"In a Land Far, Far Away"
FEATURE In a Land Far, Far Away Coordinating transplants over half a million square miles BY MARCY DIMOND A s most transplant professionals know, there are rarely typical days in the life of a clinical coordinator. That is most certainly my case as the clinical manager of Life Alaska Donor Services, with the many functions the agency provides for the entire state of Alaska. We have a service area one fifth the size of the Lower 48 continguous states and temperatures that can reach 80 below zero. I am currently a “working manager,” which means if there is a potential or active organ/tissue case, I can be found working at one of our many hospitals. I manage a staff of four clinical coordinators and 10 surgical recovery staff, and also supervise public education, family services and regulatory oversight. With 10 years in the field, I long ago accepted a lifestyle of organized chaos, but it works for me and my family—and I still love what I do. My husband recently returned from four years working in Iraq and Afghanistan, and one of the biggest challenges I have these days is finding a new home balance while keeping up with the demands of the job. In the Alaskan cities of Barrow and Kotzebue, which lie above the Arctic Circle, the arrival of the recovery team often becomes a community event. Only six I think that’s a challenge, though, for many transplant other countries in the world have territory inside the Arctic Circle: Canada, professionals; the work is quite rewarding, but the demands on Finland, Greenland, Norway, Sweden and Russia. time, emotions and families are great. 20 UNOS Update September–October 2009 THE lOgiSTicS OF DiSTAncE The greatest challenge, and quite possibly the greatest accomplishment, is navigating our state’s logistics. Alaska is home to 23 hospitals scattered across a geographical area of 586,412 square miles. In some hospital parking lots, and our own parking lot, we occasionally must dodge a stray moose or other large wildlife. Anchorage is our largest city—located in the southcentral region of the state—and the home of Life Alaska Donor Services (LADS). It is not unusual to coordinate a case in Fairbanks, 358 miles north, in the morning and another case in Ketchikan, 846 miles southeast, that evening. We travel primarily by commercial airlines, but we also will charter a flight to remote areas when we need to. Fortunately, the charter company with which we work understands the The photo above and on the opposite page are actual photos taken from one recovery, challenging logistics of Alaska—not to mention that the owner which required three different modes of transportation. Photos/Glenn Borkoski is a donor family member. One of the more interesting areas to travel is the Southeast Alaska panhandle, which often requires a flight followed by PARTnERSHiPS, cOMMUnicATiOn ARE KEy a ferry or boat ride to the recovery site. Some of the most Providing the option of organ donation in a service area one remote communities there are 900 miles from Anchorage, and fifth the size of the Lower 48 would pose a logistical challenge to travel time can take as much as four hours, with the return trip any organization. Compound that with the fact that the nearest frequently grounded for up to 48 hours because of wind, ice fog transplant center is roughly 1,450 miles away, and you have a and temperatures far below zero. challenge of some magnitude, to say the least. Last year, however, through a renewed partnership between lAnDing STRiPS, WATER TAxiS, ATvs LADS and LifeCenter Northwest (LCNW), there were 26 organ In many rural communities, there is no airport, only a landing donors, with 63 organs recovered and 58 placed. There also were strip that often is little more than a strip of gravel carved out of more than 200 tissue donors. the forest. There, we’re usually greeted by members of the local The ability to provide the option of donation with such health clinic on four-wheel ATVs to take us to the hospital. positive outcomes is the direct result of physician education The city of Ketchikan is one of those rural southeast and communication, combined with early-referral protocols communities; what many outside the state don’t know is that its and the ability to provide a timely onsite evaluation. LCNW and famous “Bridge to Nowhere” actually connects the airport, on a LADS also have tried various types of staffing partnerships since small strip of island, to the community. Sounded by mountains 2001 aimed at bridging the gap of not having a local OPO or and water, the airport has been the site of some sketchy landings transplant center located in the state. because of a lack of visibility and instrument failures because of What we have developed is a system that works best for extreme tailwinds causing a too-rapid descent. both organizations. We are able to respond quickly, support the And, even after landing at the Ketchikan airport, a ferry may hospital staff and family, and act as the eyes and ears for the not be available to take transplant staff across the water to the OPO on-call coordinator. The coordinator initiates standing mainland so they can get to the hospital. When it’s a middle-of- orders and provides donor management by phone while a team the-night landing, staff must awaken the local harbor master to of coordinators travel to the hospital from Seattle. send a water taxi. This partnership, I’m proud to say, has allowed us to increase In the northern communities such as Barrow or Kotzebue, the number of donors 650 percent over the previous year when both above the Arctic Circle, the arrival of the recovery team is no partnership was in place. U often greeted by family members and extended members of the community. In the smaller bush villages, a recovery becomes a Marcy Dimond, CTS, CTBS, is clinical manager at Life Alaska Donor Services in Anchorage. community event. Another travel challenge I must mention is Alaska’s active The Update gratefully acknowledges the assistance of Michael W. chain of volanoes. Last year, Mt. Redoubt erupted several times, French, public education coordinator at Life Alaska Donor Services, grounding planes and restricting the ability to send tissue in and who resourcefully and willingly provided facts and figures and other out of the state. Currently, there are several volcanoes in active guidance on the occasions when Marcy Dimond, the author, was out status, and there is no way to predict when they will erupt. of the office coordinating an organ recovery. UNOS Update September–October 2009 21