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When Are You Dead?
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?'"
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.
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.
"Computers are useless. They can only give you answers." - Pablo Picasso
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.
Humorous signatures are over-rated.
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.
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..
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.
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'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".
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.
"Locked In Syndrome" is not comparable to braindeath. Also, if you're braindead under the current diagnosis methodology, it's pretty much guaranteed you'll never wake up. Never ever.
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.
I sure hope you don't end up waiting for an organ that won't come because of an attitude like yours.
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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".
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 also.
This is my dad, 14 years after coil embolization to repair a brain aneurysm, a stroke resulting from a clot breaking free after the surgery and further complicated by hydrocephalus and an infection in his brain stem when he was 41 years old. As you can see, a substantial portion of his brain is dead. He has left side hemiparesis and initially had massive problems with short term memory loss, swallowing, cognitive function, lack of inhibition, etc during the first year. Today, he's almost normal, though he sometimes gets a little forgetful and he needs help walking (he never regained much of his left hand). Most of the damage was done because it took 2.5 months to get him stabilized enough to go to rehab. After the surgery for the infection in his brain stem, he was in a coma and on a ventilator. I was told that he had 3 days to come out of it or he probably wasn't going to... and, respecting his wish to never be left to live on machines, I had made the decision of when I was going to pull the plug (I was going to wait a week so he didn't accidentally hang on and die on my sister's birthday).
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."
Don't leave your mind so open that your brain falls out. Don't close it so much that you cut off the blood.
He wasn't declared brain dead... though the only stimulus he responded to during the first couple days of being in a coma was literally twisting his nipples until they bled. Had THAT not showed a response, he probably would have been. Maybe a less rigorous doctor doesn't even take it that far (and he was lucky enough to have a world famous neurosurgeon). On day #3, the day they told me was pretty much the point of no return, I came in and asked him to show me two fingers... he finally gave me a gesture, though it was just with one hand. I've gotta say, I don't think I was ever so happy to be flipped off in my life. I ran to the nurse's station to inform them and I kinda got a nonchalant "yeah, we know." Nice of them to inform me.
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?
Don't leave your mind so open that your brain falls out. Don't close it so much that you cut off the blood.
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.
"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety."
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
Georgia
South Carolina
Utah
During the French Revolution, betting on how far a headless noble would get was a popular gambler's game.
"The ability to delude yourself may be an important survival tool" - Jane Wagner -
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.