NY Med

“To Be or Not to Be”… an Organ Donor

by Columbia Surgery on August 28, 2012

Arundi Mahendran, MBBS preparing an organ for transplant

Arundi Mahendran, MBBS, MRCS, MSc is a transplant surgeon and accomplished singer. Originally from London, Dr. Mahendran completed her general surgery residency at University College London and a fellowship in abdominal transplant surgery at NewYork-Presbyterian Hospital. A recent episode of NY Med followed Dr. Mahendran as she collaborated on a living donor liver transplantation in which one brother donated a portion of his liver to the other. In this opinion article, Dr. Mahendran challenges followers to engage in a different kind of discussion when it comes to organ donation.

Organ donation is hot stuff! Slogans and advertising yell, “Organs save lives! Register as a donor now!” But surveys show that the majority of people who choose not to be donors have either not thought about the question or are deterred by uncertainty as to what the process means for them.

As a child, I was pretty stubborn. I did not respond well to being told what to do, nor how to think. I was hellbent on figuring things out for myself.  Therefore, this article is not designed to tell you that you should become an organ donor.  I simply ask that you think for yourself and consider the following question:

What does it mean to YOU to be an organ donor?

People become donors for various reasons; some do it because they’ve seen a friend die while waiting for a transplant, others because they want to give back to society. There are donors who describe it as doing God’s work, and yet others who will do it to save the life of a loved one. What would your motivation be, if you chose to be a donor?

NY Med has featured both living donor transplantation (in which a living person donates a part of their liver or one of their kidneys) and deceased donor transplantation (in which organs are donated based on the person’s prior decision to donate, or the family’s decision). Now ask yourself, what would you do if your dad needed a new kidney?  How would your family respond if you were involved in a fatal accident? Would you (and they) consent to your organs being used to help people? What makes you and your family reluctant? You may be asking why I insist on posing such morbid questions at readers who are neither sick nor dying! The simple reason is that engaging with family, friends, neighbors, and co-workers in an open and frank environment allows you to be thoughtful about the facts and clear about your motives. This is far preferable to the middle of the night scenario, when a loved one suddenly passes away or is declared brain dead.  To make this decision, when you are utterly devastated by loss and wracked with grief, is extraordinary to me. Why not think about these issues when you are healthy of mind and body, and able to discuss your wishes with those closest to you?

Organ Transplant Container

What deters potential organ donors? The first issue is fear about their fate! People worry that in the event of a life threatening condition, health professionals will not work hard to save their life if they’ve already signed up as an organ donor.  The truth could not be farther from this fear, I can assure you. Doctors and nurses involved in your emergency care are dedicated to fighting for your life; that is their primary goal, always. In addition, they have no association with the transplantation services whatsoever. Some people are concerned that they may be too old or unhealthy to become donors. But anyone can choose to be an organ donor, there is no age cut-off. If a potential donor had a medical condition, it does not necessarily exclude them from donation. Doctors will make that call at the time of death. People with strong religious beliefs may worry about going against religious teachings by agreeing to donation. Engage with your faith leaders and seek guidance on how organ donation is viewed within your belief system.

The number of people waiting for a transplant in the United States is tantamount to the entire population of Berkeley, California (100,000). While there are many substitute therapies like dialysis and special drugs, these treatments are not a panacea.  The only definitive treatment for end-stage organ failure is transplantation; without it, people die. So, I return to the first question I posed: What does it mean to YOU to be a donor? Don’t be put off by the myths and misconceptions surrounding organ donation.  Ask questions, demand answers, do the research and discover your opinion on organ donation.

Make an informed choice that you are comfortable with, but do think about the question. This is all any fellow human being can ask of you.

For more information on becoming an organ donor, please visit: http://nyp.org/services/transplantation-surgery/organ-donation-facts.html 

Stay tuned to hear more from Dr. Mahendran and connect with her on Twitter at @ArundiMahendran or on her Facebook page.

Related Links:
Orchestrating Surgery with NY Med’s Dr. Mahendran: Part I
Orchestrating Surgery with NY Med’s Dr. Mahendran: Part II


Orchestrating Surgery with NY Med’s Dr. Mahendran: Part II

by Columbia Surgery on August 20, 2012

A recent episode of NY Med followed Arundi Mahendran, MBBS, MRCS, MSc, a transplant surgery fellow at New York-Presbyterian/Columbia University Medical Center, as she collaborated on a living donor liver transplantation in which one brother donated a portion of his liver to the other. In this interview, Dr. Mahendran describes her experience in the transplant fellowship program and the importance of organ donations in the United States.

During your training program, what was your most memorable moment?

Arundi Mahendran, MBBS (left) and Benjamin Samstein, MD (right)

Over the past two years, I have been involved in some amazing, breathtaking surgeries and participated in nail-biting moments in the operating room. But the event that will stay with me was the night we lost a liver transplant patient in the OR. In the course of your career, there are sadly a few patients who die on the OR table or on the wards. A patient is always medically optimized prior to any surgery and their suitability for transplant is ensured well before they go the OR. In spite of this, on very rare occasions, a patient does not make it through the surgery. The families are naturally shocked and devastated. However, what people don’t fully appreciate is the impact it has on the surgeon. There is a perception that with time “you become used to death, a surgeon becomes desensitized.” Nothing could be further from the truth. That night, I was operating with my highly experienced attending, who is the most senior surgeon in the department. We battled for several hours first to remove the diseased liver and then to implant the new one. Every possible effort was made to save this patient’s life. However, it wasn’t to be. I will never forget the look on my boss’ face. He was absolutely devastated. You would think he had experienced patient deaths before in his illustrious career for it not to affect him personally in this way. But, he was beat, his eyes were moist and desperately sad and his body stooped. He put his arm round me and just said, “Arundi, we’ll do better next time, I promise.”

What I took from that night was that even the greatest surgeon is, at times, completely powerless. Occasionally, it can feel like all your experience, knowledge, and technical skill amount to nothing. Ultimately, all you can do is your very best at every opportunity. The rest is not for you to determine. So, the lesson I learned that night from one of the greatest surgeons in this country was humility, at all times.

How was your experience as a female in an all male fellowship program?

Arundi Mahendran, MBBS

When I arrived at Columbia, the surgeons on faculty were delighted to have a female fellow on staff and I was thrilled to work with such gifted and experienced surgeons who happened to be male. But it was a daily challenge. Why? Well, I don’t embody the typical characteristics of a transplant surgeon. I’m not male, big, and muscular (transplantation is heavy work). I’m not aggressive (I’ve often been told by male mentors that I need to be less nice and more scary!), nor do I speak with a loud voice. I do things differently, but I do them my way and I’m just as successful, if not more so. I’m assertive, I speak quietly but firmly, I’m driven and ambitious, and I care ferociously about my patients. When I joined I was told “this fellowship will put hairs on your chest…” Well, I’m thankful it didn’t, because hairiness is overrated!

I’m glad to say that by the end of my fellowship, we had all learned to adapt and respect each other’s strengths. I’m very happy to have trained at NewYork-Presbyterian Hospital/ Columbia University Medical Center and feel fortunate to have been mentored by these terrific surgeons. I would encourage any female surgeon who is considering a career in transplantation to speak with our excellent fellowship director, Dr. Benjamin Samstein. He believes in equal opportunities and works hard to attract women to the field.

As we have seen on NY Med, a transplant surgery fellowship is emotionally challenging and extremely time demanding. But we always see you smiling and joking around with patients and peers like Dr. Watkins. How are you able to maintain such a positive disposition? What advice would you give others who are about to begin their fellowships?

Arundi Mahendran, MBBS preparing an organ for transplant

A transplant fellowship is not to be undertaken without a lot of serious thought. You must be driven by a real passion for the specialty. Of all the surgical fellowships, transplant is the toughest because of the personal demands and sacrifices it requires from you. So be certain that this is what you want to do and be in it for the long haul. You often stand operating for hours and hours with no break for food, drink or even the loo! And you find yourself taking care of really sick patients who need meticulous care around the clock. It is exhausting and you feel completely demolished. My approach to any challenge in life (whether its learning a new language or going through fellowship) is to embrace the journey. There’ll be good and bad days, so learn to smile through it all because I feel enormously lucky to love what I do. A positive state of mind is infectious! It encourages colleagues to perform to the best of their ability and it inspires confidence and faith in patients.

The surgeries are absolutely awesome and keep you challenged and enthralled. Be they patients or staff members, interacting with them, listening to their banter and feeling humbled by the deep personal stories they share – that’s what gets me out of bed every day and keeps me cheerful. Having a good buddy for the ride is an unexpected pleasure. Dr. Watkins and I mercilessly tease each other and constantly bicker, it gives us something else to do when we can’t sharpen our surgical blades! We still do it now though we don’t work together anymore. I call it fencing with a scalpel!

In Episode 4 of NY Med, we witnessed a living donor liver transplant with one brother donating to the other. Currently there are over 18,000 people waiting for a liver transplant in the United States. In your experience, what are some of the reasons people give for not wanting do donate their organs? Do you think initiatives like the Facebook organ drive can change people’s perceptions and increase the number of donations?

There are two types of donors; those who choose to donate some or all of their organs after they die, and those who are healthy enough to donate either a kidney or a part of their liver whilst still alive. The latter situation is called living donation. Living donation is on the rise internationally because very safe surgical techniques have been developed which greatly diminish both the degree of risk as well as the types of complications associated with living donor surgery. In my experience, I’ve found that a lot of fear and uncertainty dominates public perceptions of what donation after death is about. There is a strong belief that by agreeing to be a donor, medical personnel will not work hard to save your life if you end up in hospital with a life-threatening condition. I think NY Med demonstrates just how hard the staff in the emergency department work to save lives. We always focus on the living and our primary goal at all times is to preserve life, not facilitate its demise. I think the key issue is how donation is dealt with in the public eye. People are told they should donate, and then made to feel guilty when they don’t agree. This is neither fair nor does it encourage donation. Making people feel guilty has a temporary effect. We want long-lasting change and to foster a culture of donation.

I want to approach donation from a whole new angle. Let’s engage with people in a very different kind of discussion and ask these simple questions: “what does it mean to you to be a donor, living or deceased?” “How would being a donor affect your life?”

Now that your fellowship is over, what will you be doing?

Arundi Mahendran, MBBS preparing for surgery

In addition to being a transplant surgeon, I’m also an academic surgeon. Throughout my residency in the UK, I was also a lecturer, teaching medical students and designing examinations at University College London Medical School. This strong interest in education led me to initially obtain a Masters degree, and now I’m spending the next 8 months writing my PhD thesis that examines how the surgical profession is trained and investigates how a surgeon develops through their training. It’s a lot of work and requires me to use a different part of my brain. I’m also back to teaching medical students, which I love, and I spend part of the week operating to keep my surgery skills sharp. But next year I will be back to full time clinical work and am currently interviewing for jobs and considering where I would like to work.

Stay tuned to hear more from Dr. Mahendran and connect with her on Twitter at @ArundiMahendran or on her Facebook page.

Also, don’t forget to catch NY Med Tuesdays at 10:00 PM on ABC!

Related Links:
Orchestrating Surgery with NY Med’s Dr. Mahendran: Part I


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