The Vital Role of Organ Donation: A Trauma Medical Director's Perspective

As a trauma medical director at Mercy Hospital's Level I trauma center in St. Louis, Missouri, Dr. Alison Gildehaus was involved in countless cases where she had to deliver catastrophic news to family members. In that role, Dr. Gildehaus was responsible for the care of the patient, while decision-making for organ donation was handled by another team. Like most hospital staff, her involvement in organ donation usually ended at the Honor Walk as the donor patient left the Intensive Care Unit and was escorted to the operating room.

Now, Dr. Gildehaus is the Chief Medical Director for Mid-America Transplant, an organization based in St. Louis that educates the community and works with families to ensure that life-saving organs and tissues are available to those in need.

To best appreciate Dr. Gildehaus' perspective on organ donation from both sides of the bedside, it is important to first understand her background in trauma care.

Caring for Life

Dr. Gildehaus has a lot of degrees: a BS in Biology at Duke University, a MS in Physiology from Georgetown University, a MD from Southern Illinois University School of Medicine, residency and fellowship in trauma/surgical critical care at Saint Louis University, an executive MBA at Washington University St. Louis, and finishing a fellowship in surgical ethics through the Association for Surgical Education. She started working as a trauma surgeon intensivist at Mercy St Louis in 2013 and moved to the role of Trauma Medical Director in 2017.

"Early in my career as a trauma surgeon and surgical intensivist, my focus was primarily singular -- the patient in front of me," Dr. Gildehaus explained. "Every decision, every action, every ounce of energy was directed toward caring for that life. That clarity of purpose is what draws many of us to the field and defines us at the bedside." 

Stepping Into a New Role

In 2024, Dr. Gildehaus stepped away from the bedside and became the Chief Medical Officer for Mid-America Transplant. In this role, she serves as a liaison with 120 partner hospitals and four transplant centers to support clinical teams, educate hospitals and physicians on organ donation, and explore innovative clinical methods to maximize donor gifts.

It wasn't an easy decision for Dr. Gildehaus to change roles. "Despite the fact that it is absolutely untrue, there are lingering stereotypes that critically ill patients may receive different care if organ donation is being considered. To protect trust in both healthcare and donation, I’ve chosen not to occupy those two roles at the same time, focusing my work now on education and understanding within the OPO space."

How is the Organ Donation System like Trauma Care?

Trauma care refers to the entire spectrum of care, from injury through rehabilitation. It involves hospitals, EMS, doctors, nurses, therapists, administrators, and families. The trauma system ensures readiness, consistency, and quality, and TMDs play a critical role in trauma system leadership. "In the TMD role," Dr. Gildehaus notes, "I was responsible not only for the individual patient, but for the performance of the entire trauma system. Yet, even then, that system had boundaries and largely existed within the walls of a hospital, healthcare system, or region."

The Organ Procurement Organization (OPO) industry similarly operates at the intersection of multiple systems: hospitals, donor families, transplant centers, donor recipients, and ultimately public trust. Trauma centers see thousands of patients a year, with continuous opportunities to improve timing, process, and outcomes. In organ donation, however, incidence is much less frequent, with approximately 132 organ transplants every day across the nation, coming from both living and deceased donors. Dr. Gildehaus acknowledges that there is a lot less control on timing and outcomes, so OPO strategy and goals focus on collaboration across complex entities to honor donor legacy and save lives as quickly and as efficiently as possible.

The Urgency Behind Organ Donation

Organ donation is a time-sensitive endeavor. There is only a short window of time to work with families, recover organs and tissues, transport the organs, and transplant to waiting patients. This can be a hard space to navigate. "Organ donation is one of the most time-sensitive, raw, grief-stricken, and emotionally-charged moments many people will experience in their entire lives," Dr. Gildehaus reflects.

Demand for organs far exceeds supply. Here are some facts from the United Network for Organ Sharing:

• At the time of writing this post, 109,013 people in the United States are waiting for an organ transplant.

• Every day, about 17 people die waiting for an organ.

• Every year transplants are made possible by approximately 17,000 deceased donors and 7,000 living donors.

• There is a very short window of time between organ recovery to transplant: hearts and lungs only have 2-6 hours while kidneys can be preserved for up to 36 hours.

How Trauma Care Connects to Organ Donation

Trauma centers care for patients who arrive with severe injuries, many of whom face life-threatening conditions. Despite the best efforts of medical teams, some patients do not survive or have sustained catastrophic injuries that preclude survival. In these moments, nothing can save the life of that patient, but organ donation offers a chance to give meaning to loss by saving others.

The collaboration between clinical teams and OPO teams requires sensitivity, clear communication, and respect for the patient’s family during an incredibly difficult time. To be clear, however, separation of duties between the teams is essential to ensure ethical integrity and maintain trust in the organ donation process.

• The patient’s medical care team is solely responsible for providing treatment and making all efforts to save the patient’s life, with no involvement in decisions about organ donation.

• The OPO team is clinically involved only after death is declared under strict medical and legal standards. However, when a patient undergoes brain death testing with a diagnosis of “brain death” or when a decision to withdraw life-sustaining treatment has been made by the patient or family in collaboration with the hospital team, the OPO is involved in discussions to support informed decision-making, while maintaining full separation from medical care.

• The OPO team independently evaluates donor eligibility, educates and obtains consent from the patient’s family or verifies prior authorization, and coordinates the recovery and allocation of organs.

  
  

This clear division prevents conflicts of interest, ensures that patient care is never compromised by donation considerations, and upholds transparency and respect for both donors and their families.

Organ Donation Doesn't End at the Honor Walk

Staff line the hallways for an Honor Walk.

Honor Walks provide a final opportunity for family, friends, and hospital and OPO staff to show respect and dignity to the donor hero and their family. Many hospital employees have witnessed or participated in an Honor Walk as a donor is transported from the Intensive Care Unit to the operating room. But for most staff, involvement in or knowledge of organ donation ends with this ceremony.

Dr. Gildehaus explains how her perspective on organ donation has evolved in her new role. "I’ve come to truly appreciate organ donation not as something separate from care, but as a continuation of it. It is a true partnership between the bedside teams who carried the patient’s care forward to their final moments, and the OPO staff who escort the donor hero and their family through the next stages. This work only succeeds if it is built on trust: trust between OPOs and hospitals, between clinicians and the processes that support them. And most importantly, trust from patients and families during some of the most difficult moments of their lives."

Families face overwhelming grief when a loved one has died, but choosing organ donation can be a source of comfort, knowing their loved one’s legacy lives on through others. Many families report feeling pride and solace in their decision to donate.

For recipients, organ donation means a second chance at life. Transplants can restore health and independence, allowing people to return to work, school, and family life. Stories of transplant recipients thriving after surgery underscore the profound impact donation has on individuals and communities.

Being a Trauma Surgeon Makes Her Better at Her Job

Dr. Gildehaus is unique in her involvement on both sides of organ donation. She has delivered hard news to families after expending all resources to care for their loved one, but she has also been able to ensure dignity and honor for those who bravely choose organ donation and to enable a second chance at life for people with critical illness and organ failure.

"My experience in trauma has profoundly shaped how I show up in this space," she shared. "I understand the pace, the pressure, and the weight of responsibility. And I carry a deep respect for the bedside teams who live that reality every day. I feel a responsibility to help bridge those worlds to ensure that donation processes are clinically sound, operationally aligned, and worthy of the trust placed in all of us. Because at the end of the day, this is not a shift away from the bedside. It is an expansion of the responsibility that begins there. I still love to care for people with people – and I will do it every day."

How You Can Make a Difference

National Donate Life Day is an opportunity to reflect on the power of organ donation and encourage others to register. Here are practical steps everyone can take:

• Talk with your family. Share your wishes clearly with your family. Knowing what our loved ones want helps provide peace when decisions must be made in times of grief.

• Register as an organ donor. Most states allow you to sign up online or when renewing your driver’s license.

• Support donation awareness. Participate in local events or share information on social media.

• Consider living donation. Some organs, like kidneys or parts of the liver, can be donated while alive.

  
  

The Importance of Organ Donation in Trauma Care

Trauma care and organ donation are closely connected because many potential organ donors are patients who suffer severe, often irreversible injuries. Trauma teams focus first on saving the patient’s life using all possible interventions. If those efforts are unsuccessful and death is declared, the patient may become a candidate for organ donation. High-quality trauma care is essential because it helps preserve organ function, ensuring that, even in death, patients can save or improve the lives of others through donation.

Organ donation can be deeply meaningful for trauma patient families because it creates a sense of purpose and hope in the midst of sudden and overwhelming loss. When a loved one dies from a traumatic injury, families often have little time to prepare or say goodbye, which can make grief especially intense. Donation offers an opportunity for something positive to come from that tragedy, allowing their loved one to save or improve the lives of others.

Dr. Gildehaus considers an honor to have worked in both spaces. "Many families find comfort in knowing that their loved one’s legacy lives on through recipients, transforming loss into an act of generosity and compassion. This process can support healing, provide a sense of pride, and help families cope with their grief over time."