Please be dying, but not too slowly
A courier’s reflection on the journey of organ donations and mortality
Content note: This essay reflects on death, organ donation, and end-of-life decisions.
Waiting for Someone to Die.
4–6 hours. That is how long a pair of lungs remain viable between the time it’s removed from the donor to the time it gets into the waiting recipient. Of those 4–6 hours, I would be spending the majority of time as its steward, getting it from a hospital in Los Angeles, California to another in Dallas, Texas.
In the hours before that entire process is a person waiting to die. Due to HIPAA and other privacy policies, a lot of the information is on a need-to-know basis only. For me, it’s knowing what I need to get the organs to the recipient hospital, still viable.
It doesn’t stop me from wondering what happened before though. Was he (or she) a victim of the car accidents that happen on our California highways daily, a familiar pink ‘donor’ mark affixed to his driver’s license? Or was he battling something chronic, the gift of breath to another on his final will?
I sat outside the Emergency Department of the hospital, rehearsing each step of the way that would get me to the airport in time for the scheduled flight. “Tell them you have live organs in hand”, “make sure the TSA doesn’t open the container”, “tell them at the gate you need to get off the plane first”… I had the authorization in hand at the ready, things I need to prepare to say already recited.
This wasn’t my first time getting something time-critical off the ground. In fact, it’s been about a decade since I made my first delivery from LAX-HKG at the age of 21. Usually they were essential replacement parts for a grounded aircraft, or a fix that was keeping the factory floor from operating; Usually, the timeliness of that delivery was measured in dollars and cents: the cost of the plane’s useful life, the value of the equipment and personnel sitting idle. This time it was different. There were two people on the operating table, on both ends of my timeliness, and I was responsible for it.
The Weight of Organ Transplant.
I was to be the steward of something human, something technically alive but not yet belonging to one. I found that poetic. As I waited outside the Emergency Department, swatting the summer mosquitoes in their persistent onslaught on my arms, my mind wandered to other things.
I recently discovered how an economist designed what decided the “Who gets what” in organ donation. I don’t imagine an average person would connect life-saving work to money science. I read that in the book titled Who gets what and why by Alvin E. Roth, the professor of economics who helped design the market. The science of market-making transferred the weight of deciding who gets to live from a single person to the same mathematical machinery that runs the stock market without pricing it. The invisible hand of price first described by Adam Smith that made markets efficient is taboo in the market of organs and for good reason. The book is a good read if you want to learn more.
My mind drifted to other things. The weight on the custodians of the dying man, who were to decide when to pull the plug. That foggy, indeterminate place between life-and-death. The medical and personal decisions that led there. The surgical team as they spread the ribs to get to the lungs. The weight on the doctor making the cut.
Nonetheless, I knew that once it got to my hands, that weight transferred to me. I had the opportunity to help save a life. Admittedly, that rattled me.
Someone Died.
The time came, and passed. I was now in the car, ready to race my way to the airport. “Lungs not out yet” was the latest message I got from my point-of-contact at the hospital, the message glaring at me from my phone screen in the darkness of the night.
Minutes turned to an hour. I felt equal parts restless and concerned, and I started sending out messages to my handler to have backup plans for the flight schedule. I felt guilty as I let out a yawn — it was getting to be the dead of night and I was to make a red-eye flight. Someone was on their deathbed, I had to remind myself. I couldn’t rush it, even as I had to rush it to its destination. I grew increasingly concerned, worried I might miss the last flight and hence the window of viability. Driving wouldn’t work even if I willed myself to: speeding down the Interstate alone would take 20 hours.
“Lungs were declined”. I opened the message and stared hard. It didn’t change. “Lungs were declined”. Why was it rejected? Was it damaged? The wait too long? I might never know.
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The man had died. The space between life and death closed.
I felt equal parts sad and relieved, and I felt guilty for that. Sad that a person had died, and sad that their lungs had died with him; Relieved that the weight was off me, at least for now. I went through a rollercoaster of emotions, and wondered what it would be like when I have to once again go through that in a white coat someday.
That’s how I found myself waiting for someone to die — their lungs out so that someone else may have them. Please be dying, but not too slowly.
Disclaimer
- Content note: This essay reflects on death, organ donation, and end-of-life decisions.
- If the title “Please be dying, but not too quickly” sounds familiar, it’s because it is. The title echoes the inspiring essay of Bess Stillman and her late husband, Jake Seliger, who was battling cancer. I can only hope that I could be as vigilant and resourceful for my loved ones if life ever took that course. Read their story here, a reminder of the gaping hole of clinical trials that the healthcare community still need to work on.
https://bessstillman.substack.com/p/please-be-dying-but-not-too-quickly
https://bessstillman.substack.com/p/please-be-dying-but-not-too-quickly
- I do not know the identity, including gender, of anyone involved and used the he/him pronoun for the length of the essay. It’s simply a choice that I have come to, certainly without the intent to misidentify or neglect the significance of any group.
- Where I’ve used more emotive language, it is only to express myself fully, in the hope of engaging the reader in my authentic experience. I am fully respectful of the gravity of the situation.
- As the story is for a broad audience, I took care to avoid using any sensitive information not necessary to describe the story.
Other things that went through my mind — for personal note and as points of discussion
- Innovation to keep the organs viable longer. This would certainly help make more organs viable.
- I reflected on the entire value chain and logistics that made it possible for organ transplant across state lines on a 4-hour flight. The economic machinery that enables something like this is certainly incredible.
- I had been considering getting my Private Pilot License for years now, and in the desperate moments I had wished I already had one. I’ve read somewhere of pilots volunteering their time to transport organs. It would be a nice retirement gig.
- I wonder how the medical team decides when to harvest the organs and hence pull the plug on the dying patient.
Other things you may be interested to read about
- Who Gets What — and Why: The New Economics of Matchmaking and Market Design. https://newbooksnetwork.com/who-gets-what-and-why
- Reasons Why Organs From Deceased Donors Were Not Accepted for Transplantation https://pubmed.ncbi.nlm.nih.gov/31378471/
- HIPAA https://www.cdc.gov/phlp/php/resources/health-insurance-portability-and-accountability-act-of-1996-hipaa.html
