Surgeon: Remove Kidneys for Transplant Before Donor's Death

[Steve Williams]

What do you guys think?

http://gma.yahoo.com/surgeon-remove-kidneys-transplant-donors-death-162522325--abc-news-health.html

 

[es347]

THAT my friend is the most slippery of slopes..

 

[RBFC]

The Island is coming next....

Lee

 

[Phelonious Ponk]

I don't understand. Are they suggesting harvesting organs "before their cardiac and respiratory systems stop functioning," or are these patientients being "maintained on mechanical ventilation." If the later, and the family has given consent for life support systems to be shut off, shut it off and harvest the organs as soon as there is no heart beat. Or is that not soon enough?

Tim

 

[Keith_W]

I was a bit surprised to read that article. Over here in Australia, when you are declared brain dead, you do not have to wait for circulatory arrest to declare death. Ergo - if your brainstem reflexes are absent, and a consultant neurologist declares you brain dead - your organs can be harvested if you consented to organ donation, AND if your next of kin consents. In reality, many of these people are in ICU on mechanical ventilation, circulatory support, etc etc. It is generally understood that in the absence of life support, the patient would suffer circulatory arrest and die. Hence, the sole determinant of death here is brain death.

 

[Steve Williams]

I don't understand. Are they suggesting harvesting organs "before their cardiac and respiratory systems stop functioning," or are these patientients being "maintained on mechanical ventilation." If the later, and the family has given consent for life support systems to be shut off, shut it off and harvest the organs as soon as there is no heart beat. Or is that not soon enough?

Tim

Tim

They must have no brain activity and harvesting is done while there is still cardiac and respiratory activity. They suggest no waiting but harvest the organs now

 

[Keith_W]

I don't understand. Are they suggesting harvesting organs "before their cardiac and respiratory systems stop functioning," or are these patientients being "maintained on mechanical ventilation." If the later, and the family has given consent for life support systems to be shut off, shut it off and harvest the organs as soon as there is no heart beat. Or is that not soon enough?

Tim, it often isn't so clear-cut. When you are in ICU, you are usually on a ventilator. The ventilator may be put in several modes, but the main modes are mandatory ventilation (machine initiated) or spontaneous ventilation (patient initiates a breath, machine senses the drop in pressure and delivers a breath). There are of course modes in between, e.g. mandatory minute volume - where if the patient fails to breath up to a threshold set by a physician, the machine will deliver more breathing (either through increased frequency or increased volume) to make up. FURTHERMORE, the patient is usually on all sorts of sedatives to minimize suffering from the discomfort of having so many big tubes shoved down various orifices.

If the patient is critically unwell and fails to make any spontaneous breaths, it can be a bit hard to tell if this is because they are actually brain dead or whether they are not breathing because of over-sedation, or the failure of the sedative drugs to clear because of other reasons (liver failure, kidney failure, etc).

Therefore, absence of respiratory effort is not a good indicator of death. Neither is circulatory arrest, for all sorts of other reasons which I won't go into. In fact, the definition of death is rather complex. If you are interested, I suggest you read Peter Singer's "Rethinking Life and Death". Link.

 

[Thomas.Dennehy]

Another expression I wish I could unlearn -- "beating heart cadaver."

Audio via Fresh Air: Blurring The Line Between Life And Death

 

[cjfrbw]

If you ever delve into ethics, they become enormously complex rather quickly.

That is why they have ethics experts and ethics panels.

As a layperson, I think that anything that benefits the actively living over the pseudo-living is OK. Any form of artificial life support to a brain dead individual to me renders him dead, and his organs should be available.

On the one hand, aggressive surgeons aren't known for their tender emotions towards the living or dead. On the other, superstitions and fears about death and dying shouldn't stand in the way of helping somebody who can benefit.

 

[rbbert]

"Brain death" is death in all 50 states for many years now. The actual criteria for brain death continually evolve but have always included accounting for drug effects; as well the ventilator needs to be turned off for a specified period of time and generally 2 EEG's 24 hrs apart need to show no activity.

But the article in question suggests harvesting before actual brain death (i.e., death), but rather when brain death is felt to be inevitable. There are many cases where a patient is not "dead" (or "brain dead") where irreversible brain damage has occured and eventual death with (essentially) no chance of recovery is possible; those are the cases referred to in this article.

 

[flez007]

There is a local law down here where everyone becomes a donor unless there is an implicit declaration of the contrary, one must be of course clinically dead.