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When Are You Dead?

Posted by Soulskill on from the as-soon-as-the-organleggers-spot-you dept.

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?'"

24 of 516 comments (clear)

  1. I have an organ donor card... by jawtheshark · · Score: 5, Interesting

    ... 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)
    1. Re:I have an organ donor card... by Anonymous Coward · · Score: 5, Insightful

      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.

    2. Re:I have an organ donor card... by Anonymous Coward · · Score: 5, Interesting

      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.

    3. Re:I have an organ donor card... by Sad+Loser · · Score: 5, Insightful

      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.
    4. Re:I have an organ donor card... by Zakabog · · Score: 5, Insightful

      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.

    5. Re:I have an organ donor card... by russotto · · Score: 5, Informative

      Brain death is irreversible, you don't come back from that. If something comes back, it will be a vegetable, not the original person.

      If you RTFAd, you'd find out that one person who was certified brain dead and whose organs were about to be harvested DID come back and was not vegetative. You can argue that they weren't really brain dead, but that just moves the argument up a level to how you determine brain death.

    6. Re:I have an organ donor card... by rthille · · Score: 5, Insightful

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

      --
      Awesome furniture, accessories and cabinetry in Santa Rosa, CA: http://humanity-home.com/
    7. Re:I have an organ donor card... by iter8 · · Score: 5, Insightful

      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.

    8. Re:I have an organ donor card... by phantomlord · · Score: 5, Insightful

      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.
    9. Re:I have an organ donor card... by ATMAvatar · · Score: 5, Insightful

      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."
    10. Re:I have an organ donor card... by Idarubicin · · Score: 5, Informative

      And there has never been a heart transplant recipient who has lived more than 10 years.

      Bollocks. The current record is 31 years, set when 1978 transplant recipient Tony Huesman died in 2009. Dwight Kroening finished his first Ironman triathlon 22 years after his transplant. Five-year survival runs around 70%, and ten-year survival for heart transplants is about 50%.

      A heart transplant certainly isn't a panacea; it's not a magical cure, and it carries serious and ongoing risks--but it's also not the unmitigated disaster that you seem to think it is.

      --
      ~Idarubicin
    11. Re:I have an organ donor card... by ozmanjusri · · Score: 5, Funny

      Although, honestly, chickens are the stupidest birds in the world,

      You have clearly never watched The Kardashians.

      --
      "I've got more toys than Teruhisa Kitahara."
    12. Re:I have an organ donor card... by demonlapin · · Score: 5, Informative

      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.

    13. Re:I have an organ donor card... by willpb · · Score: 5, Insightful

      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

    14. Re:I have an organ donor card... by michelcolman · · Score: 5, Insightful

      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.

  2. THe Real Quesion is... by chill · · Score: 5, Funny

    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.
    1. Re:THe Real Quesion is... by iniquitous · · Score: 5, Interesting

      Two days after I proposed to my wife, she was t-boned on a major street. She broke both clavicles, cracked a couple ribs, and fractured her sacrum. Unconscious, she was airlifted to the hospital.

      When she came to, her first mumbled words were, "Not dead yet!"

      P.S. She recovered completely.

  3. My death will not be compromised! by LighterShadeOfBlack · · Score: 5, Informative

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

    Comprise. The word is 'comprise'.

    --
    Spelling mistakes, grammatical errors, and stupid comments are intentional.
  4. No Organ Doner Here by Anonymous Coward · · Score: 5, Interesting

    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.

    1. Re:No Organ Doner Here by Anonymous Coward · · Score: 5, Insightful

      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.

  5. Answer by bXTr · · Score: 5, Funny

    When you stop pounding at the inside of your coffin.

    --
    It's a very dark ride.
  6. I want my CUT! by erroneus · · Score: 5, Interesting

    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.

  7. Never!! by Indigo · · Score: 5, Funny

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

  8. Re:2 million for who? by AK+Marc · · Score: 5, Informative

    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.

    --
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