George Kramer does not have your run of the mill job. As a matter of fact, not many people could handle his line of work. As a tissue procurement specialist, Kramer, 45, removes specific tissues earmarked for donation from a person who has died. He's been doing this work since 2005 and has no plans of switching careers any time soon.
Kramer, who lives in Indiana with his wife and daughter, took some time from his busy schedule to chat with LoveToKnow Death and Dying about tissue procurement and donation.
What exactly is a tissue procurement specialist?
"What I do for a living might not be considered mainstream corporate America. As a matter of fact, either you are fascinated by it or grossed out by it, there is no happy medium. Tissue procurement is the removal of the skin, bones, various tendons, heart (while the heart is considered an organ, tissue organizations use the three valves on top), both the femoral and saphenous veins and the mandible (jaw). The removal of said tissues is only taken out with consent from the next of kin. It is up to him or her what will be removed and what will not, and that is taken very seriously.
"Once we arrive at the hospital, funeral home or a coroner's office, we are taken to either an operating room suite or the morgue. A team consists of the circulator, who is in charge and does the paperwork, and two technicians. Sometimes there will be a trainee, but usually only three people go out on cases."
What type of special training or schooling did you have to complete?
"The training of a tissue procurement specialist is extensive. While no degrees are required, you must view films on safety, procedures and a plethora of other ones pertinent to the job. A rule of thumb is if the person is alive but on a machine, to remove organs, you need a degree, if a person is expired and you remove tissue, you do not need a degree.
"Then you are required to take mandatory tests and must pass them. After that you have to read a myriad of SOPs (Standard Operating Procedures). Only then are you allowed to travel with a team. However, you are not allowed to "cut" until you have viewed a few recoveries. The trainee will then take either the right or left side and the technician across from that person will help train the newbie. There are annual tests that must be taken and passed. In addition, the industry is in constant flux new and updated SOPs are introduced and must be read and signed off. The FDA is one of the primary overseers of the industry and they hold us accountable to a very high standard, with which I concur."
How did you get involved in this line of work?
"The work of a tissue procurement specialist was unknown to me. I knew about organ transplantation, but did not know tissue procurement existed. That is until I started a job as a manager at a nursing home. The job entailed me to work closely with many other department heads. One who I befriended was sitting in my office one afternoon. I am naturally curious and asked the woman what she did before her advent to the nursing home. She explained to me what sounded like an astonishing and breathtaking field. She did tissue procurement work. She got out of it to help people with dementia and Alzheimer's. I asked her if there were any openings and she said there was. She helped me secure an interview and I was hired. I have never looked back again.
"Most of the people who do tissue procurement have a medical background. I was going to school to become a surgical technician but had to forgo it. I went all the way until I had to do the clinical portion. You had to go to school a few days a week and then went to hospitals to complete your studies. It was an unspoken stipulation that it would be difficult to work when doing the clinical aspect. With a wife and a baby on the way, there was no way I could take a year off without having money coming in."
What do you like most about your job? What do you like least?
"What I really enjoy about my career choice is that one full donor can save up to 75 lives. How heartwarming is that! Additionally, no donor is the same. While what we procure is essential the same, there is never a case that is the same as the former one. It is always at a different location and always, obviously, different donors. When we have to drive far away, we always engage in interesting discourses and I get to learn about the different technicians and circulators.
"Furthermore, another taxing feature to my profession is the amount of time spent away from home. There have been times where I had no cases for two weeks and only received on-call pay. Additionally, I could be gone for a long time. On one particular occasion, I had four cases back to back. They were spread across the expanse of Indiana. I was gone for close to two days. While that does not happen often, it does occur. Having two cases in a row happens with more regularity. Copious amounts of time I am gone for a full 24 hours or more.
"Moreover, one of my least favorite things about my job is having to remove hearts from infants or children. If the infant is a certain weight or age, a heart can be removed for donation. While I applaud the parents for permitting it, it is rough on the family and the technicians that have to remove them. It changes you. You look at children, especially your son or in my case my daughter, in a new light and appreciate them more!"
The Importance of Tissue Donation
Why is tissue donation so important?
"Tissue donation is important because through someone's untimely death, new life can be found. The death of a loved one is devastating. It is sad to watch people cry in the emergency rooms where they were just informed of their family member or friend did not make it. How warming and pivotal would it be that through death you can breathe new life into someone that desperately needed what your loved one could provide? Is that not the important factor here? The continuation of someone's life underscores the reason for donation.
"When we are summoned, we usually know the cause of death and whether or now they will get an autopsy. That bit of information helps. When we go to a hospital, funeral home's morgue or a coroner's office, we know if it is a coroner's case some coroners want us to draw blood from the femoral vein instead of the subclavian artery.
"Is that important or germane? Yes, because we have to work with a lot of people who either condone tissue recovery or are against it. What better way to build a rapport than to adhere to a request?
"We need to build an affinity with professionals because tissue donation is important. It is vital to spread the word that it is essential because donation can enhance lives. Need a hip or knee replacement? Need an operation that requires someone else's body part? You can't get what is not donated for transplantation."
Do you have any stories to share about your work?
"The stories of a person's demise is often heart wrenching. Suffice to say, it can bring you to your knees on occasion. One such theme is suicide. I have witnessed suicides by hanging and self-inflicted gunshot wounds from the very old to the very young. It is distressing to bear witness to its aftermath. It leaves family uprooted and in great despair. There can be no closure if despondency is undetected. One recourse is to have his or her tissue (and organs) donated to further augment another life.
"Each year, we hold a memorial for the families of the donated and its recipients. I make it a point to attend every year. Last year, I brought my wife and people's speeches brought her to tears. It is an emotional event and I am honored to be able to attend. Stories range from people who had first, second and third degree burns, which without donation from someone's skin, would have died. People who had loved ones lost and allowed donation tell their heartfelt stories about their significant other, child or whomever had been taken away before their time."
How can individuals get more involved in different tissue donation programs?
"Since tissue donation information is not widespread, as of yet, the important thing to consider is how to get people to notice the significance of donating. People could call hospitals or their local tissue banks to find out how they can help spread the word."
Is there a certain time frame from the time a tissue is removed until it has to be placed in another person?
"It is imperative to consider the timeframe from time of death until removal of tissues. If the body had not been refrigerated you have 15 hours to make the initial incision. If the body was refrigerated, you have 24 hours. For the heart and veins, you have to remove them before 12 hours. Sometimes it takes some time to gain consent from a grieving family, which is totally understandable. There were times when I got called out and we were told that we had to get in the office STAT or ASAP because we were on a time crunch."
What qualifies a tissue for transplantation? And how is a recipient found?
"There are a few factors that qualify a tissue for transplant. One is age. Certain tendons cannot be removed before and past certain ages. The same is applicable for bones, hearts and veins. Our office has an age limit on every graft we take. A company we procure for has different age requirements so oftentimes if someone is too old for us; we will take it for them.
"Another qualification we base it on is the med/soc. It is several pages of questions that have to be asked the next of kin that is vital to ensure proper recoveries. If the next of kin said that his or her loved one did not have cancer, aids or hepatitis, etc., then we go on the assumption that they did not until the serology report comes back. However, there are pages of conditions that rule out donations."