Slain American soldier lives on in liver recipient
It was a sunny June afternoon in Afghanistan's Korengal Valley, and Drees had just grabbed his fifth box of ammunition when he was hit.
With bullets raining down like hail on the armored vehicle filled with American soldiers, a single bullet clipped the edge of the turret before smashing into Drees' right cheek, taking out his right eye and pushing through his brain.
Medic Luke Spangler caught the Wisconsin teenager as he fell into the vehicle, quickly checked his injuries and worked feverishly to stop the bleeding as the vehicle raced to an aid station.
It was the first stop of a final journey that would end four days later in Germany.
As his mother, father and twin brother traveled from Peshtigo, north of Green Bay, to say goodbye, somewhere in Europe - most likely elsewhere in Germany - a 62-year-old man was about to receive a life-changing organ donation.
The man would never know Drees' name, and Drees' family would never know his identity. But the two men will forever be linked by a sniper's bullet and the selfless act of a soldier killed less than a month after leaving for Afghani-stan on his 19th birthday.
YES to organ donation
Like every U.S. military member deploying to Afghanistan and Iraq, Drees was asked if he wished to be an organ donor.
He said yes.
Drees had debated the merits of organ donation in an ethics class at Peshtigo High School, and his family knew his wishes.
After being wounded, Drees was evacuated to Landstuhl Regional Medical Center in Germany. Donated organs must be transplanted within hours, so his liver was given to someone on a waiting list in the Eurotransplant system, which serves seven countries. Although transport to another country is possible, it most likely stayed in Germany.
It's a rarely told fact of the wars in Iraq and Afghanistan that a significant number of U.S. service members who die at the large American military hospital in Germany are donating their organs to whoever needs them. The people who need them are Germans. Germany has one of the lowest organ-donation-participation rates in the Eurotransplant system.
Attitudes toward organ donation in Germany are shaped by Nazi medical experiments in World War II as well as the legacy of the East German health-care system under socialism, in which people had no control over the fate of their bodies.
As a result:
• In Germany, 17 percent of adults are registered to become organ donors. In contrast, the figure in America is 37 percent. Among the U.S. military, the percentages are even higher.
• Landstuhl, the largest U.S. military hospital outside America, is one of the top hospitals for organ donations in its region in Germany.
• Roughly half the troops who died at Landstuhl from combat injuries since 2005 were organ donors. That's the first year the U.S. military allowed organs to be donated by American troops who died in Germany.
• From 2005 through 2010, 34 American military members who died at Landstuhl donated a total of 142 organs, according to Deutsche Stiftung Organtransplantation, the German organ organization known as DSO.
More than 30 patients on waiting lists were saved last year by organs donated by U.S. military members at Landstuhl, said Undine Samuel, a physician and medical director of the DSO region that includes Landstuhl.
In Germany, decisions over whether to use the bodies of some for the benefit of others are laden with historical and emotional baggage stemming from racial laws during World War II and vast differences in organ donation policies in East and West Germany in the decades before the Berlin Wall fell in 1989.
Outrage over Nazi atrocities led to the Helsinki human-rights accords and international bioethics rules. Germany went a step further; the first two articles in its postwar constitution deal with individuals' rights of bodily integrity. Decades later, after the reunification of East and West Germany in the 1990s, Germans would pack town hall meetings to debate the issue of who has the right to determine when someone is dead and how their body will be used.
In West Germany, where Holocaust memories made the notion of protecting bodily integrity paramount, "Physicians wouldn't even approach a family about donating organs because they were so afraid the family might be disturbed," Linda Hogle, a medical anthropologist, said in an interview in her Madison office.
Opinions were just as emotional in socialist East Germany - but for different reasons. People injured in an accident might be taken to a major medical center, and if they died, any body part or tissue could be used for experiments, research or organ donations.
Some good from all the bad
For Steven Drees' family and friends, German attitudes toward organ donation made no difference. Like many grieving families who give consent for organ donation by their loved ones, all they cared about was that his liver was given to someone who needed it, that something good come from something tragic.
Though some organ recipients in the U.S. meet their donors or donors' families, German law is strict about anonymity. The age and gender of organ recipients and donors are released, and recipients can send anonymous thank you notes to donor families.
Drees' family received a letter telling them a 62-year-old man was given his liver. The soldier's parents and girlfriend wish they could learn more about the man.
Drees was close to his maternal grandfather, a Navy veteran who died of leukemia when Steven was a youngster.
"The thing that settles me the most," said his mother, Dawn Bayer, "is that at 62 years old, he's probably someone's grandpa. So Steven saved someone's grandpa."
A typical kid
If the man who received Drees' liver in late June 2009 could find out more about his donor, this is what he would he learn:
Before he became a soldier, before he became an organ donor, Steven Drees was a bundle of energy who seemed to speed from one activity to the next, collecting friends along the way. When he was 7 or 8 he told his dad he wanted to be a baseball pitcher, so Paul Drees bought him a glove and ball and the two spent hours in the backyard practicing.
Steven played video games and basketball and had a winning smile. He liked fast cars, and he wasn't embarrassed to hug and kiss his mother in front of his basketball teammates.
Though he was a twin, he and his brother, Chuck, looked nothing alike. They were close growing up but had different hobbies. Steven joined the Army before he graduated from high school in May 2008 and left for boot camp a few weeks after commencement.
Drees shipped out from Fort Carson, home base of the Army's 4th Infantry Division, on May 26, 2009. It was his 19th birthday. His unit - Delta Company, 2nd Battalion, 12th Infantry Regiment - arrived in Afghanistan two days later.
Spc. Luke Spangler, a 30-year-old Ohio native, remembered Drees as someone in tune with himself, a good soldier who most likely would have been the next in his platoon to get promoted. Though a gun turret can be a scary, intense place, Drees managed to boost the morale of his platoon and keep things light.
Mission to an IED
On June 24, Drees and his platoon were sent out on a route- clearance mission after receiving word about an improvised explosive device nearby. Several armored vehicles pulled out of Forward Operating Base Asadabad traveling east and took some enemy fire on the way out. The soldiers were expecting trouble on the return trip that afternoon.
As the platoon's medic, Spangler always rode in the last truck in the convoy along with the platoon sergeant. Drees was their gunner. Before the mission, Drees' main weapon, an Mk 19 grenade launcher, was not working, so he brought an M240 machine gun.
On the way back, the unit was ambushed, taking heavy fire from at least four positions. Drees was firing his weapon full-blast, shooting more than 500 rounds, Spangler said. Spangler had just handed up a fresh box of ammunition to Drees when the gunner was hit in the face.
"He tried to stay up; he was fighting when he went down. When I caught him he was localizing pain, trying to grab for his face. He was somewhat coherent but he had lost his right eye. I got the head wound bleeding to stop. I got him back to the aid station - that took about 15 minutes. We were able to hook him up to saline, get his airway open. ... I was breathing for him on the bag for a while."
It took about 45 minutes for a medical helicopter to arrive. It took Drees to Bagram Airfield, where he received more treatment. Then he was flown to Landstuhl.
Though the military sends casualty-notification officers to the homes of fallen service members, families of the wounded are notified by phone. Within hours of the ambush, Bayer received a call from someone at Fort Carson. She and her ex-husband, Paul Drees, were told death could be imminent.
Each family of the mortally wounded is offered a U.S. government-paid trip to Germany to say goodbye to their loved one at Landstuhl. If the patient is a potential organ donor, the family is asked for permission.
As Drees' family flew to Germany, their minds were in different places. Paul Drees had come to grips with the fact that he was flying to Landstuhl to say goodbye. Dawn Bayer still held out hope.
At Landstuhl, doctors told them the grim prognosis. Drees was hooked up to machines, and a bandage covered the right side of his head. They were told he would never recover, that his brain was dead. They signed organ-donation papers. His heart, liver and kidneys were viable.
The family's signatures set in motion a process starting with notification of Germany's organ-procurement organization. Waiting lists were scrutinized through a database and hospitals notified. Before organs are removed, transplant recipients must be identified and transplant teams ready.
By the time this was done, Drees' body was starting to shut down and his kidneys were no longer viable. To Drees' family it seemed to take forever; at one point, they considered withdrawing their approval. But a potential liver recipient was located.
The decisions by U.S. military families have a profound effect in Germany. In 2010, only six out of 205 hospitals in the DSO's central region, which includes the large cities of Frankfurt and Mainz, had more organ donors than Landstuhl, and four of those were university hospitals with thousands of beds. Landstuhl has 150.
Further, few patients die at Landstuhl because the critically wounded are first sent to facilities in Afghanistan and Iraq. For those who make it to Landstuhl, the main funnel point for wounded traveling back to the U.S., the average stay is only 72 hours.
American troops who die at Landstuhl - where the average age of combat casualties is 27 - are ideal organ donors because they're young, fit and healthy.
Teams of German doctors and technicians come to Landstuhl to remove the organs; American military doctors do not assist in the retrieval. A different team handles each organ; if several organs are being donated, dozens of medical personnel are involved.
In Germany, 12,000 people are on waiting lists and three to four die daily. The average wait in Germany for a heart or liver is six to 12 months; the wait for a kidney is six years. One in five people waiting for a liver in Germany dies before one becomes available.
"The thing that settles me the most is that at 62 years old, he's probably someone's grandpa. So Steven saved someone's grandpa."
Mother of Steven Drees