When Are You Dead? 516
Hugh Pickens writes "Dick Teresi writes in the WSJ that becoming an organ donor seems like a noble act, but what doctors won't tell you is that checking yourself off as an organ donor when you renew your driver's license means you are giving up your right to informed consent, and that you may suffer for it, especially if you happen to become a victim of head trauma. Even though they comprise only 1% of deaths, victims of head trauma are the most likely organ donors. Patients who can be ruled brain dead usually have good organs, while organs from people who die from heart failure, circulation, or breathing deteriorate quickly. But here's the weird part. In at least two studies before the 1981 Uniform Determination of Death Act, some 'brain-dead' patients were found to be emitting brain waves, and at least one doctor has reported a case in which a patient with severe head trauma began breathing spontaneously after being declared brain dead. Organ transplantation — from procurement of organs to transplant to the first year of postoperative care — is a $20 billion per year business, with average recipients charged $750,000 for a transplant. At an average of 3.3 donated organs per donor, that is more than $2 million per body. 'In order to be dead enough to bury but alive enough to be a donor, you must be irreversibly brain dead. If it's reversible, you're no longer dead; you're a patient,' writes David Crippen, M.D. 'And once you start messing around with this definition, you're on a slippery slope, and the question then becomes: How dead do you want patients to be before you start taking their organs?'"
My death will not be compromised! (Score:5, Informative)
"Even though they compromise only 1% of deaths [...]"
Comprise. The word is 'comprise'.
Scary (Score:4, Informative)
At least one of the cases described in the linked article should be grounds for legal action, at the very least dismissal of these surgeons from their jobs. Case #2 seems a collection of mistakes and errors: was permission granted by or even asked from the family? Dismissing objections of one of the teammembers? Designated target dies before even receiving liver and the donor dies as well? I mean... this sounds like a case for a law school, not for medical school.
However... most donations are rigged with very careful procedures precisely because of all the legal pitfalls. Given the good it does to help with the mourning process of the family of the donor, and the good it does on the other side, there is a powerful drive to make sure we improve this procedure.
And also: more research on stem cells is desperately needed.
Re:Lies. (Score:3, Informative)
No it says A doctor does so, not ALL doctors do so.
Re:I have an organ donor card... (Score:5, Informative)
If you RTFAd, you'd find out that one person who was certified brain dead and whose organs were about to be harvested DID come back and was not vegetative. You can argue that they weren't really brain dead, but that just moves the argument up a level to how you determine brain death.
Re:I have an organ donor card... (Score:4, Informative)
And headless chickens still run around.
Oh yes they do for sure!
https://en.wikipedia.org/wiki/Mike_the_Headless_Chicken [wikipedia.org]
Re:2 million for who? (Score:5, Informative)
Re:I have an organ donor card... (Score:5, Informative)
Christian Science, Jehovah's Witnesses, and the Shinto faith. [beliefnet.com]I'm most familiar with the Christian Science viewpoint:
The basic idea is that God made a body with its particular destiny, and it's not man's job to screw with that plan. Some followers believe this means God gave them knowledge, intelligence, and the ability to cure disease, and no matter what happens, it's because God allows it. Other followers believe this means God made a plan for every part of the body, and if someone acts against that natural plan, they're violating the plan.
I agree with GP: This is an issue between patients and their doctors. Personally, part of my overly-elaborate assisted-suicide (though I don't yet know who or what will assist or in what manner or at what time) plan is that if I'm ever in a situation where 4 out of 5 doctors randomly chosen say I'm beyond reasonable hope for recovery, start cutting out recoverable parts. I have no interest in using them again.
Re:No Organ Doner Here (Score:2, Informative)
"The system is not evil, doctors are not ghouls just waiting for the next big organ score."
This is your OPINION.
Actual events I have personally witnessed indicate that you are far from correct.
I work as an ER MD in a large metropolitan hospital. I could tell you stories
which would give you nightmares for the rest of your life. I am not, nor will I
ever be, an organ donor, because I do not want any incentives attached to
whether I live or die.
I've seen people "let go" when they could have been saved. You cannot
begin to imagine how much you carry such things around with you for the rest
of your life. Let's just say that your view of the "system" not being "evil" is
naive in the extreme, and leave it at that. Now if you will all excuse me I
need a good stiff drink.
Re:I have an organ donor card... (Score:5, Informative)
The Church of Christ Scientist does not have a specific position regarding organ donation.
Or, in other words, some followers believe different things from other followers, as noted previously. There are groups (whom I've dealt with personally) that oppose organ transplant. No, the entire religion doesn't oppose it, but groups within it do.
Though I can only speak for personal experience from a past career, I've dealt with religious opposition to medicine from people who call themselves:
That list is from medical records where people opted out of organ donation, and cited religion as the reason. Elsewhere, they specified a religion. Now, I only worked with the data, and not the patients themselves, so I can't elaborate more (though if anyone has insight on the atheist, I'd love to hear it).
In short: No religion outright opposes organ donation. Many religious groups do.
Re:I have an organ donor card... (Score:5, Informative)
And there has never been a heart transplant recipient who has lived more than 10 years.
Bollocks. The current record is 31 years, set when 1978 transplant recipient Tony Huesman died in 2009. Dwight Kroening finished his first Ironman triathlon 22 years after his transplant. Five-year survival runs around 70%, and ten-year survival for heart transplants is about 50% [nationalpost.com].
A heart transplant certainly isn't a panacea; it's not a magical cure, and it carries serious and ongoing risks--but it's also not the unmitigated disaster that you seem to think it is.
Re:I have an organ donor card... (Score:4, Informative)
What crap. A friend of one of my daughter's friends is a transplant recipient. I met her at a Halloween party a couple of years ago. She's about 13 now, I think. Without a transplant, she'd have been dead as a toddler. She seems pretty normal and happy to me, having a good life.
Another good counterexample is cornea transplantation: http://en.wikipedia.org/wiki/Cornea_transplant#Prognosis [wikipedia.org]
Re:No Organ Doner Here (Score:5, Informative)
Good for you for being an ER doc. I have a lot of respect for you guys. Having said that, I'm an EMT, and I've seen stuff that would curl your hair. You get them after we've pulled their various parts out of the car (not always at the same time) and cleaned them up for you.
I've gotta say, I know a bunch of docs at one of the best trauma centers in the country, and they are without exception good people fighting a forever-losing game against death. There's all sorts of people who "could" be saved - but for what? It's not a money thing at least to the folks I know - they just don't see fighting to keep the patient in a coma on a vent for a few more days as appropriate - to the patient, or their families.
Since I'm sure you'd shit all over any hypothetical I offered, here's a real case: Massive car accident on the highway, one guy didn't have his seatbelt on and went partway through the windshield. Massive head injuries (open skull and brain tissue on the windshield), and cardiac arrest. He was our only "red" patient, but we didn't do CPR.
Now first of all, the standing protocols in my state is "do not perform CPR if it was caused by a traumatic cardiac arrest", so we were doing right by that. Notwithstanding, we perhaps could have pumped him with some lactated Ringer's, tubed him, and performed compressions. We may have even brought back a pulse (his brainstem appeared intact). But for what?
Let's say you are that guy's wife, or brother, or son. Which is better? "He died in a horrible car accident" or "He's in a coma, it doesn't look good"? Sure, the doctor can say up and down that he won't make it, that the windshield ripped out parts of his cerebrum and people don't come back from that, etc - but it doesn't matter, most people get their hopes up because he isn't actually dead. Then a few days later the guy dies, or even worse, his next-of-kin has to make the decision to give up. If it were me, I know which one I'd rather have, for me and my family. Get it over with and leave it at that. Don't stretch it out to various stages.
And yes, those things will stay with me for the rest of my life. But we still made the right call.
I don't know what you mean by saved. Perhaps you mean the guy coding could've been stabilized, but they gave up, or perhaps you mean the terminal cancer patient wasn't vigorously resuscitated. If "save" means "most likely could've returned to a mostly-normal life", that's a tragedy worthy of big punishment. But if "save" means "kept alive for a few more hours/days", I can't say I share your disgust at the doctor having some mercy to everybody involved and just letting it end naturally.
Re:I have an organ donor card... (Score:5, Informative)
Re:I have an organ donor card... (Score:4, Informative)
Maybe a less rigorous doctor doesn't even take it that far
Actually, the criteria for brain death are widely published and understood. And the doctor who declares brain death is not the one who gets the organs - it's a neurologist or neurosurgeon, not the transplant guy.
Re:I have an organ donor card... (Score:4, Informative)
No, try reading the rest of the thread. I was talking about severe brain trauma in the context of the scenario of OP, who spoke about being brain-dead. The brain changes constantly, and my brain tomorrow won't be the same as my brain today, that hardly means I think I deserve to die tomorrow. I am not suggesting we kill everyone who loses the ability to juggle as the result of a major concussion. I just think that if we start replacing parts of the brain of a person with severe brain-trauma to a degree where the resulting person is pretty much indistinguishable from someone who has had a complete brain transplant (if such a thing were possible) we've abandoned 'curing the patient' and crossed into mad-scientist 'create new life' territory, and we're still using the body as an organ donor, but we're donating all the organs to the new person.
Besides, saying there are 'quite a few people who disagree with me' is irrelevant. If you have an opinion on any (semi-)controversial subject there will be billions who will disagree with you. I'm not interested in a popularity contest, if you disagree try giving an argument that is not based on pulling my words out of context and misinterpreting them.
Of course there would be situations where it's not clear how much the original person would change when using the miracle brain regeneration device, but I think the brain-death scenario is not one of those situations, so please don't go all Loki's Wager on me.
Re:I have an organ donor card... (Score:4, Informative)
Actually, it can increase your chance of survival. The doctors may try harder to stabilize you if they know you're a potential donar, because they know that even if you don't survive your organs are worth something. There's a slim chance that the extra effort to stabilize you will save your life, if the doctors were wrong to write you off too early. Assuming ER doctors (or paramedics) are more likely to make a bad call than a doctor deciding to switch you off in the ICU (where they have time to think), the organ card might be a net gain for you.
Either way, it makes *very* litte difference.