The pathology laboratory is closed on weekends, but from time to time it happens that employees are called in to carry out an extra assessment of whether an organ is suitable for use for transplantation.
– We are not looking at all donors, but at the cases where they have seen something in their regular checks that make them unsure, says Rodrigo Munoz Mitev, pathologist and part of the emergency team.
When a potential donor is identified, out of respect for the deceased, one does not want to keep the body and organs alive longer than necessary and the transplantation process begins as soon as possible.
A new heart on Valentine’s Day
Valentine’s Day 2021 fell on a Sunday. Sara Issa, a biomedical analyst, is asked to rush to work to meet a fellow pathologist. It was about a possible organ donor from Lithuania where something unusual had been seen. A tissue sample from the patient was flown in by helicopter to Lund, where Sara was waiting.
– They had found indentations in the lungs, but did not know if they were tumors or if it was something else. It turned out that the recalls were due to air pollution, nothing else. We were able to recommend using the organs from the patient and that led to someone getting a new heart, on that very day, she says.
This was already the second case in the new year where employees had been called in during closing hours. It was usually those who lived closest who were called in and it became clear that there was a need to organize a formal emergency response function at the unit. A few months later there was a rolling emergency schedule and today the staff group is very satisfied with both the arrangement and being able to participate and contribute to more organs being taken care of.
Different from the usual process
In the daily work, the pathology lab examines tissue samples to determine if and what kind of disease the patient has and how to treat it. It is a solid process where a lot of time is spent processing tissue samples so that the pathologists have good material to read and make a diagnosis from. For emergencies, an accelerated process known as frozen section is used instead.
– It is a technique that is not perfect, we do not get perfect images from which to make a diagnosis. But it is good enough to be able to give an assessment of the quality and to answer whether the organs can be used, says Rodrigo Munoz Mitev.
The cases that are received during the emergency usually result in positive reports, which is also different from the everyday life of pathology.
– The fact is that in pathology we are used to giving rather bad news, for example that the test shows that it is cancer, says Rodrigo Munoz Mitev.
Sara Issa agrees.
– You get sad that the patient has to go through everything they have in front of them because of the answer we give. But with the cases we work with within our preparedness it is more harmonious somehow. Afterwards, I feel that we have done something that leads to something positive, instead of causing misery for the patient. This is an organ that has been saved so that more lives can be saved. You see the effect immediately.
More organs are allowed to live on
Since the start in June 2021 until today, they have received 18 cases during standby time. The number of cases is increasing and in 2023 the emergency line was used 7 times.
– The number of cases does not mean that you have only been able to use the particular organ we have received, you can help up to 9 people from each approved donor. Instead of just assuming that the organs are not suitable, they use us. With our help, in the doubtful cases, you can actually find out whether it works or not, says Sara Issa.
– So far, we have not had a case where we have found anything malignant. We have twice observed benign changes. And only once for a liver biopsy was it advised not to use the liver as there was a lot of fat, says Rodrigo Munoz Mitev.
– With preparedness, it is usually positive news. We give someone the opportunity to continue living, he concludes.
The next time Valentine’s Day falls on a weekend, the pathologists’ emergency team is ready to step in if needed.
About organ and tissue donation
Right now, around 680 people in Sweden are waiting for a new organ. In 2023, there were 92 people who never had time to get a new organ. These 92 people died or were permanently removed from the waiting list for a new organ. The most common reason why you are permanently removed from the waiting list is that you have become too ill to cope with a transplant operation and the lifelong medication that entails.
In the Southern healthcare region, the number of people who donate organs after their death is around 30 people per year. Up to 9 organs can be harvested from each organ donor, on average 3.5 organs are used per donor. Even tissues can be transplanted and improve the quality of life of more people. There are also donations from living people, for example kidney donation.
Donated organs and tissues are matched with recipient patients who may be in the Nordics and sometimes also other parts of Europe, depending on where specialist knowledge is available.
Within Region Skåne, for example, VO surgery and gastroenterology at Sus in Malmö during 2023 performed 68 kidney or pancreas transplants. There are currently around 125 people on the waiting list for kidney and pancreas transplants.
Take a position on organ donation in the donation register (socialstyrelsen.se)