12/05/05a WARNING: GRAPHIC/DISTURBING

9:21 a.m. I see a light move across the wall in front of me and when I look out the window a white van is passing and heading around back to the receiving area. Ah. There they are. I take my report and head back to the autopsy suite, turning off lights and locking doors as I go. I swipe my keycard and the garage door opens. There are four people, three women and a man, standing there. They've got enormous amounts of "baggage" with them. Several cardboard boxes and hard-sided carriers that I assume contain their equipment. They are a friendly, cheerful bunch and I feel at ease immediately.

There is a lot of chatter as they get things ready for the harvesting. A "prep" table is set up using an empty tray from the cooler. They cover it with a clean paper cloth and put several culture tubes on it. Apparently, they test every piece of tissue they take to make sure it's sterile. A large clear plastic bag is also on the table and it contains gauzy "cuffs" that the tissues will be placed in before they are wrapped in plastic and deposited in a very large styrofoam lined shipping box.

Tissue donation includes things such as tendons, valves, blood vessels, skin, and bones. In this case, the body has a lot of glass adhering to it from the accident, so they will not be taking skin. I've watched skin be harvested before, though, and can explain the process a bit. After they make sure the skin is clean and sterile, they run a device that looks kind of like a cheese slicer along the epidermis. It shaves off long, papery thin strips all along the back and torso. Shiver.

Blood vessels and valves will not be taken, either, because the body was left unrefrigerated too long. I guess I'll have to wait for some other time to watch that.

One nurse is set up behind the makeshift prep table. She will catalogue and pack each tissue that is taken. The other three spend several minutes washing the body with disinfectant and iodine. They make sure that every surface it touches is sterile. Then they use a substance that reminds me of plastic wrap only stickier and cover the skin of the entire body with it.

After the body is completely prepped, one nurse begins cutting a long, straight line through the skin of the upper right arm all the way down to the wrist. The other two do the same on each leg, cutting through the skin and flaying it back as they go.

The muscle is a rich, dark red and full of blood and I watch in fascination as they disect out tendons from origin points on the foot, follow them up to where they merge into muscle, and then, several inches up the muscle, cut through a thick chunk of meat to release it from the leg. There are three tendons taken from the front of the legs in this manner. Each tendon is then brought to the catalogue nurse. She is told which tendon it is and which leg it is from before she swabs it, wraps it in plastic, labels the bag, and places it inside of a gauze cuff. She puts everything into a shipping box. I ask her where it goes and she says, "New Jersey where it is cleaned and processed."

I imagine what a dandy job those New Jersey guys have. Processing and cleaning human tissue. Shiver, again.

From there, they move to the bones. First they bend the knee and begin disecting out the tibia (biggest bone in the lower leg) at the knee joint. They are careful to keep as much of the surrounding tissue intact as they can, being mindful that these bones might be used to replace entire joints.

The tibia is released at the knee first and then separated from the foot bones. Same with the fibula, which is so thin and covered in muscle that it would be easy to miss if you weren't looking for it. The real trick is the femur, which is the largest bone in the body. It has a long ball joint that fits into the pelvis and it is very difficult to reach in there and release it. The nurses have to make large circles with the bone and I hear sucking noises as joint fluid sloshed around.

The process on the arms is similar, only not quite as much work as the bones are smaller and the shoulder joint is not as deep.

After they are finished harvesting the bones, they pull the saran wrap stuff off of the skin. It helped to keep the body from getting greasy and dirty. I look at what is left of the body. Basically, it is a torso with long bags of skin leading to feet and hands. Gag.

"Just wait until we've finished the reconstruction," one of the nurses says, "It'll be a lot better."

First, they use tie backs to mark the major blood vessels that the funeral home needs to penetrate in order to do a proper preservation job...trading blood for embalming fluid that has been tinted to make the dead person's skin look pink and alive again.

Then, they replace the leg and arm bones with white PVC pipe that is adjusted to just the right length. Huh. PVC pipe's not just for plumbing anymore.

Finally, they sew the skin back together with thick, wax-coated cord and wash the body one more time before closing the body bag and replacing it in the cooler.

Clean up is messy. There is, as you can imagine, a lot of blood and fat and muscle smeared everywhere. But they clean it up like troopers and leave the place looking better than when they came.

I know that is a very grotesque description, but it's the reality of tissue donation. And I would feel very bad if this blog entry discourages anybody from being a donor. It is a very good thing to do. You can help improve the lives of others and might even be able to save lives with your gift.

That said, I am an organ donor myself. But it'll be a cold day in hell when my long bones are replace with PVC pipes and my skin is shaved from my torso.