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?'"
I have an organ donor card... (Score:5, Interesting)
Re:I have an organ donor card... (Score:5, Interesting)
And headless chickens still run around. What's your point? If your brain is dead, reflexive reactions to pain from your spinal cord certainly aren't enough to warrant anesthetics.
No Organ Doner Here (Score:5, Interesting)
My wife is a physician and she is not an organ donor and when we got married she made me opt out of organ donation.
She did a rotation in one of the largest and most respected shock-trauma units in the country (University of Maryland) as part of her residency and says that as soon as they wheel somebody in with head injury trauma the team goes to work to save them but at the same time one member of the team starts typing the organs for possible transplant.
She says she won't sign the card because she doesn't want somebody trying to "save" her when there are hundreds of thousands of dollars involved if it goes the other way.
Re:I have an organ donor card... (Score:4, Interesting)
How do you know what treatments will become available tomorrow?
If I'm braindead today, who cares what becomes available tomorrow? Maybe if a viable way to restart brain impulses after brain death occurs, I'll reconsider having signed my organ donor card. Anything could happen, I suppose, but I'm doubtful that technology will happen in my lifetime. As it is, I have signed it, and I have made a living will which states clearly that if I'm brain dead they're to line up organ transplant recipients and terminate life support. I'd rather give others a chance at life than continue to exist as a vegetable in the hopes that they might, maybe, some day come up with a way to undo that damage.
Re:THe Real Quesion is... (Score:5, Interesting)
Two days after I proposed to my wife, she was t-boned on a major street. She broke both clavicles, cracked a couple ribs, and fractured her sacrum. Unconscious, she was airlifted to the hospital.
When she came to, her first mumbled words were, "Not dead yet!"
P.S. She recovered completely.
I want my CUT! (Score:5, Interesting)
Okay, read that in whatever punny way you like but after seeing the prices organ donors' organs fetch, I want to be an organ donor but I want to be paid for it NOW.
The only one who doesn't benefit is the donor!! How wrong is that?! If I am going to be a donor and the medical industry is going to benefit from it, then they need to share that benefit with me. Sure. Put me on a health plan and require me to live within certain healthy standards. I don't drink that much anyway. I don't do drugs. I don't smoke. I don't run around having casual sex either... (not my choice really... I think I would if I could.) I'm a pretty healthy candidate all in all.
I know by my asking for this I'm setting myself up for one of the opening scenes from Monty Python, but I'm certainly not going to volunteer myself while other profit from it.
Re:I have an organ donor card... (Score:2, Interesting)
Not necessarily. There are people who seem braindead but they are awake [wikipedia.org], and some others can wake up [wikipedia.org] from a comatose state. The diagnosis of brain death tends to be inaccurate.
Re:Take my organs, but how 'bout some anesthetic? (Score:4, Interesting)
Seems more likely that there are medical reasons rather than cost reasons, perhaps wanting the harvested bits to be as free from anything that might cause complications in their next home as possible.
Re:No Organ Doner There (Score:4, Interesting)
Meanwhile, if you don't have a card, costs are limited to the effort of bringing you back. In the event of the worst happening, they can keep you on life support and ask your next of kin about harvesting. Sucks for the people on waiting lists, but it's not like they aren't already cooling their heels.
Re:I have an organ donor card... (Score:3, Interesting)
Would you trust a doctor from 100 years ago today?
More than a doctor today, much more so.
From the summary, it says each person is worth 2 million dollars in a 20 billion per year industry. I would say that can cause some bias. Maybe, even a little unethical behavior. I remember reading recently about an operation in China where people were being harvested.
If we say an average doctor's salary is 200k per year that means each person they certify creates 10 years worth of salary to be distributed around the hospital staff and surrounding industries. Even if the doctor himself is not being pressured to certify brain death, others in the hospital certainly are under pressure.
So... yeah... I would trust a doctor from 100 years ago a little bit more since I think they would be less pressured by finances and their disgusting influence on ethics in medicine.
Re:I have an organ donor card... (Score:5, Interesting)
IAAD and sometimes diagnose brain death - a lot of this academic debate ends up just scaring people or firing up various religious groups who have a problem with donation (but often have less of a problem with receiving donated organs).
I do not believe in a god, but I don't believe in organ donation either. I don't generally see a high quality of life for the recipients. In most cases it's just prolonging the agony. If the patients had more legs and the doctor had DVM after his name, this would have been called "inhumane".
It's time we drop the religious moral bullshit and treat our patients with as much respect as we treat our pets. Which includes letting them go when this is best.
No, you can't have my liver, unless you intend to eat it.
And, cthulhu damn it, let me die with some dignity!
Re:I have an organ donor card... (Score:5, Interesting)
We're talking about some imaginary technology that allows regrowth of brains from splattered bone, rock and whatever intruded masses with blood supply cut off to large portions for lengthy enough periods to kill a good deal of the tissue off. If we ever develop that degree of technology, I suspect growing new hearts, livers, kidneys, lungs, corneas and the like will have happened a long time before, and no longer will we have much need of organ donors.
Of course then we'll have people like you demanding "Let the headless motorbike rider who left most of his brain on the pavement of I5 live so his body can be reused, you have no right to let a perfectly good body die!!!"
Re:I want my CUT! (Score:2, Interesting)
What you forget is that most people with an organ donor card will in fact not donate any organs, because their circumstances of death make it impossible.
Why would anybody want to pay you for a "service" you are most likely to never provide?
Re:I have an organ donor card... (Score:4, Interesting)
Re:I have an organ donor card... (Score:5, Interesting)
From the summary, it says each person is worth 2 million dollars in a 20 billion per year industry.
If a person is worth so much, then why is "gifting organs upon death" required to be a donation?
It seems the dead person's estate should require a cut of this 2 million that their organs are being sold for; to help their kin with the loss, any debts, etc.
I see a fundamental problem with gaining massive profit from someone else's donation.
Re:I have an organ donor card... (Score:5, Interesting)
If someone else has to be snuffed in order for me to receive a transplanted organ, I do not want it - no matter how badly I may need it.
Re:I have an organ donor card... (Score:5, Interesting)
I sure hope you don't find your organs being harvested because the doctor prefers to say "probably won't live" rather than "possibly will survive".
As they anesthetize the donor, I guess you won't wake up before they pull your organs. It leaves absolutely no chance that you'll open your eyes and say "Why is my chest open? Close it!"
My standing order regarding my life is this. If there's a chance I will live, give me the chance. If there's absolutely no chance that I will survive, let me go. If I am looking at a long, painful, terminal condition, give me the means to end it myself, and you can take what you want.
At some point, we all die. That's a given. If you die wishing someone else would die so you can get their organs, you don't deserve to live. You're wishing the early termination of another, when they may have had a chance, so you may have a chance. Why not go take organs from homeless, and give them to those who can afford such things? Pretend I didn't say that, it'll be the new Republican health care and economy saving plan.
Kidney transplants are counterexample (Score:4, Interesting)
When kidney transplants became feasible they were also covered. So the notion that you have to be rich or have excellent insurance to get a transplant is just plain wrong.
This is not to say that the system isn't borked, but that happens long after the transplant. Specifically, once you have a undergone a successful transplant you no longer have ESRD, so Medicare coverage stops. But your need for anti-rejection medication does not, and it's expensive. That's a separate thing, and the guidelines for it were set back when transplants rarely lasted for more than a few years. So the rules say that Medicare pays for the medication for 36 months, then coverage ends.
As a result a not-insignificant number of people with transplanted kidneys are forced to stop taking the necessary medication because they cannot afford it. Their transplants fail, and once that happens they're back in ESRD and on dialysis. And their Medicare coverage resumes. Oh, and did I mention that the medications are expensive, they're still significantly cheaper than dialysis? So this is truly a case of penny-wise, pound-foolish.
One final note. The coverage issue was addressed by the health care reform bill, but that particular provision doesn't kick in until 2014.
Re:I have an organ donor card... (Score:5, Interesting)
Re:I don't have an organ donor card (Score:4, Interesting)
Only those people who cannot be brought back to a fully conscious life. That, to me, seems to be a safe and conservative boundary. The life is lost anyway.
The same can be said about the old guy, the poor guy and about political undesirables. Hell, the same is said about young children with a mild mental handicap [bioedge.org]. (and that's not the only paper advocating such a viewpoint)
The other people on the waiting list will be very grateful.
This sentence mostly shows just how little you know about transplantation. The problem is not the amount of organs, but whether a donor can be found with a compatible immune system. For any given recipient, it is extremely rare that there is more than 1 good donor, likewise most available organs are never used for anything. This would be true even if everybody donated organs.
It is frightening how strong an opinion people can have when being ill-informed to such a degree.
So no, nobody on the list will be grateful in the least. If there is an organ that would match me, chances that it will match someone else needing an organ are tiny. So nobody will be grateful.
If you were terminally ill and could only be saved with an organ from the victim of a traffic accident, would you refuse? If not, then stop being a hypocrite.
Oh great, hyperbole. If you were terminally ill and could get better if you just had the doctors kill some unknown homeless person, would you ? Some mentally retarded kid ? Some usually comatose old guy ? A black woman perhaps ? An infidel ? A republican ? A communist ? There's plenty of people who argue those lives to be less than worthwhile. "If not, then stop discussing."
And for the record, if I was not sure about the circumstances in which said organ was taken, yes, I would refuse. For one thing, why would my life be worth more to the doctor than that of the guy they cut open for the organ in question ?