I’ve been a trauma chaplain for just under ten years. Never in a million years did I imagine I’d spend my days in emergency departments and intensive care units. In fact, when I was a youth minister, I did everything I could to avoid hospital visitations. I hated hospitals. They creeped me out. The sights, the sounds, the smells—none of it sat right with me.

Then a friend mentioned something called Clinical Pastoral Education, or CPE[1].

I had no idea what CPE was—or how being accepted into the program at Mercy Health would change the entire trajectory of my life. I couldn’t have known that those long hours, hard conversations, and bedside prayers would lead me to my true calling: the sacred, often invisible work of being an Organ Donation Advocate.

At the time, I knew almost nothing about organ procurement. What little I did know came from medical dramas on television—which, I quickly discovered, is a terrible place to get your facts about this field.

It was during my first unit of CPE that we met the Hospital Development representative—the liaison between our hospital and the Organ Procurement Organization (OPO)[2] She came to speak with our chaplain cohort, and that one conversation would plant a seed I didn’t yet know was growing.

In 2017, we were told that over 3,000 Ohioans were waiting for the life-saving gift of an organ. The Hospital Development coordinator broke it down for us:

2,400 were waiting on a kidney,

400 on a liver,

150 on a heart,

100 on lungs,

and around 50 on a pancreas or other organs.

“These are our friends, our relatives, our neighbors,” she said. “All of them live right here in Ohio—waiting on someone to say yes.”

At the time, I didn’t think much of it. I went home and went about my evening like any other.

That night, as my wife and I often did, we sat down to watch an episode of Grey’s Anatomy. The storyline centered on a child waiting for a transplant. Grey’s always had a way of hitting you in the gut—this episode was no different.

I remember watching that scene and suddenly imagining myself in those parents’ shoes.

What if it were one of our kids?

What if they were waiting—and no one said yes?

That night, without fanfare or second-guessing, I logged on to www.donatelife.net and registered to be an organ, tissue, and eye donor.

A few months went by, and I was rounding on the neuro intensive care unit when I ran into the Hospital Development Coordinator again. She lit up when she saw me and said, “There’s my chaplain friend!”

We exchanged a few pleasantries—she asked how I was doing with my studies and how the internship was going. Then, almost casually, she said, “Hey, want to see what brain death testing is like?”

I paused. I’d heard the doctors talk about brain death before—being on the neuro unit, it came up often—but as a chaplain, I never thought I really needed to know the details. I knew the basics: that once brain death is declared, that’s the legal time of death. That’s when the conversations about donation begin.

Still, something in her tone—a mix of curiosity and invitation—made me say yes.

After observing the brain death testing, I was invited to join the Hospital Development Coordinator during the donation conversation. She gave me simple instructions: Don’t talk about donation. Just be present. If the family brings up anything spiritual, I’ll defer to you. I nodded, humbled to be invited into such a sacred moment.

The conversation went well. The coordinator led with compassion, clarity, and patience. And when the time came, the family said yes.

That donor went on to save three lives through the gift of organ donation—and to enhance the lives of countless others through tissue and eye donation.

What I didn’t realize then was that this invitation—this quiet moment in a small ICU conference room—was the beginning of something much bigger. That first “yes” opened the door to many more. It drew me into the work that would eventually become my career: walking alongside families at the intersection of loss and legacy, and advocating for the gift of life.

It’s been almost eight years since that first donation conversation. Since then, I’ve been part of hundreds of conversations with grieving families—helping them see how their “yes” can become a silver lining on one of the worst days of their lives.

My career has taken me from the front lines of donation as a Family Services Coordinator, to managing a team of advocates in central Ohio, and now back to the bedside as a donation advocate traveler—spending most of my time in the Appalachian region of the United States.

And yet, in all those conversations, one stands out.

One moment when, despite all my training, I broke. I had to excuse myself from the room, find the nearest bathroom, and let the tears come. I’m not someone who cries easily—my Slavic and English roots have taught me how to hold it all in—but this case hit differently.

Thank God I had an orientee with me who was able to carry on the conversation while I pulled myself together. When I returned to the room, I sat beside that man—still grieving, still reeling—and helped him reach a decision that ultimately led to a “yes” for organ donation.

That conversation was the first time I felt the full weight of my calling. The moment where I understood, deep in my bones, why Appalachia matters so much to me. It’s the reason my wife and I founded the Whetstone Family Foundation[3]—and the heartbeat behind the stories, research, and reflections that follow in this book.

In the first chapter of this book, we’ll explore that case in depth. Although it took place after I had already begun researching and developing the training I now offer, it laid the foundation for every story that follows. It reveals why, despite a growing national awareness of organ donation, the unique realities of Appalachia demand a different kind of approach—one shaped not only by science and systems, but by place, people, and history.

Appalachia is often defined by its geography—mountains, rivers, and winding roads—but the real story lies in its people. As of 2022, more than 26 million Americans call the Appalachian region home, stretching across 13 states from southern New York to northern Mississippi. Despite its beauty and cultural richness, the region carries a disproportionate share of the nation’s economic and healthcare burdens.[4]

The median age in Appalachia is 41.3, slightly older than the national average, and its population growth has lagged behind the rest of the country.[5] In rural Appalachian counties, median household incomes fall more than $10,000 below the national rural average.[6]While the region’s poverty rate has improved in recent years, it still hovers around 14.3%, with many communities facing persistent financial insecurity.[7]

Educational attainment remains a key challenge and opportunity. Roughly 90% of adults in Appalachia hold a high school diploma, yet only 28% have completed a bachelor’s degree.[8]These gaps have long-term implications—not just for economic mobility, but also for access to healthcare, including organ donation education and registration.

Health disparities are particularly acute in this region. Rates of chronic illness are higher, life expectancy is lower, and access to consistent medical care is uneven.[9]These realities—combined with limited infrastructure and lingering mistrust in institutional systems—form the backdrop for every donor conversation in Appalachia. It’s not just about medicine; it’s about culture, context, and the complex terrain of trust.

[1] Clinical Pastoral Education (CPE) is a professional training program for spiritual care providers and chaplains that combines classroom learning with supervised clinical experience in hospitals or other healthcare settings. It emphasizes self-reflection, interfaith competency, and the development of skills to support individuals during crises, illness, grief, and trauma.(Association for Clinical Pastoral Education, ACPE.edu)

[2] An Organ Procurement Organization (OPO) is a federally designated nonprofit responsible for coordinating organ donation and transplantation within a specific geographic area. They work with hospitals, donor families, and transplant centers to recover and allocate organs for lifesaving transplants. (U.S. Department of Health & Human Services, Health Resources & Services Administration. organdonor.gov)

[3] The Whetstone Family Foundation is a charitable organization founded in 2023 to support students in Appalachian Ohio pursuing careers in medicine and the arts. The foundation provides scholarships, mentorship, and advocacy to address educational and financial barriers in underserved rural communities. Learn more at www.whetstonefamilyfoundation.org.

[4] Appalachian Regional Commission. “Appalachia’s Population.” ARC.gov

[5] ARC. “The Appalachian Region: A Data Overview from the 2017–2021 American Community Survey.”

[6] ARC. “Rural Appalachia.” ARC.gov

[7] ARC. “ARC Releases New Data Revealing Appalachia’s Economic Improvements.” ARC.gov

[8] ARC. “Educational Attainment in Appalachia.” ARC.gov[9] ARC. “Health Disparities in Appalachia.” ARC.gov

Next Chapter: Chapter One: The Anatomy of a Barrier