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Medicine Science

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?'"
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When Are You Dead?

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  • ... and I'm surprised that anyone is surprised by any of this. Frankly... If I'm braindead, or even slightly above braindead so that I can breathe myself, just kill me, mm'kay? There is no way in hell that I'll ever be "me" again. The "me" is dead, and that zombie-corpse-thing is not "me" anymore. Help others, save the financial cost and emotional burden to my family (even though I live in Europe, I expect the financial cost to be low... )... Take them, help someone. I am dead if my neocortex is not functioning correctly anymore.
    • by Anonymous Coward on Sunday March 11, 2012 @06:15PM (#39320327)

      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.

      • by Anonymous Coward on Sunday March 11, 2012 @06:22PM (#39320369)

        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.

      • I sure hope you don't end up waiting for an organ that won't come because of an attitude like yours.

        • by Penguinisto ( 415985 ) on Sunday March 11, 2012 @10:50PM (#39322333) Journal

          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.

          • by willpb ( 1168125 ) on Monday March 12, 2012 @01:07AM (#39323159)

            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]

        • 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.

        • Re: (Score:3, Insightful)

          The transplant industry always says stuff like that, but if you consider the survival rates and quality of life post-transplant, maybe you wouldn't be missing out on that much after all.
      • by demonlapin ( 527802 ) on Sunday March 11, 2012 @10:49PM (#39322321) Homepage Journal
        That would be the spinal cord, which can be alive when the brain is dead. And to prevent it from going haywire, we actually do administer anesthesia to dead people. I certainly spent enough late nights on call during residency doing organ harvests to know that.
      • by michelcolman ( 1208008 ) on Monday March 12, 2012 @05:21AM (#39324185)

        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.

    • by Sad Loser ( 625938 ) * on Sunday March 11, 2012 @06:30PM (#39320439)
      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).

      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.
      • by Empiric ( 675968 )
        religious groups who have a problem with donation (but often have less of a problem with receiving donated organs)

        Care to name one?

        Yeah, I know, the quickest way to win these debates with yourself is to entirely make up your supposed opponents' supposed position, but at least one anecdotal example of evidence would be nice.
        • by Sarten-X ( 1102295 ) on Sunday March 11, 2012 @07:58PM (#39321097) Homepage

          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.

      • by arth1 ( 260657 ) on Sunday March 11, 2012 @07:43PM (#39320981) Homepage Journal

        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!

      • by phantomfive ( 622387 ) on Sunday March 11, 2012 @07:49PM (#39321025) Journal

        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).

      • 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.

        Like organ donors, perhaps? I am one, and I'm not cancelling my card over any of this, but don't subscribe to doctor's arrogance that deciding how to manage our ends is yours to do. It's ours. We appreciate your services, but don't forget that's what they are.

    • by Dr. Hellno ( 1159307 ) on Sunday March 11, 2012 @06:35PM (#39320471)
      I agree completely, but I was a little surprised by the tests we apparently use to determine brain death. I assumed there might be an EEG to check for brain activity, but apparently they give you a wet willy and poke you in the eye, then turn off your air for a little while.
      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.
    • by Zakabog ( 603757 ) <john@@@jmaug...com> on Sunday March 11, 2012 @06:37PM (#39320501)

      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.

      • by ATMAvatar ( 648864 ) on Sunday March 11, 2012 @09:47PM (#39321941) Journal

        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.

    • If I'm braindead, or even slightly above braindead so that I can breathe myself, just kill me, mm'kay?

      Of course. If signing myself up as a donator takes lessens my informed consent in the case of massive trauma to my brain, so be it. Please use what you can to help somebody else, because if all I've got left is a few stray brainwaves, I'm really not going to notice if you take my heart and lungs and I really don't want my wife and daughter to spend any time worrying over a human rutabaga.

      Now, some may fin

    • by Beardo the Bearded ( 321478 ) on Sunday March 11, 2012 @09:33PM (#39321837)

      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.

  • by chill ( 34294 ) on Sunday March 11, 2012 @06:16PM (#39320329) Journal

    The real question is how fast will this thread deteriorate into a Monty Python quote fest?

  • by markdavis ( 642305 ) on Sunday March 11, 2012 @06:17PM (#39320333)

    >"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.

  • by LighterShadeOfBlack ( 1011407 ) on Sunday March 11, 2012 @06:19PM (#39320353) Homepage

    "Even though they compromise only 1% of deaths [...]"

    Comprise. The word is 'comprise'.

  • Interesting (Score:5, Insightful)

    by dontPanik ( 1296779 ) <{moc.liamg} {ta} {smlesedn}> on Sunday March 11, 2012 @06:19PM (#39320355)
    Interesting article, but I'm going to categorize it under scare-mongering. I'll accept the next to nothing possibility of being still alive while they take my organs, if that means saving other's lives.
  • Yessss! (Score:4, Insightful)

    by Alex Belits ( 437 ) * on Sunday March 11, 2012 @06:21PM (#39320365) Homepage

    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.

  • by theodp ( 442580 ) on Sunday March 11, 2012 @06:25PM (#39320387)

    From the article: "Even some of the sharpest critics of the brain-death criteria argue that there is no possibility that donors will be in pain during the harvesting of their organs...But BHCs[beating-heart cadavers]-who don't receive anesthetics during an organ harvest operation-react to the scalpel like inadequately anesthetized live patients, exhibiting high blood pressure and sometimes soaring heart rates. Doctors say these are simply reflexes." OK, but didn't we once say something similar about operating on babies without anesthesia [naturalnews.com]?

  • Scary (Score:4, Informative)

    by St.Creed ( 853824 ) on Sunday March 11, 2012 @06:26PM (#39320401)

    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.

  • No Organ Doner Here (Score:5, Interesting)

    by Anonymous Coward on Sunday March 11, 2012 @06:29PM (#39320425)

    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.

    • by Anonymous Coward on Sunday March 11, 2012 @07:08PM (#39320721)

      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.

  • Answer (Score:5, Funny)

    by bXTr ( 123510 ) on Sunday March 11, 2012 @06:30PM (#39320429) Homepage
    When you stop pounding at the inside of your coffin.
  • by aaaaaaargh! ( 1150173 ) on Sunday March 11, 2012 @06:34PM (#39320463)

    That sounds like pretty good news to me because the worst thing I can imagine is being held alive artificially in a coma.

    So yes, please don't hesitate to let me die after a severe head trauma and give my organs to others. Thanks!

  • by Anonymous Coward on Sunday March 11, 2012 @06:47PM (#39320561)

    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.

  • I want my CUT! (Score:5, Interesting)

    by erroneus ( 253617 ) on Sunday March 11, 2012 @06:54PM (#39320611) Homepage

    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.

  • by Man On Pink Corner ( 1089867 ) on Sunday March 11, 2012 @07:03PM (#39320685)

    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)

    by Anonymous Coward on Sunday March 11, 2012 @07:04PM (#39320687)

    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.

  • Never!! (Score:5, Funny)

    by Indigo ( 2453 ) on Sunday March 11, 2012 @07:14PM (#39320759)

    They can have my organs when they pry them from my cold, dead... oh wait.

  • by NoNonAlphaCharsHere ( 2201864 ) on Sunday March 11, 2012 @07:18PM (#39320787)
    DUH! When Netcraft confirms it.
  • by fahrbot-bot ( 874524 ) on Sunday March 11, 2012 @07:35PM (#39320895)
    Ask Spock [wikipedia.org], Ellen Ripley [wikipedia.org], or (my favorite) Aeryn Sun [wikipedia.org]. They've been dead at least a few times.
  • by ukemike ( 956477 ) on Sunday March 11, 2012 @08:22PM (#39321279) Homepage

    a $20 billion per year business, with average recipients charged $750,000 for a transplant

    Seriously, if this is such a big business, I want to be paid for my organs. Why should some medical institution or insurance company profit from my flesh? Obviously I won't be around to enjoy it, but I hope my son will. I would be very happy to know that my heart, liver, kidneys, eyes, etc. provided funding for his college education. I can't figure out any other way I'm going to be able to put him through school. Hell the state universities cost more than the private ones did in the late '80's.

  • by mevets ( 322601 ) on Sunday March 11, 2012 @08:56PM (#39321577)

    Is drinking and driving laws. During the period where drinking and driving was the norm, and seatbelt/helmet use was almost unheard of, there was no lack of young, healthy donor organs.
    Social pressure has wreaked havoc on this, and created a new, younger class of unemployed.
    The answer is simple - re-enable driving around shit-faced and MDs will be swimming in spare kidneys and other bits; and we can resume full employment.

  • by assertation ( 1255714 ) on Sunday March 11, 2012 @11:57PM (#39322777)

    I have an organ donor card.

    Under our ( U.S. ) current ( lack of ) healthcare system, if I got cancer or something similar, it could ruin me financially. My bank account would get emptied out and I would lose everything.

    Yet, someone could charging 2 million dollars for my organs if I died of a head trauma. I doubt all of that would be hospital costs and none of it would be going to my family or friends.

    Why the hell should I donate my organs to a system, for free, when they will profit like crazy from it, but if I am living with a severe disease that same system will bankrupt my ass?

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