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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?'"
... 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.
Ahhh...the great dumpster continuum. Many a free computer will be found there. -- sowth (748135)
The real question is how fast will this thread deteriorate into a Monty Python quote fest?
Learning HOW to think is more important than learning WHAT to think.
>"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.
"Even though they compromise only 1% of deaths [...]"
Comprise. The word is 'comprise'.
Spelling mistakes, grammatical errors, and stupid comments are intentional.
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
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.
Contrary to the popular belief, there indeed is no God.
The article specifically states that the doctors feel it is unlikely the body feels pain, but two forms of light anesthetic are still used.
If I end up with *severe head trauma* please DO NOT resuscitate.
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?
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.
Therefore, by the (faulty) logic you're using, you're just a cow with a keyboard - osu-neko (2604)
This is completely nonsense. No doctor goes around hoping to declare patients braindead so that we can take your organs. At least in my state, only a board-certified neurologist can even make the determination of brain death. The exam for braindeath may seem "simple" but it test the most basic neurological reflexes, and you can only be declared brain dead if those reflexes are not present.
And as for "Doctors don't have to tell you or your relatives what they will do to your body during an organ harvest "
It's called an organ harvest. I think most people realize that they're going to have to do surgery to get the organs out...
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.
When you stop pounding at the inside of your coffin.
It's a very dark ride.
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!
Riiiight.... Seems legit to me
>$20 billion per year business, with average recipients charged $750,000 for a transplant
No? It's free, at least while the NHS still exists. I'm happy to give my organs whether I'm brain dead or really dead. I'm not that important and saving a life is one of the most amazing things I can think of to do in my life.
I care not for your karma and your mod points.
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.
... you're legally dead the instant you stop paying taxes.
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.
That is the question underlying the entire discussion.
I have a so-called "living will" that sets standards for when I should not be resuscitated.
I don't really care if a miracle cure comes along later.
When I'm done with my body, I'm happy that someone else can get some use out of whatever parts remain usable.
"Value of a human life" is more than just a "life or death" question. The quality of life is of concern in this issue as well.
"He's feeling much better."
"Flyin' in just a sweet place,
Never been known to fail..."
I want to be able to (1) be an organ donor (2) who the hospital doesn't know is an organ donor until AFTER they decide they can't save me, and even then maybe it's another hospital that knows instead, and (3) only let my organs go to people who aren't assholes. Well, not the wrong kind of assholes, anyway. They can be quite rude, but they can't be mean.
-- IANAL, this isn't legal advice, and definitely isn't legal advice for you. Also, Squee!
Exactly how can you have informed consent when you're brain dead?
Sounds like they're complaining that brain dead is brain dead.
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.
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.
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.
At least in the USA.. It doesnt seem to matter how dead you are if you were a sexually active homosexual male... you cannot donate your "High Risk" tissues.
Luckily! There are some hospitals that will accept "High Risk" organs from male homosexuals! hooray!!
but.. where do I put my orientation? on my drivers license? Do I have to tell my family? They didnt ask me at the DMV!! How can I keep my "High Risk" organs away from the unwitting public?!
Inquiring minds want to know.
I never trusted that a doctor would make the right call.
Before I was married, I kept a donor card with my ID which said, "Ask my mom," and listed her number.
Once I got married, I updated my donor card to say, "Ask my wife" and listed her number (unless we're both unable to ask, in which case we both have our own mother's listed).
Both know my wishes, and both will see that they are carried out.
They can have my organs when they pry them from my cold, dead... oh wait.
DUH! When Netcraft confirms it.
You're dead, obviously.
PS: I don't reply to ACs.
How about... 10% (or some number you negotiate prior to death) of the gross proceeds can be assigned to whatever beneficiaries you have specified.
It seems kind of shady to complain about a shortage of something when you not only have price controls on it, but the price you control it at is zero.
Can you be Even More Awesome?!
Unfortunately no.
There is so much whining about "needing more donors", but the really easy way to insure that is to allow for payment for organs. I think quite a few people will sign donor cards if they think their family may get $50K for their liver or something. We might want to have an additional level of review (a panel of Independence doctors and more exhaustive tests) to declare brain death for a "donor for pay" to reduce the chances of abuse.
Market based solution FTW.
Why is there an "insightful" mod and why isn't it "-1"? If I wanted insight, I wouldn't be reading
I read several comments talking about removing their organ donor status. I have done the same several years ago, when i first heard about the illegal organ trade, killing people in comas and such.
However, I have heard that even if your card specifically reads NOT ORGAN DONOR, they will still harvest your organs, right there in the hospital. They might accidentally not read your license or overlook checking your records "in the haste to preserve organ freshness"
Beware the hospitals and their organ business, and here's to hoping that they honor our Drivers Licenses, but how are you supposed to defend against evisceration by a "Doctor" while you are in a deep, head trauma coma? without anesthetic..... sounds like horror movie material
Either profit belongs in "the system" or it doesn't.
Let's assume profit *does* belong in the system. Where does the donor's estate factor into this? It (and by extension, the surviving family) doesn't see a dime for these organs that are worth hundreds of thousands of dollars to "the system".
Please stand clear of the doors, por favor mantenganse alejado de las puertas
Ask Spock, Ellen Ripley, or (my favorite) Aeryn Sun. They've been dead at least a few times.
It must have been something you assimilated. . . .
That's a lie in the article fabricated to shock. The cost of a transplant is $750,000, but they don't mention what that is, and then imply that's the cost of the organ. That's the cost of the doctors and drugs and tests and such to put an organ into someone, assuming the organ is free. Add $50,000 for the organ, and it'd move the cost to $800,000. Moving organs is expensive, and the article is written by an anti-transplant person trying to dissuade others from donating.
Learn to love Alaska
I would think the appropriate way to determine how dead you are is measure your brain activity and multiply by your credit score then add your net worth. When that reaches zero, congratulations, you've become a productive member of society and the six rich folks getting your organs thank you.
So if I am an organ donor, and I have a head trauma, what exactly is the X% chance that I'm "harvested" when I would have revived? What is the Y% that I would have died anyway? And what is the Z% that I'm revived to a really crappy bed-ridden semi-veggie burden on society life? For me in the "worst case" where I may have recovered, I still gave my life for someone else. That's what soldiers and firefighters do.
No one lives forever. Grow up, people.
Gently reply
If I'm worth that much dead, there should be a market for selling organ rights, where what's successfully harvested yields a payment to my estate. That in turn would make the organ market more liquid and efficient, and bring down the cost of organs.
"How dead do you want patients to be before you start taking their organs?' The answer, "Poor enough dead".
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.
-- QED
Yes, but it would be nice to think that my family won't be impoverished paying for my final treatments when so many make so much money from it. The least they could do is take care of the bills.
The wife and I both revoked our organ donor authorizations on our drivers license. While the other one can sign the consent, our personal rules are far more strict than the guidelines the hospital has to follow for organ donors.
When I was a firefighter there were too many times bodies were being prepped for organ donation before parents had even signed the consent forms. We both revoked our organ donation authorizations.
That's our life, the big wheel of shit. - The Fat Man, Blue Tango Salvage
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.
> I want to donate my organs, consider me dead if I'm 80% brain-dead
What does that even mean? 80% brain-dead? If only 20% of your brain is still functional you're no less dead than compared to 0% functional. Try randomly destroying 4 out of every 5 transistors on your CPU and see how it runs.
Apparently she did mind. She tried it for a rotation and apparently chose to do something else after.
If my brain damage is severe enough that I can't at least hold a public office, then it's best to just let me go.
I made the decision to mark the donation card or not. I took as much time as I wanted to inform myself, more time than I would have had to think than if the paramedics asked me. Sure, I may not understand all the intricacies, so what? I made my informed decision.
Then got told by the state "thanks, but no."
Can we have your liver?
Blog
Larry Niven's short story The Jigsaw Man extrapolated an organ donation slippery slope back in 1967, introducing the term "organlegging" to the world. The main story follows someone convicted for death and subsequent disassembly as they try to escape that fate. Interleaved with it is a future history of increasingly minor crimes that result in a death/donation sentence, as society's ability to use and therefore demand for organ transplants grows. The twist at the end involves how minor the convict's offense was, relative to current laws.
In Chicago, one often isn't removed from the voter registration lists until several years after the actual date of death, so they're still eligible to vote.
That's the best explanation I've ever heard. "Dead" is simply the expectation that you're never going to be what we call "alive" again. Sometimes we're more certain than others. Run over by a steamroller? Yeah, we're pretty certain you're dead. Brain dead? We're pretty certain you're dead, just ever so slightly less so. Heart stopped? Ok, you're not dead, but you're definitely in danger of it if we don't get it started Very Soon Now.
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?
Well it's before Ken tells you "You are already dead."
Did you know 80 to 90% of the moderators on slashdot wouldn't recognize a troll even if one dragged them under a bridge.
The sheeple aren't going to listen. I'm in favor of organ donation, but I'll trust my relatives to make the decision when the time comes. I'm not advertising to anyone that my organs can be harvested to make them money.
LK
"Hi. This is my friend, Jack Shit, and you don't know him." - Lord Kano
Back when dialysis was first perfected, the machines were extremely expensive and only rich people could afford to be treated. And since that's effectively a death sentence to the very large numbers of people in end stage renal disease (ESRD), there was a huge fuss. In the end, Medicare was extended to cover the cost of treatment for anyone with ESRD. No age restrictions, nothing.
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.
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 -
Only if they inherited the patents on your body.
"The ability to delude yourself may be an important survival tool" - Jane Wagner -
I only relinquish my organs on the condition that the transferee will not be charged a total cost of not more than 20k to include all costs and services.
I like it, open source organ donation.
Got Code?
I can't believe that it really costs $750,000 to harvest someone's liver and put it in someone else. Medical costs are so inflated in the US, it's absolutely ridiculous... You're telling me it costs the same amount to transplant a liver as it costs to produce 35-40 mid-range (~$20,000) cars??
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
> forcing someone to give up their organs is just as, if not more, despicable as trying to force celibacy on someone by denying them access to contraceptives. people have to be free to make their own choices.
Except this entire conversation is in the context of *donors*, who by definition have given their consent, so it doesn't make any sense to accuse me of forcing people.
I find it most offensive that you somehow find it "moral" to claim a right on my organs. Let's see if you reciprocate : can I cut out your heart ? You claim a right on mine, so why can't I have yours ?
How about younger children where killing an older person might save them (killing = the older person doesn't agree) ? What about a rich person needing a heart and a poor person "not having a liveable life anyway ?". What about a politically desirable individual needing one ?
I would not be able to live with a "donated" organ that was taken under the conditions you seem to think give you a right to kill other people.
Lots of good arguments against selling organs exist, notably the corruption one. Taking money out of the equation makes it a little easier to avoid the situation of rich people taking advantage of poor people and paying them to die. A better solution would be to waive all medical expenses in the keeping of the donor corpse alive (before it became a corpse, of course). That way, you get some value out of it without getting any money out of it. A better way would be to take care of every single funeral cost for the bits that they want to bury.
While I *do* have a signed donor card, it does occur to me that if there's $2m floating around that goes to hospitals to transport organs from donor corpses to recipient patients, then they may as well make it $2.2m and use that extra $200k to free my family from the burden of funeral expenses. Once again, you get value out of it without anyone giving out negotiable currency.
All that people want is a fair deal, and if donors see $2m going around for their organs while their family languishes in poverty after an expensive and long illness, they're understandably bitter and would rather feed their organs to the worms than give it away.
I'm a minority race. Save your vitriol for white people.
Seeing as there are many people who willingly watched 2 Twilight movies I'd have to say there are many people who can be considered braindead. Most would complain if you used their organs for a usefull purpose though.
Well, I might have a way, but it only works on a semi spherical planet in a vacuum.
When are you dead?
- easy, the moment you take your first IT job.
"That's the way to do it" - Punch
They have started comprising on the spellcheck.
Well, I might have a way, but it only works on a semi spherical planet in a vacuum.
You are dead enough if you like Justin Bieber's music/Twilight/"Keeping up with the Kardashians".
Well, I might have a way, but it only works on a semi spherical planet in a vacuum.
This is one of the many reasons why any private healthcare model is broken. As soon as there are financial incentives for anything the care of patients, both donors and recipients, is secondary.
I give blood and have a donor card. I do this willingly knowing that I am helping society. If my donated blood or organ was the source of profit for some company, would I donate? I don't know, but I can't see why some company should make a profit out of something I donated.
Private healthcare is a scourge. Nobody should be made bankrupt by illness, or even have to worry about it (financially). In the UK our NHS provides whatever you need, regardless of means - it's just a shame that the current government is in the process of destroying it as a reward to private healthcare companies who funded them at the last election.
I have a donor card but I intentionally do not fill it in - I would like someone else to have the use of it after I die
...when I damn well say so. Pass the brains.
Oh, I'm sorry sir, I thought you were referring to me, Mr. Wensleydale.
Can anyone comment on this? Seems the least that could be done if your an organ donor.
NOT UNTIL I SAY SO
I know such people who lead perfectly normal lives. I've done tech-support for them, and I can confirm that they ARE brain dead.
Slow down, cowboy! It has been 4 hours since you last posted. You must wait another few hours.
I am an organ donor. My biggest fear is the fact that I am an organ donor may discourage some doctors from fighting their hardest to keep me alive. Essentially, the fact that a doctor knows I am an organ donor may encourage the doctor to give up on me too soon with the hopes that my organs may save someone else.
So here's my proposition: Keep a patients organ donor status hidden from doctors until after they declare me dead. That would at least balance the playing field.
I would like to see some stats comparing organ donors and non-organ donors- is more "final hour/last ditch effort" treatment given to non-organ donors as opposed to organ donors? Do physicians tend to go to more/less lengths to save an patient if he/she is an organ donor?
That is informed consent, nobody goes into that without, thinking about it first.
Doctors are human. That means they're fallible, both potentially by well-intentioned accident and by ill-intentioned malice. For all of that, they still hold the proverbially power of life or death over their patients, including me. I don't distrust a doctor any less because he may declare me dead before I "really die" than I would because he may accidentally prescribe a medication neither of us knew I was deathly allergic to, or because he may have an under-the-table life insurance policy on me and the settlement on that would make his next couple of Lexus payments.
I live until I die. After that, if the tissues which once sustained my life can be of use to someone else after I'm done with them, terrific. Leave enough of my lifeless corpse for my family to mourn me in whatever fashion they prefer (I won't care, so whatever is sufficient for them is sufficient) and get the maximum benefit to others that you can.
Welcome to the Panopticon. Used to be a prison, now it's your home.
No, we actually gave them isoflurane. Like I said, it's to quiet the spinal cord.
the act of creating the new person, and why would you create one new person (who, depending on the severity of the former brain damage, may have no skills and/or memories) when you can harvest some organs and preserve the lives of several already existing people?
Wow spectacularly sick way of looking at the world. You will go far.
Deleted