WATERLOO - Alex and Asia Pruskler are waiting.

It has been nearly one year since their father, Michael Pruskler, died suddenly while working on a new home in Parkersburg. Nearly one year since they and Pruskler's longtime girlfriend, LuAnn Buchholz, told Sartori doctors and nurses they wanted their loved one's tissue to help someone in medical need.

It could be another six months before the family finally learns just how many people the 48-year-old man helped as he left this Earth.

"We've been told that since he was younger and in very good shape, his tissue could help about 100 burn victims," Asia Pruskler said.

Tissue and organs

Paul Sodders, public affairs manager for the Iowa Donor Network, said tissue donation is far more common than full organ donation. Tissue donations can include skin, bone, veins, arteries and heart valves. During a full organ donation surgeons can recover the heart, kidneys, liver, lungs, pancreas and small intestines. Iowa does not have a program for intestine or combination heart and lung recoveries.

"Typically organ donation has to happen when a person is declared brain dead. That person then has to be maintained on a ventilator until we can get them ready for recovery and transplant," Sodders said. "Tissue donation can happen after almost any death."

Brain death occurs in less than 1 percent of all deaths, so the need to educate people about organ donation is acute.

"We know the opportunities are so small for it to happen, we need to make sure that the wishes of those who want to donate are carried out," he said.

Unlike organ recovery and donation, which usually must be completed within 24 hours, donated tissue can be frozen until needed. However, because there is a waiting list for most tissues, a match usually is found quite quickly, Sodders said.

The tracking process can take months, though. Families like the Prusklers sometimes wait up to 18 months to learn how many people were helped by their loved one's donation. Sodders said the lapse also allows additional privacy for the donor family and recipient.

Making the choice

Buchholz and Michael Pruskler never talked about organ donation.

His daughter Asia, 18, said they had only discussed it once in passing.

"My dad always thought people driving on motorcycles were crazy. When they would drive he would say, 'There goes an organ donor.' One of those times I asked him if he was an organ donor and he said 'Yeah,'" she said. "That was it."

Neither woman was surprised to learn Michael had checked the organ donation box on his driver's license.

That mark was all representatives from the Iowa Donor Network needed to begin the process of tissue or organ recovery. Milda Mullesch, the director of case management services at Allen Hospital and a donor network liaison for the Cedar Valley, said the network tries to send someone out to talk directly with the family, though sometimes the only contact is over the phone.

Buchholz was surprised when a nurse approached her about the possibility of donation.

"I work in a health field and didn't even realize that once someone was dead they could still donate," she said. "I was only thinking about vital organs, and I knew they had to keep the blood circulating for that."

Once the donation has been confirmed, someone from the network completes an extensive medical and social history questionnaire with the closest family member to determine if the donor engaged in risky lifestyle behaviors or had any medical conditions that would preclude them from proceeding with the recovery.

Buchholz said the decision to donate helped her better handle the grief over losing Michael - they had been together nearly nine years when he died.

"Just knowing that a part of him does still go on and lives in other people and helped them make their lives better, that has helped me," she said.

Not an easy talk

Talking about organ or tissue donation with loved ones isn't always easy, said Tammy Warren, a nursing supervisor at Sartori Memorial Hospital.

For families like the Prusklers, coming to terms with the decision was easier, in part because Michael made his wishes known by checking the box on his driver's license. But not everyone has renewed their license since the option was first made available in 2005, Sodders said.

The Iowa Donor Network encourages everyone to register with the Iowa Donor Registry, especially if they haven't made the designation on their driver's license. The registry, found online at www.iowadonorregistry.org, also allows people to choose which organs or tissue they feel comfortable donating.

The state requires doctors or nurses to report all deaths to the Iowa Donor Network so the family can be consulted about possible donations. Warren has talked with many families that had a difficult time coming to their final decision.

"If the deceased hasn't indicated they want to be an organ donor and the family declines, that is fine. We don't judge you if this is something you can't do," Warren said. "When a family says 'There is just no way I can do this,' we need them to feel OK about their decision no matter what they decide."

Despite the delicate nature of such discussions, both Sartori and Covenant Medical Center were recently honored for their work in this area. The Health Resources and Services Administration presented hospitals with consult rates greater than 25 percent a certificate of accomplishment. In 2008, Sartori had a 55 percent consult rate and Covenant achieved a 36 percent rate.

Sodders also has been contacted after a death by families on both sides of the tough decision. Those who chose not to donate explained their reasons: Usually they never discussed the possibility with a loved one. Those who opted for donation often say they were thankful and relieved they had a conversation about organ donation with their family member.

"They are just happy they didn't have to make that decision on their own; that their loved one had already made it for them," Sodders said. "At the time of someone's death, especially when they are very close to you and it is unexpected, there is so much running through their head, they are just relieved to know that is one decision they didn't have to make alone."