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Medicine Science

Doctors Try Controversial Technique To Reduce Transplant Organ Shortage (npr.org) 69

Posted by msmash from the how-about-that dept.
A controversial organ retrieval technique is gaining traction across the U.S., promising to alleviate chronic organ shortages but also sparking intense ethical debates, NPR reports. Normothermic regional perfusion, now used by half of the nation's organ procurement organizations, restores blood flow to organs after cardiac death. Proponents argue it increases viable organ supply and improves transplant outcomes. Critics, however, question whether the procedure blurs the definition of death.

Doctors Try Controversial Technique To Reduce Transplant Organ Shortage More | Reply

Doctors Try Controversial Technique To Reduce Transplant Organ Shortage

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  • I thought that the current concept of death included several factors of which lack of brain activity was an important one? If we focus only on Cardiac Death, doesn't that mean that some people who could have been saved were allowed to die so that we could harvest their organs?

    I mean, I'm not a doctor, nor do I play one on tv, but that's how it looks from the outside looking in...

    Anyone more educated in this please feel free to enlighten us all.

    • Re: (Score:3)

      by gweihir ( 88907 )

      "Cardiac Death" does include end of attempts to restart it or presence of a DNR. Hence brain-death is assured to follow (if it has not happened before already), especially as the brain is not among the organs getting that perfusion. There is really nothing "controversial" here except by the usual clueless "non-consenters" that really do not know what they are talking about.

      • especially as the brain is not among the organs getting that perfusion.

        According to TFA, perfusion involves connecting an external pump across the (inoperative) heart. I fail to see how one would exclude the brain from the effects of this maintenance. Unless one puts a clamp on the patient's neck.

        You start up the external pump and continue to check for brain activity. At least that's the way I've heard it's done on all the medical TV shows.

        • Right in TFA

          "The surgeon also clamps off blood flow to the brain to prevent resumption of brain activity. But that step raises questions too, including whether some blood might still be getting through to restore some neurons."

          Basically the complaint is that might not be complete and a few (probably already fatally starved of oxygen to the point they won't work) brain cells may accidentally get oxygen.

          • Re: (Score:2)

            by gweihir ( 88907 )

            Well, the complaint is stupid. Have you ever handled a hemostat? I have some here as tools for other purposes. These are not weak and nothing is going to leak and in a harvesting scenario they are going to be handled by an experienced and competent surgeon.

        • especially as the brain is not among the organs getting that perfusion.

          According to TFA, perfusion involves connecting an external pump across the (inoperative) heart. I fail to see how one would exclude the brain from the effects of this maintenance. Unless one puts a clamp on the patient's neck.

          You start up the external pump and continue to check for brain activity. At least that's the way I've heard it's done on all the medical TV shows.

          https://www.tandfonline.com/do... [tandfonline.com]

          "the great aortic arc vessels are clamped to assure there is no re-circulation of blood to the brain/brainstem"

      • Now I have read TFA, which I should have done first, instead of just reading the /. summary. I think that the science is clear, I also believe that for some people, seeing the heart start up again, because they are 'pumping it' can freak people out, or, as with one case, when they disconnected from her, she began breathing on her own... But to me, after reading the article fully, it seems that the science should be pretty much settled.

        • Re: (Score:2)

          by gweihir ( 88907 )

          The science is settled. People are not because they do not understand the science. But what else is new?

    • After reading the article it seems these are people who are unable to live without life support and are more or less already functionally dead and will not be recovering. Honestly, I came here to ask what the heck the moral dilemma even is because I dont understand what moral issues they're referring to and the article doesnt really explore the morality issue they lay out any better than the Slashdot summary. It seems these people would be dying whether we were using their organs or not so what's the proble

      • Morality and religiosity are not equal. The religiously indoctrinated are led to believe you MUST preserve life to the exclusion of all other variables. Going to suffer horrifically for the rest of your life? Too bad, god teaches you cannot kill yourself nor assist anyone else in that measure. full stop. Brain dead vegetable on a gurney? too bad whatever SCEINCE says about your brain, your spirit is what's you and its attached to your LIVING body and its a sin to rip it from this mortal coil by ANY means.

        O

        • I like it! Good statement and logical. Yeah, it used to be that almost all doctors subscribed to the, "... MUST preserve life to the exclusion of all other variables." thought, as far as I understand it, back in like the 40's and before. I mean, when Dr. Kavorkian came along in the 80's? 90's? many in the medical field just thought he should lose his license to practice, as I recall.

    • Cardiac arrest != cardiac death. Attempts to restart the heart would need to have failed for a cardiac death to have occurred. The organs aren't touched until a patient is declared dead - the requirement for this is not lack of a brain activity.

    • Death to Dust (Score:4, Interesting)

      by Okian Warrior ( 537106 ) on Tuesday July 09, 2024 @10:52AM (#64612475) Homepage Journal

      I thought that the current concept of death included several factors of which lack of brain activity was an important one? If we focus only on Cardiac Death, doesn't that mean that some people who could have been saved were allowed to die so that we could harvest their organs?

      I mean, I'm not a doctor, nor do I play one on tv, but that's how it looks from the outside looking in...

      Anyone more educated in this please feel free to enlighten us all.

      Go read Death to Dust [amazon.com] some time, it's a fascinating read.

      The executive summary is this: assuming the body is intact and shows no sign of decay, there is no good rule to determine whether someone is dead.

      The book mentions the case where the bodies from a civil-war cemetery had to be moved, and as part of that process they surveyed the conditions and noted whether there was evidence of the deceased showing signs of life after burial. Bodies lying on sides or face down, scratches on the inside of the lid, that sort of thing.

      I don't remember the actual statistic, but I do remember it was a shockingly large percentage, something like 6% of the bodies had such evidence.

      The book points out that the widespread fear of being buried alive was the driving force behind embalming, because once you're embalmed you're definitely dead. It has excerpts from the user manual of the embalming machine saying things like "when you begin the process the body may sigh, writhe, or even sit up. The operator may rest assured that such actions are temporary and will quickly pass".

      The definition of death is "when decay is inevitable", but before overt evidence of decay you can't really tell. The book talks about a woman (Scotland, IIRC) who was pronounced dead by a doctor with no evidence of breath or heartbeat, buried, was heard calling for help, dug up, and lived for 7 more years.

      Whether there is a *practical* definition of death for medical purposes is left as an exercise for the reader.

      • Definitely going to get the book. Thanks for posting an actual informative slashdot comment.
      • great info, thank you! Yeah, I had read about the days back in the 1800's-early 1900's when they used to have bells above ground that the 'deceased' could ring if they were mistaken buried alive.
      • The book points out that the widespread fear of being buried alive was the driving force behind embalming

        For a similar reason, some graves had bells (above ground) which were tied to a string which was run into the coffin so if someone was buried alive, they could ring the bell to alert someone. There were other methods [historycollection.com] attempted to verify a person was dead.

    • Re: (Score:2)

      by sjames ( 1099 )

      Brain death gets surprisingly complicated, especially once the courts get involved. For example, >a href="https://en.wikipedia.org/wiki/Terri_Schiavo_case#Schiavo_III_and_IV:_PVS_diagnosis_challenge">Terri Schiavo.

      A big elephant in the room, often resuscitation attempts stop if the brain has been without oxygen long enough that recovery is unlikely. Determined effort might actually eventually re-start the heart, but then you get a living body with nothing like a functional brain. Arguably the person i

      • yep, I recall the Schiavo thing vividly, she had the same last name as one of my favorite teachers from back in the day, hence I followed it more closely than some. Different parts of the brain appear to then die at different rates... like apparently the Medula Oblongata, as it seems to be required for a heartbeat, while the rest of the brain is gone. I had not known that. Though my mom (RN, MS Nursing taught the medsurg nursing courses at Boston University back before she became a lawyer) would always tell

    • Re: (Score:2)

      by taustin ( 171655 )

      Life support generally isn't turned off if there's significant brain activity.

  • To make it simple. They take organs from a dead person then make the organs alive again then put them in a living but soon to be dead person without the organ transplant otherwise. I am more concerned about the dying people instead of dead people who were presumably organ donors. Not like they are forcing these organs on anyone; feel free to drop dead if you do not want them but leave the rest of us alone.

    • I am OK with this only if they constantly monitor the brain to ensure there is absolutely zero brain activity introduced while making "organs alive again."

      If they can't guarantee that, they are not getting my organs if they do this kind of harvesting.

      • I am OK with this only if they constantly monitor the brain to ensure there is absolutely zero brain activity introduced while making "organs alive again."

        If they can't guarantee that, they are not getting my organs if they do this kind of harvesting.

        Of course it is voluntary. There is a question however. It would be completely possible to install a heart assist pump, kidney dialisis, respiratory assist, and all manner of procedures to keep a person with coma brain activity or even seeming lack of it at some small level for a long time. https://bioethicstoday.org/blo... [bioethicstoday.org] Some people today believe that Terri Schiavo was murdered, in great irony - this was during the time Katrina hit, and there were politicians wanting to rescue her if needed, while otherw

        • As Stalin said, 1 death is tragic and many are just a statistic.

        • The question for me is the process. This would have to be "opt-in," as in the doctors can't do it unless they make it very clear and I sign off on it explicitly. Often when you go into the ICU there's no opportunity to ask these questions.

          • The question for me is the process. This would have to be "opt-in," as in the doctors can't do it unless they make it very clear and I sign off on it explicitly. Often when you go into the ICU there's no opportunity to ask these questions.

            I have a pretty explicit advance directive. I've seen too many family members decompose while living. No heroic measures for me, and palliative care only if I stand a good chance of never recovering anyhow. Some might think that extreme.

            The only problem is if they ignore it. https://www.johnahartford.org/... [johnahartford.org]

            • I have a pretty explicit advance directive. I've seen too many family members decompose while living. No heroic measures for me, and palliative care only if I stand a good chance of never recovering anyhow. Some might think that extreme.

              Not extreme, premature optimization maybe.

      • This. There is no "simple" except to simpletons. Grey areas are the majority and there is no black and white in this world.

        My only fear is being essentially tortured on the brink of death while my brain dies slower than normal because of this. Horrible to imagine hallucinating not fully ludcid because some residual bloodflow is partially keeping you alive.

            I think they should normalize a shot to the head like cattle before harvesting my organs.

      • Re: (Score:2)

        by sjames ( 1099 )

        If they accidentally induce some brain activity, it won't be much and it won't result in you conscious.

        "Sometimes dead is better"

    • To make it simple. They take organs from a dead person

      You're begging the question [wikipedia.org]

      All arguments are simple if you dismiss the concerns of one side and declare the other the victor.

      To make it not so simple, some people don't accept your assertion that the donor is dead.

      Many of those people vote.

      • You are simpletons if you think I implied any of this is simple. I simply simplified the article for simpletons then expressed my opinion. I know it is anything but simple to justify allowing new organ transplant procedures to the mostly ignorant masses while these all require clear consent. It is immensely ironic of people to impose their opinion on other people who wish to consent to a medically sound procedure because you have moral qualms. You are all entitled to your opinions whether you lack simple re

  • The definition of death has been continuously blurred by human progress.

    Essentially death is the farthest you can go without coming back. All it takes is one black swan to upend the current conception of death.

    Heart stopped? Dead. But he came back. Ok, so heart stop doesn't mean dead. So, what's dead? When the doctor fucking says it is, now shut the fuck up and stop asking questions.

    • Indeed, almost nothing in biology has a clear definition when you really dig into it.

      It's obvious when you're well away from the edges. Person: alive. Cloud of acetylene: not alive. Person walking around and talking: living. 2000 year old skelly dug up from a Roman burial site: dead. Dog and palm tree: different species. Mule and... well whatthefuck is going on there! Bonus points for a fertile mule.

      Same with death really.

    • Yes, exactly, like a persistent vegetative state is more or less as good as dead from a quality of life standpoint but deciding when to throw in the towel and harvest the organs is difficult.

    • There are 2 types of 'death' in transplant terms.

      Deceased from Cardiac Dead (DCD) - body cold or cooling and dead with no heart beat (obvs)

      Deceased from Brain Death (DBD) - body warm and heart still pumping

      This is essentially trying to improve the quality of DCD organs to those of DBD donors by performing regional perfusion. Note that the heart won't come back to life, and the brain is not perfused.

      There are also a number of standardised tests performed to confirm 'brain death' before you start wondering.

      Ja

  • The "definition of death" being used to delay and obstruct this advancement is proof that the only argument against this advancement is by people who don't understand anything about this. These are organs cut out of a human body. Where's the definition for that? Working or useless, those are the only definitions then.

  • The person who has died and/or their family have made a decision to donate their organs. To me the ethics are super simple - if this is the best chance to make their decision save other lives then the ONLY ethical thing is to use it.

    The rest of it is people trying to justify their careers by making a controversy out of something that IS NOT controversial to the actual donor or their family.

    I'm sorry Ms. Smith, we tried to donate your sons organs like you wanted, but the ethicists said we couldn't use the t

    • I'm sorry Ms. Smith, we tried to donate your sons organs like you wanted, but the ethicists said we couldn't use the technology to make sure it was successful.

      Or: I'm sorry Ms. Smith, we tried to donate your sons organs like you wanted, but we couldn't do so without risking a long, drawn out death for your son.

      • We're talking a time-frame of hours here, not days or weeks. They already most likely went through the longer period of reaching that decision to pull the plug/DNR.

        • Not if you're unconscious or in a mental state that makes it hard to think. I've been in hospital several times in this state, with serious pneumonia, pain, and other conditions.

          I do need an advanced directive, too. But that's hard to decide, too. I know I don't want to very slowly die of dehydration or asphyxiation (my lung capacity is very slowly falling), but we also can't ask doctors to actively put us out of our misery. We can thank religious assholes for that.

  • Not That Big a Deal (Score:5, Insightful)

    by jpatters ( 883 ) on Tuesday July 09, 2024 @12:54PM (#64612923)

    I really don't know where the opposition to this is coming from. The idea here is to use an external machine to profuse the organs with blood while they are still in the donor's body, just prior to removal. They block off the arteries going to the brain so there is no chance of re-profusing the brain. To me this is not really any different than if they just removed the organs first and then used a machine to profuse them. In either case the donor is pronounced dead first, and when organ donations are involved, at least in the US, the criteria for declaring death have strict protocols.

    • Re: (Score:3)

      by PPH ( 736903 )

      I really don't know where the opposition to this is coming from.

      False negatives.

      If someone is dragged into a hospital in cardiac arrest, they are often put on "whole body" perfusion, including the brain. If the patient tests brain dead for hours or even days, the usable organs will still be OK. People have donated successfully days, even weeks after brain death. But what if they wake up before the plug is pulled?

      The whole "clamp off the brain" sounds too much like the doctors have a delivery schedule to keep.

    • Do you recall some Marvel movie about a doctor who became a sorcerer? I think it was called Dr. Strange or something. Not my bag of tea; however, the opening scene includes one doctor calling "death" and to begin organ harvesting someone who was not dead yet, but was not in a position to being saved by the doctor who was attending. Another doctor comes up and asks Dr Strange to help out and the guy ends up being saved.

      Not typical, but people are utterly terrified of being called "dead" before they are reall

  • People are so picky and weird about the dead. Organ donation should be compulsory, assuming they're viable. Otherwise, it's just a useless corpse. Cemetaries are unnecessary wastes of space.

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