From grief to gift

12 October 2017 | Clinical Care and InnovationUpcloseAllied Health 

Stock image stocksnap/Rhendi Rukmana​

Aloysius Seah, a Transplant Coordinator in SingHealth, often bears the brunt of families’ grief when he approaches them to start the organ donation process after their loved one has been certified brain dead.

Under the Human Organ Transplant Act (HOTA), if the deceased is a Singaporean or Permanent Resident, above the age of 21 and is mentally sound, his or her organs and tissues, such as kidneys, heart, liver and corneas can be removed for transplantation upon death from any cause, unless he or she had opted out.

Organ donation should start as soon as possible for a higher chance of success in transplantation. However, it is hard for families to come round to the idea of donating their loved ones’ organs while coping with the sudden loss.

Aloysius understands how difficult it can be for the family. So does Patricia Chua, a Principal Medical Social Worker from Singapore General Hospital, who provides emotional support to the family throughout their ordeal. She journeys with them even before a grave prognosis is given, to the eventual certification of brain death and through the organ donation process that follows after. 

“Brain death usually follows sudden, traumatic events. Even if families may understand and accept brain death at the cognitive level, their grieving for the unexpected loss of a loved one takes a long time to heal. Wanting some control over the decision of organ donation is part of their coping mechanism,” said Patricia.

Among the families whom Patricia has cared for, it was a young couple who left a deep imprint on her.

“They were married for more than 10 years and really wanted to have a child. Just when they had a baby girl, the wife collapsed at work and was rushed to SGH. I was activated upon her admission to ICU to provide emotional support to the husband.

“All the difficulties that I face when speaking to family members on organ donation are worth it. Because there are really lives saved.”

“Within a week, I saw the husband suffer from intense grief before he gained acceptance of his wife’s death and eventually, agreed to organ donation,” she recounted.  

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Transplant Coordinators are called in upon brain death, and works closely with Patricia to support patients’ families throughout the process of organ donation.

Before Aloysius broaches the subject with the family, he discusses with Patricia to understand the family’s views on organ donation and the family dynamics. Patricia attends the family conferences together with Aloysius to provide the connection.

“We face objection from some families as they felt that their loved one did not opt out of organ donation because they did not understand HOTA. There are also those who object due to fear of disfigurements on the body and clashes with their religion,” said Aloysius. “My priority is to address their concerns, and give them enough information and time to process it.”

Despite the emotional intensity of the work, both Patricia and Aloysius find deep meaning in helping these families come to terms with their loss and see organ donation as a gift of life.

“I remind myself that whatever pain I feel for the family, or reaction I get from them, is a small part of what they go through. I am privileged to be able to help them in their darkest moment,” shared Patricia.

For Aloysius, long working hours are part and parcel of an organ donation process. He stations himself at the hospital for up to 36 hours to coordinate the process and reassure the family that he will take care of their loved one’s body while the family takes a break or attends to other matters.

What gives him the energy to carry on? Aloysius shared this story.

“Once, I was invited to join a heart transplant team’s walkabout. The team pointed out one of the patients who was sitting up and eating her breakfast. I learnt that just days ago, she was bedridden, very ill and was on a liquid diet. Then I was told she was the recipient of a heart donation I facilitated over the weekend! It was a defining moment for me.

“All the difficulties that I face when speaking to family members on organ donation are worth it. Because there are really lives saved.”



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