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?'"
Re:I have an organ donor card... (Score:5, Insightful)
There's a section in the article that states the Beating Heart Cadaver (BHC) still feels and responds to pain, yet no anesthetic is administered because the BHC is not considered to be a person anymore. I am canceling my organ donor card.
When no longer alive (Score:3, Insightful)
>"When Are You Dead?"
Easy- when you can no longer be made to be alive anymore :)
(Sounds silly, but it is kinda valid- can't restart heart, and/or can't restart breathing, and/or can't ever recover brain function/consciousness). Of course, in reality, it can be a bit more difficult to define. Personally, I think it is all about the brain. If the brain is irreversibly damaged to the point there will never be consciousness, I don't care how functional the rest of the body is, that person is DEAD.
Interesting (Score:5, Insightful)
Yessss! (Score:4, Insightful)
Yessss! When my brain no longer works, I want to be asked if it is broken enough to consider me dead! Or, better, have my stupid relatives decide that!
Out of all the alternatives, I would rather rely on a doctor's decision.
Re:I have an organ donor card... (Score:5, Insightful)
It is good to have this debate, but like abortion, this is an area where people who deal with the messy situations that life provides should get to drive the policy, rather than any particularly flavour of god-botherers.
Re:I have an organ donor card... (Score:5, Insightful)
I'm cool with all my parts going into other people once brain death occurs, but I guess I'd just like them to check a little more rigorously to be sure it has occurred.
The article offers something of a solution: don't sign the card, but provide your family with instructions that your organs are to be donated after enough tests have been run to be sure your brain is kaput.
Re:I have an organ donor card... (Score:5, Insightful)
I work on a research campus, that helps...
Seriously though; it would be nice to believe that a miracle-cure for massive brain injuries is just around the corner (or in fact, a miracle cure for pretty much anything serious), but realistically you have to weigh your odds, and I don't like them. If I'm that much of a vegetable, I wouldn't want to hang around hoping..
Re:I have an organ donor card... (Score:5, Insightful)
Exactly. People always say "Well what if they don't revive you and you could have been saved!" Honestly who cares? At the point of no return (my organs are being removed) I'm dead anyway! I'm not going to be sitting around for years looking back and thinking "Oh man I wish those doctors tried harder to save me" I'll be dead. Then anything they want to do with my body after that (organ donation, filming another Weekend at Bernie's) is completely up to them. I'd prefer to be useful to someone after death and telling me that there's a chance I might not be fully 100% dead before they officially pronounce me dead just because i'm an organ donor isn't going to change that.
Re:I have an organ donor card... (Score:4, Insightful)
You cannot put back a soul into place once the brain matrix has rotten. The lungs or the heart may be restart, but it is no different than a computer with a fried CPU in which the cooling fans are still spinning. And no, you cannot repair the "CPU", because it would involve rebuilding trillions of neural connections that are unique to each human being and define, directly, who they are. Even in a far, far future in which you could repair these connections you would not know what to do since no one would bother (or afford) to take a backup of their own soul in case of trauma, and in such a sci-fi world rebuilding the body from scratch would probably be easier.
Brain death is irreversible, you don't come back from that. If something comes back, it will be a vegetable, not the original person.
You could just as well cure a T-Rex fossil.
Eh, don't keep me around (Score:4, Insightful)
I have a cousin who years ago was in a massive car accident and thrown through the windshield. Full coma and braindead. His family kept hope for a while and then had the plug pulled. Shockingly he kept breathing which seemed to give everyone hope. Here we are 15 years later and he is just as much brain dead as he was then but his direct family has been absoluetly through the ringer and his parents are absoutely broke. Looking back on what that has done to his family and what his quality of life is, I would absolutely say go ahead with the donation and make someone else's life better.
Kill this bullshit story, please (Score:3, Insightful)
Not only does the summary have absolutely nothing to do with "news for nerds," but it reveals an agenda that is probably (if you scratch it deeply enough) based on religious asshattery rather than sound medical, scientific, or ethical principles.
Case in in point: 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.
You know who else emits brain waves and breathes spontaneously? Pretty much every life form in kingdom Animalia.
Why did the submitter not choose to reveal his/her actual agenda, rather than duping an editor into publishing this stupidity? Organ donation saves lives... real lives, lives which are distinguished by characteristics beyond the ability to inhale oxygen and exhale CO2.
Wrong Checkbox (Score:3, Insightful)
If on the DMV form you have an exclude checkbox for organ donation, 98% of population will donate their organs by default. So much for human psychology... as a society we are at a stage where we need make some conscious choices if supply is low we need to understand all possible root cause and try to fix them.
Re:I have an organ donor card... (Score:5, Insightful)
I'm not sure why you're not modded up yet.
The whole article argues that we don't really know when someone is "dead" yet in the cases outlined; just best guesses by doctors.
Would you trust a doctor from 100 years ago today? Maybe we should hedge a bit that we may be killing people for their organs who aren't quite dead yet, and some more research needs to go into when you're officially "braindead".
Re:No Organ Doner Here (Score:5, Insightful)
Your wife is a physician and doesn't realize that organ harvesting and transplanting is a very time sensitive procedure? Typing the organs right away, even before death is declared, saves a bunch of precious time that if wasted could lead to a non-viable organ in the end. Just preparing for possible contingencies is not nefarious, it's logical. In the end, if the patient recovers, then hooray for the patient! We move on to the next possible organ donor.
The system is not evil, doctors are not ghouls just waiting for the next big organ score. And personally, I feel that if you are morally opposed to organ donation, you should be morally opposed to organ reception; that is to say, feel free to opt out of the system, but your name should be on the bottom of the UNOS list if the time comes you ever need the help of said ghoulish transplant doctors.
Re:I have an organ donor card... (Score:5, Insightful)
You're trying to convince us here that two different states of coma are comparable to braindeath. This is not so. Not to mention, by the way, that you have better odds of winning the lottery than waking up from a coma after you've been in said coma for more than a year.
Re:I have an organ donor card... (Score:4, Insightful)
Even if the brain could be physically repaired, I doubt there will ever be medical technology capable of restoring a person. We're talking massive head trauma, which more than likely means the cognitive, emotional and memory centers of the brain are destroyed or nearly so. Imagining that at some point you could be stuck in a vat and have your brain regrown would likely mean that you would largely be a whole new person. Maybe in some far off future we'll be able to back up our brains and restore them in case of serious damage, but that's not going to happen any time soon.
Re:I have an organ donor card... (Score:4, Insightful)
this is an area where people who deal with the messy situations that life provides should get to drive the policy
It says each body is worth $2million. You don't think the people who deal with 'messy situations' can be corrupted by $2million? You might personally be a beautiful and friendly doctor who never does anything wrong, but the average human is going to be thinking about that $2million (even if it just goes to the hospital, and they don't get it personally).
Re:I have an organ donor card... (Score:5, Insightful)
I sure hope you don't end up waiting for an organ that won't come because of an attitude like yours.
Re:I have an organ donor card... (Score:5, Insightful)
Wrong. Recipients of kidney transplants have a high quality of life. As an anecdotal example, my son received a renal transplant 20 years ago and is sill going strong. For something non-anecdotal, see this [nih.gov] also.
Re:I have an organ donor card... (Score:4, Insightful)
I'm fairly sure those treatments will not include an artificial brainstem within a timespan relevant to me.
If your brainstem is shot, the rest won't matter much.
Re:when you can no longer post on /. (Score:3, Insightful)
You sure? there seem to be a few brain dead posters still around...
Re:I have an organ donor card... (Score:5, Insightful)
The younger the brain, the more plasticity it has and the more capable of recovering from severe brain damage it is. You might not be the exact same as you are now, but my dad certainly has a decent quality of life today. "He" is definitely still very much there, though sometimes he gets frustrated because he can't do everything he used to do, particularly in way he used to do it. He hates that he's dependent on others... but he finds plenty of enjoyment in life, looks forward to the time he gets to spend with his grandkids, etc. After years of resistance and despite being a grade school dropout, he's finally decided he wants to start learning about computers and stuff.
Massive brain damage isn't the end of the world, though it can certainly be difficult. I understand that it's quite scary to think about and a lot of people would rather be dead than face those challenges. That said, the younger you are, depending on just how severe the brain damage is, you can still have a positive life afterward and you still can even be you. Not every case is an absolute case of permanent vegetative state or "losing the soul."
Re:I have an organ donor card... (Score:2, Insightful)
Yeah, but you're making decisions now for half of yourself. How can you even guess what he might want? After all, even half of yourself might have a higher IQ than many retarded people. Shall we just start harvesting their organs?
Re:I have an organ donor card... (Score:4, Insightful)
Brain tissue, once dead or severely damaged, can't realistically be restored the way it was, in much the same way that you can't restore a paper than has been burned. "You" is the structure of your brain. Even if damaged parts could be replaced with healthy new neurons, the old structure would be gone, which may change you in any number of ways (lost memories, lost skills, changed personality).
Re:I have an organ donor card... (Score:4, Insightful)
> Even if the person is no longer you, They still have a right to live.
Except that person doesn't exist until the brain is repaired. Before you perform the magic brain-restoration procedure there is no person 'inhabiting' the body, so the right to live does not apply. The act of repairing the brain to a useful state would be the act of creating the new person, and why would you create one new person (who, depending on the severity of the former brain damage, may have no skills and/or memories) when you can harvest some organs and preserve the lives of several already existing people? Why create a new person and effectively donate all the organs to him/her?
Re:I have an organ donor card... (Score:4, Insightful)
I'm very glad your father survived and has regained much of his abilities. Was your father ever actually declared brain dead though? There's brain injury and then there's brain injury. Keep people alive just in case somehow a massively and catastrophically damaged brain might somehow make it back out the other side seems more like basing decisions based on someone else's anecdotal claims (like yours, for instance).
Re:I have an organ donor card... (Score:5, Insightful)
At the end of the day, doctors can and do make mistakes... and the patient's family is going to weigh the doctor's opinion heavily. Some won't allow it to overcome their internal biases, some have no biases and will just blindly do what the doctor says whether it is really in their loved one's best interests or not. In the end, we circle back to the question posed here... just how do we know when you are really dead for certain?
Re:I have an organ donor card... (Score:4, Insightful)
That's my view too. My greatest attribute is my intelligence and it forms, if not the entirety, the greater part of my persona. I solve puzzles for work. I play strategy games in my spare time to keep my brain going. As it was said in Sherlock Holmes, "I am a brain. The rest is mere appendage."
If I'm to the point where wiping my own ass is an accomplishment, come on man, I'm not in there anymore. Grieve, let the meatsack go, and celebrate the physical end of Beardo.
As for the parts, once I'm in that state or worse, I am done with them. I've said this before, but I'll say it again. Give my lungs to a old man so his grandkids can take their breath away. Give my heart to a teenager so it can get broken by her first crush. Take my kidneys out to a pub and have a beer on me. Watch one more sunrise with my corneas. Donate what's not useable to science. Burn what's left, use it to fertilize an apple tree, and bake me an apple pie.
Re:I have an organ donor card... (Score:5, Insightful)
I think the point made by the article is that we need more rigor in determining that the person is dead before the organs are removed. Obviously, they'll be dead afterwards.
There is no check for brain activity. They poke you a few times and remove your breather to see if you can breathe on your own. Note that a coma patient would fail some of those as well, and people *do* awake from comas. There is a big rush to declare you dead so that the organs can be harvested.
A "brain dead" patient is a money pinata, waiting to be whacked.
Re:I have an organ donor card... (Score:4, Insightful)
Would you trust a doctor from 100 years ago today?
More than a doctor today, much more so.
You're insane. 100 years ago, leeching was still practiced, antiseptic surgery was still a relatively new concept, useful antibiotics didn't exist, blood transfusions were just barely being made practical on a significant scale, and organ transplants (other than skin) were still 40 years away.
If you're so far gone that modern doctors might be tempted to call you done for even though there's a very slim chance that modern medicine could bring you back, then you're so far gone that the doctors of 100 years ago would already have given their condolences to your family and headed home. And they wouldn't have given up prematurely because at that point, without modern life support equipment you're absolutely, positively gone.
I'll take modern medicine, thanks. It's imperfect, and the financial incentives for the physicians don't align all that well with the interest of the patients, but in large part it works, and you can't say the same for what passed for medicine in 1912 -- though it was orders of magnitude better than what we had in 1812.
Re:I have an organ donor card... (Score:3, Insightful)
Death is a prognosis, not a state. (Score:4, Insightful)
That's the best explanation I've ever heard. "Dead" is simply the expectation that you're never going to be what we call "alive" again. Sometimes we're more certain than others. Run over by a steamroller? Yeah, we're pretty certain you're dead. Brain dead? We're pretty certain you're dead, just ever so slightly less so. Heart stopped? Ok, you're not dead, but you're definitely in danger of it if we don't get it started Very Soon Now.
Re:I have an organ donor card... (Score:4, Insightful)
Well, donors don't get paid in the US, either (and the article didn't say that). The article said that a body generates about $2 million in income for various parties (hospital, surgeons, etc.).
Think of it like this: If you're the owner of a toy store, and you got free toys because the next-door shop shut down (died), you'll still be asking full price when you sell them, and your customers will pay it.
Re:I have an organ donor card... (Score:5, Insightful)
I don't trust how the system is set up right now. Last time I went to renew my license I didn't check the organ donor box, the DMV checked it for me anyway. I keep having to go online and cancel my registration, which is rather annoying. My issue is that these registries are run by private corporations with a financial incentive to be able to harvest people's organs and there aren't enough regulations in place. I would be willing to donate if it didn't involve money and I knew my rights would be protected.
Here are a few state donor registries where you can edit your donor information and make exclusions
Florida [donatelifeflorida.org]
Georgia [donatelifegeorgia.org]
South Carolina [donatelifesc.org]
Utah [yesutah.org]
Headless humans still run around too... (Score:5, Insightful)
During the French Revolution, betting on how far a headless noble would get was a popular gambler's game.
Re:Kill this bullshit story, please (Score:4, Insightful)
While you're right that the OP is probably a religious asshat trying to get his wacky agenda some air time, you can't deny the huge incentive hospitals have to declare someone "brain dead" who maybe is or maybe isn't or is maybe on the cusp, because they make $750K PER ORGAN harvested.
...
What nonsense. Organ transplants COST $750,000 to perform because they are difficult, elaborate, high-tech, risky procedures -- it can't be done for $5 grand by Dr. Nick. That money goes to a lot of expenses the hospital doing the transplant has pay for, large amounts of medical supplies, a lot of highly trained human labor, etc. And you realize, I hope, that this is not some profitable side-line a hospital adds on to fatten its bank balance. Transplants requires special certified, highly qualified teams that must pass rigorous certification. Many transplants are done in regional centers that specialize in doing them because it makes the transplants more successful (practice makes perfect) - these centers aren't medical casinos raking in dough.
Re:I have an organ donor card... (Score:5, Insightful)
That's exactly the kind of reaction I was afraid of when I saw the article. Thousands of people who are waiting for a transplant to save their life, will die because of people reading articles like this and going "maybe there's a tiny little chance that the doctors are wrong, who knows, maybe I'll still feel pain even without a brain, and maybe they'll find a miracle cure to revive dead brains during the hours that I'm brain dead, and who knows what else...".
Someone who needs a transplant to survive, has a 100% chance of dying if he or she does not get that organ. Weigh that against your "maybe this" or "maybe that". Once the doctors declare you brain dead, even if through some magical unexplained event you do come alive again, you're likely to be more like a zombie than your old self. And if your brain is dead, even though your body "responds" to pain, "you" won't feel a thing. Your brain is dead, you are not conscious, who cares if some of your muscles still twitch in an automatic reaction to pain.
Maybe people with a donor card should get priority to receive organs before any of the irrational and/or selfish cowards do. That would probably help a lot in the shortage of organs.
I don't have an organ donor card (Score:3, Insightful)
I find it most offensive that you somehow find it "moral" to claim a right on my organs. Let's see if you reciprocate : can I cut out your heart ? You claim a right on mine, so why can't I have yours ?
How about younger children where killing an older person might save them (killing = the older person doesn't agree) ? What about a rich person needing a heart and a poor person "not having a liveable life anyway ?". What about a politically desirable individual needing one ?
I would not be able to live with a "donated" organ that was taken under the conditions you seem to think give you a right to kill other people.
Re:I have an organ donor card... (Score:4, Insightful)
That's some faulty logic. With so much money at stake, warlords aren't killing people to harvest organs. Poor people voluntarily do it for a small cut of the profits. The black market already exists, and the laws are keeping those black market activities alive.
http://science.howstuffworks.com/environmental/life/human-biology/organ-donation7.htm [howstuffworks.com]
The donors were recruited mostly from the slums of Brazil, flown to South Africa where the operation was performed, compensated between $6,000 to $10,000 and returned home [source: Rohter]. The South African middlemen were then able to sell the organs for as much as $100,000 [source: Handwerk].
There's absolutely NO POINT in banning compensation to the donor, because as soon as the organs are harvested, the people who have them can sell them. What do you think would change if organ donors received $500k in the US, except that the shortage of organs would fall?