in so that his presence is soothing, not more painful.
He can't take the pain out of the situation, but he doesn't plan to add to it.
When she cries, he finds himself crying with her. That's not uncommon.
"Sometimes I just can't not cry," he says. "It's a highly emotional time and we have to grieve as well." It's particularly hard for some of the IOR's specialists when the potential organ donor is a child, he adds.
McMahan and his wife, Colleen, don't have children. "Just two dogs and a cat and several tropical fish." But that doesn't make it any easier to talk to someone whose child just died.
"Sometimes it's hard to say what I need to say. But I have to make sure they understand the clinical condition of the loved one. I have to find words to speak to the family's level of understanding.
"The main thing is, do they understand that death has occurred. That's hard, because the heart still beats and there's color and temperature and sometimes it looks like the patient's just sleeping. But machines are providing the color and the temperature and the heartbeat, preserving for the families the option of donation."
This mother knows the truth; she's beginning to come to terms with it. And she indicates that she's willing to donate her son's organs, although she doesn't want tissue or bones removed for transplantation.
McMahan's job has just begun.
Donating organs or tissue or bones shouldn't be broached until it's obvious that death has occurred, McMahan says. But sometimes, when it's obvious that survival is impossible, the topic comes up.
Often, the family raises the issue, hoping to create something good in a situation that can only be foul.
Clear lines separate the hospital staff, charged with treating a potential survivor, from transplant specialists like McMahan, who only become involved when saving a life is impossible.
No one in the transplant process is ever involved in the declaration of death, which is always based on meticulously documented basic medical standards. And once death has been declared and a family agrees to donate organs, the patient is discharged from the hospital on the computer, then readmitted.
That protects the family from being billed for anything in the transplant process, which used to be a problem. Organ donation is a gift and once the decision is made, all cost to the donor family stops.
For the next 90 minutes, the woman, her family and McMahan explore legal and medical issues.
Families always want to know if the body will be mutilated. The answer is no. An open-casket viewing will be possible, unless the original injuries prevent it.
He also has questions for the family. Because this death involved a child, he doesn't have to ask about things like sexual activity, but he does need a medical history. With an adult, he'd have to ask about risk factors for disease, although the donor will be tested for HIV, hepatitis B and C, syphilis and herpes. A T-cell count will be done.
He walks them through the donation process and what they can expect as far as details like when the body will be returned. He explains that the evaluation of the organs, which he will personally oversee, takes at least three to four hours. During that time, he'll also be locating the recipients of the organs.
When the removal of the organs is complete, he says, the body will be released to the medical examiner's office or the mortuary.
The entire transplant process will be completed in less than 24 hours, he assures the anxious mother.
She acknowledges, aloud, that her son is dead.
The family has gone home and McMahan turns his attention to the 12-year-old boy, frozen in time by an accident. Miraculously, parts of him will live on, providing new hope and life to people whose time clocks were slowing.
McMahan starts the organ evaluation process. Although a hospital nurse will continue to make basic checks like blood pressure and organ oxygenation levels, McMahan has, with the mother's decision to donate organs, taken over the care of the boy. Although machines are providing function, physiological factors can lead to organ failure. He orders the lab tests, which are given priority processing because organs must be transplanted quickly. The results will be back in two or three hours.
While he waits, he starts working the phone.
McMahan has a computer printout listing potential matches for the heart, liver and kidneys of the child. Those are the organs the mother chose to donate.
McMahan starts trying to place the heart first. Sometimes, he'll place multiple organs with the same recipient, like a heart-lung transplant, or a liver and kidney.
Kidneys are matched by genetic markers and blood type.
Other organs are placed by size and blood type.
Where potential recipients fall on the priority list depends on how sick they are.
He's placed organs on the first phone call. And he's also had it take 20 calls to place a single organ. Sometimes organs are rejected because they're slightly injured.
Once he's lined up recipients, he starts lining up local doctors to recover the organs. In some cases, the team that will transplant the organ into the patient sends its own doctor, but often it's done by surgical teams that are specially trained for organ recovery.
The patient is dead, but each recovery requires not only a surgical team but an anesthesiologist to monitor fluids and oxygen levels. The teams also have to be coordinated, the procedure choreographed like a precise dance. Hearts come out first, kidneys later. Usually that involves separate surgical teams.
Depending on the situation, McMahan may also have to arrange transportation of the organ to its intended transplant center. Ultimately, that's coordinated with the recipient hospital.
The human body has the potential to help scores of people. In a perfect case, someone gets a heart, another a liver. In fact, a liver can be split in half and help two people. The kidneys can save two people, the pancreas another. Even the small intestine can be recovered for transplant.
The most common transplants, though, are the corneas, skin grafts and bone and tendon donation. They can literally help 40 or 50 people.
And skin and bone transplants aren't quite as time-driven. Donor tissue can be recovered up to 24 hours after death. They're also possible when injuries prevent other organs from being used.
Although organ donation is a confidential process, the woman receives a letter one day.
I thought you'd like to know, McMahan writes, what the gift of your son's body has done. A young woman received his heart and is doing well. His liver and one kidney were transplanted into an infant in another part of the country. The other kidney has gone to another young woman.