> When told of my upcoming case, I had mixed feelings. On the one hand, being in perfect health, unaccustomed to suffering and therefore easily disconcerted by the thought of death, I was horrified. My attitude toward death was like that of a young person standing blindfolded and tied to a post, awaiting a volley from a firing squad. The whole concept made my blood run cold. Yet the case also aroused in me a feeling of relief. Simply put, there was no risk of malpractice, as my patient was already dead. Many anaesthesiologists have such self-centred thoughts when taking care of ASA 6 patients.
> After we moved her from the gurney to the operating table, the doctors and nurses, so used to taking care of living patients, stared at one another stupidly, as if not knowing why they had come together or why they stood around the table.
Sorry this strikes me as embellishing for the case of writing a story.
Background: I was a neurosurgery resident at a level 1 trauma center. I was involved in determining brain death (though the final certification was by an attending surgeon). I worked closely with the transplant team. I declared (normal) cardiac death many times. I had many agonizing conversations with families about withdrawal of care.
Anesthesia is a 4 year residency. Even the 2nd year anesthesia residents I worked with had more of an awareness and lack of naivety that this author shows.
And the OR teams were much more prepared and professional than this. They knew what they had to do and why they had to do it.
If there are other physicians here, I would love to hear your opinions, but this whole piece strikes me as overwrought and full of embellishments to make a certain point.
Yes I agree with you. This doesn’t add up to me. Especially this part:
“On the one hand, being in perfect health, unaccustomed to suffering and therefore easily disconcerted by the thought of death, I was horrified.”
When one is a medical student starting anatomy working on cadavers I remember such thoughts being common. But by the time one had gone through years of medical school and then years of residency I would be quite astounded that one would still have such a reaction.
I work near health environment, and what I notice is a heavy selection. If someone doesn't tolerate "living cadavers" they quickly take options: go to the private sector, take a speciality that doesn't deal with such events, or in the worst cases they drop out to something like the pharma industry.
My own personal experience with deceased donor transplantation is the pre-donor screening imaging to make sure there’s not a surprise cancer hiding for the recipient…
This had the flavor of being written by one of those types who’d rather write breathless blog posts about taking care of patients than actually taking care of them.
If you’ve been to medical school, you know the type.
Not a doctor, but I did grunt work in a pathology lab to pay through undergrad.
> the doctors and nurses, so used to taking care of living patients, stared at one another stupidly, as if not knowing why they had come together or why they stood around the table. For a brief moment, each one of us likely had the same supernatural vision, how for the past six hours, after being declared brain dead, this woman had lain under the measureless power of death. Six hours she had been officially dead. Six times had the hour hand on the clock moved – and she had lain dead. Now she had re-entered the world of the living.
I saw that reaction to death exactly two times during morgue drop offs: once from a younger L&D nurse—although I think it was more the inside of the morgue walk-in creeping her out—and once from an ER nurse with a 9 year old (asthma attack). Never from any doctor, although granted I almost never saw any doctors at all at that shitty community hospital. I don’t think it really stops being weird, I think it’s baked into our brains just like arachnophobia in some people, but I’d be concerned if an OR team, let alone a transplant team, were sitting around in silence like that. Usually they listen to the radio.
It’s fairly common for people to be paid by special interest groups and lobbyists to put their names on ghostwritten articles. It’s what got Amber Heard in trouble. I could see it happening to doctors.
Thats what most journalists do these days. I was even told straight to my face that "creative writing" was necessary as the mediaoutlet already knows what their readers like, and therefore facricate paragraphs which they know will be well received. Facts are unwanted, especially if they lead to complicated explanations. JOurnalisms is dead. Its only kept alive by the false claim that it (not in its current state) is necessary to keep democracy alive, which is also a self-surving lie at this point.
I’m open to this cynical perspective but what do you think the journalists feel about their profession? Are they simply doing this to survive and earn a living? Or are they aware of its corruption? Or do they somehow think they’re still performing the job of defending democracy? What about people like professors who teach journalism? It’s hard to imagine that everyone is totally corrupt as to not want facts, although I do agree that news outlets have biases…
It's likely just a selection process similar to politics. Are you willing to lie, mislead, deceive, and sell yourself to the highest bidder? No, well then good luck beating your opponent who is doing all that, going to have more funding, more widespread appeal, and never a single inconvenient position because his positions on everything are whatever polling tells him the voter wants to hear.
Newspapers (and employers in general) can now do similar filtering, if they want to, thanks to social media. If you're not committed to pushing a desired narrative, and willing to spin anything to fit it, then you're not getting hired. And given the state of society today, it's unclear if a newspaper with objective or diverse reporting would be able to compete against the current batch of confirmation bias delivery services.
The first half of your comment provides a sufficient reason why something resembling journalism stays alive: readers want these stories.
What does this have to do with democracy, and what's the causal chain that goes from democracy (or the zombie of democracy, I guess) to keeping journalism in suspended animation?
Journalists claim their work is necessary for the democratic process. Which they use as a reason why their work is supposedly important, even though they are not really reporting anymore, just making up things.
In my hometown, there is a foundation focus on propagating some declaration about Tibet people sacrifice human in their traditional religion. the reference is New Yorker...
I find this article is trying too hard to be poetical.
It all starts with the title. What they describe is not the "Last hours of an organ donor". The last hour of the organ donor was spent in a car. They had an accident. After the accident they were in pain, fear and distress. We don't know the exact details but after some time people trying to help arrived. There might have been firefighters extracting her and paramedics trying all they could to save her. They transferred her to a hospital where they might have tried even more advanced things to save her. They failed. That's the end for that person. That was the "last hours of the organ donor". The process described in the article is not the last hour of her. It is beyond that.
> Indeed, she might even wake up and look at us, I fantasised. She might be raised from the dead.
If this was written by a real doctor I'm concerned that they are not mentally fit to practice this speciality. This article reveals that they don't have the right emotional constitution to perform the job without harming themselves.
> Simply put, there was no risk of malpractice, as my patient was already dead.
This again is wrong on so many levels. You can still ruin the organs. You can in fact kill many people during this procedure. Not the one under the blade, for that person is already dead. But the ones waiting for the organs. Will they be able to sue you? Probably not. So they are right there is no "risk of malpractice lawsuit" , there is still a high risk of malpractice.
It's a good read. It's very pro organ donation but also talks about the dark side of this practice, of potentially killing patients to harvest their organs, among other things.
I am more familiar with the emotional toll organ donation takes on potential recipients who are basically waiting and hoping for someone young and healthy to die in a tragic accident that they might live.
Because of the focus of this piece, I will leave this link to two previous comments of mine:
I guess the idea is that the psychological burden of having received a donated heart caused the woman to have hallucinations? I don't know what to do with that information, but I wanted to look at a charitable interpretation of the suggestion.
It reminded me a lot of some of the stories told by that poor fellow currently blogging his way through late-stage neck cancer, and whose posts lately have often reached the front page - specifically, it reminded me of his posts that talk in detail of what it's been like for him and his partner trying to negotiate the modern medical industry, and which would read like something out of Terry Gilliam's most darkly comedic fever dreams were it not for the literally life-and-death import of their subject matter.
I doubt anything like that was the author's intent, but who cares? Theirs is the first, not the last, of the hands which shape the text.
Yeah that’s really weird. On the one hand, certain precision operations are already carried out by robots guided by surgeons on a computer screen, and experienced surgeons in certain domains can even oversee multiple robotic operations simultaneously.[1] On the other hand, unless you’re willing to put up with failed organ retrievals to save a little bit of money, I can’t imagine humans out of the loop any time soon.
[1] Source: A family member recently retired after working in the OR for more than three decades.
Yeah it was jarring — wouldn’t be surprised if the first draft didn’t contain it at all, and the editor forced it in there so the piece would have a “hook” to current events.
Honestly one of my biggest hangups about becoming an organ donor is the fact that the final decision is made by doctors.
I have not had good experiences with doctors. More often than not, I have experienced doctors' being wrong about my health status, and recommending treatment that ultimately does me more harm than good. How could I trust that same class of people to make as important a decision as this, knowing it'll be luck of the draw which one I get the day of some fateful accident? Even if I can name the person finally responsible for authorizing taking my organs, they're going to be doing it trusting the judgment of whichever doctor happens to be on shift.
We also can't know if--and if so, how often--they get it wrong. As the author mentions repeatedly, we can't know when "brain death" is "real death," or whether the medications given to preserve organs prior to cardiac death actually cause "real death."
It's the most important set of dice I can possibly roll. How can I make that bet? How can I bet that these people will accurately assess when I'm dead, even if I were to remove potential conflicts of interest from calculation entirely and grant that they were purely well-meaning? Even if the chance of being wrong were miniscule, the consequence to me of being on the wrong end of it is total.
I wish we could find a way to revive organs after death rather than having to keep them in a quasi-alive state. I would love to donate parts of myself so other people can live, after I'm done using them to live.
I feel mostly the same way, but kinda think that the doctors who decide if I live or die will do so whether or not I’m an organ donor.
It’s statistically more likely to die before the change of a shift, or before the weekend, or (more cynically, and less scientifically backed) before tee-time. People are people, and they make mistakes and have biases and get tired even if they went to med school for X years.
So, If I’m close enough to be an in someone else’s book for some silly reason, at least it means somebody gets to live if I’m an organ donor.
I think I'm more concerned about the cases when it's their actions that would cause my death. Like, when people are declared brain dead, it's common that the heart and other organs are still operating fine. As far as I understand, there isn't some hard and fast line where anything changes between "no detectable brain activity" and "let's take out the organs." Those events can be separated by minutes, hours, or days with minimal difference.
What if they're wrong and I'm not actually dead? I certainly would be after my usable vital organs are removed, but what if I wasn't before?
I can see the argument, what kind of life is it really if all you're doing is lying on a table, nit conscious and not moving for the rest of your life? Maybe you'd rather not live at that point anyway.
But on the other hand, what kind of death is it to be cut open and have all your organs removed?
One of my biggest fears is a “Johnny get your gun” (or Metallica’s ‘One’) scenario where I’m actually aware but cannot communicate it. That seems worse than death.
For organ donation the organ removal doesn’t kill you. They take you off of life support equipment keeping you alive first. Basically it’s the same way you would have died if it weren’t for extreme modern medical intervention.
Either way, you should communicate with your loved ones about what you want to happen if you’re diagnosed as brain dead. Ideally memorializing it in writing. It’s hell to have to make that decision without knowing what the patient would have wanted.
It’s not the largest of the concerns involved but (if you haven’t) you might also want to consider the financial and mental/emotional cost to the people having to take care of you.
This sounds biased (because I hold biases) but it’s not intended to convince. We had a family member on a ventilator recently and it sucked. But at least there were plans put in place before it happened.
The article made it sound like they actually don't turn the other devices off in case of brain death, because it's so much better for the organs that they be kept in as close to a living state as possible. If your lungs can keep moving air (even assisted by a ventilator) and your heart can keep pumping blood, it's better that they do so, right up until they're extracted.
>They take you off of life support equipment keeping you alive first.
They absolutely do not do this. You're kept on life support until the very end because it's important to keep the organs oxygenated. You're also not given any anesthetic because it's presumed you're completely brain dead and unable to feel anything. Given our primitive understanding and testing for brain death, I'm not comfortable with that.
So they receive the same sort of anesthesia as a surgery patient? When I asked other doctors about this I was told the patient was given some things to control blood pressure, etc, but not anesthesia, as it would be 'wasted'.
edit: I admit I didn't read the article, I get queasy reading about that sort of stuff.
Yes, the same sort of anesthesia. You mention blood pressure in particular. Controlling pain, usually with opioids, is a huge part of controlling blood pressure.
I cannot strongly enough recommend you find and build a relationship with a Direct Primary Care doctor. It will totally change your relationship with modern medicine. Not only will that doctor actually care about your health continuously, but he will connect you with specialists in his own referral network, who will treat your issues with similar care once you mention that Dr. SoAndSo referred you as his patient. At the end of the day, for better or worse, doctors are people too.
I live in the greater Los Angeles area and could not agree less. Primary Care is in deep trouble and will only get worse.
I nominally have a Primary Care doctor that works for a large health care org - nonprofit that pays its CEO ~$18M/year. When he was new and had few patients, he took time and initiative. Since then and especially after Covid, his attention to detail has dropped and his bosses increasingly dictate what he can and cannot do. He has to refer specialists within the health care org if they have that specialty. On a couple of occasions he has suggested I go to a specialist but he has no names to recommend. He is perfectly happy to be a salaried employee where the nuts and bolts of running a practice are taken care of by his company. He won't say how many patients he has on his roster but given the time to get an appointment it must be in the hundreds. The front office pushes Urgent Care whenever they can which dumps the whole concept of a doctor who knows you into the toilet. Pay a premium (natch) for someone who doesn't know you and doesn't give a damn (see the reviews).
He is required to type 90wpm into the Epic system which prompts him on what to do during the 10-15 minutes he is authorized to spend on me. I am fortunately alert and functional when I have seen him but when that is no longer the case, I am well and truly hosed.
If by Direct Primary Care you mean "Concierge medicine" where one pays a private practice Doctor a yearly fee for improved access, I tried that as well before the guy above. The doctor was a big talker when selling his practice but he was scatterbrained, unfocused, and inept in actuality spending more time talking about his extreme politics than actually paying attention during the exam and my questions. I bailed after a physical exam and followup.
Before that I had Kaiser which is beneath contempt.
Every doctor, medical org, and insurance talks up the relationship between patient and primary care but once you're in, it's a f&*king joke. There are no success stories I can find among my coworkers and acquaintances. We're all on the same stinking sinking ship.
Actually by far the worst experience I have had with doctors was the year I hired a DPC. I had such high hopes for that model, but she was just an awful, awful physician.
This year is my year of recovering from that experience. It's costing me tens of thousands of dollars.
As another point, my PCP moved to a concierge model a few years back. We stuck with him and couldn’t be happier with the situation. Finding a good doctor you trust and have a good relationship with can be hard, but very worthwhile.
I am very sorry that it cost you so much in pain and in dollars. I do sympathize with you that DPC/Concierge is a lot of hype along with the high costs.
> It will totally change your relationship with modern medicine
I'm glad you really like your primary care doctor, really, but no it won't. They're still slaves to the broken system they work for (insurance) and they're still overworked and underprovisioned.
> Not only will that doctor actually care about your health continuously
I think "care" is being used too generously here. Their job is to _be aware of_ your health. They don't "care" about it, necessarily.
> but he will
I can't help but point out this use of "he"
> who will treat your issues with similar care once you mention that Dr. SoAndSo referred you as his patient
This is again not true, but again, really happy this is your experience.
No, of course not — but the correct English third-person nominative singular pronoun for a human being of unknown sex is ‘he,’ just like the correct English third-person possessive singular pronoun for a building is ‘her’ and the correct German first-person nominative definite article for ‘Mädchen’ is ‘das.’
There’s absolutely nothing wrong with using correct English.
I think the down votes are because "Direct Primary Care" doctors opt out of the insurance system. That's the point of the model. They collect monthly subscription fees instead dealing with your insurance company.
Granted, if they want to refer you to anyone else, your insurance may be involved, but not a few of them also have arrangements with those "health sharing ministries" where the patient cash pays for any procedure with the assistance of other people in the health share, which again saves enormous amounts of money by skipping the insurance system.
Those "health sharing ministries" are a complete scam. They take your money and provide you nothing. Sort of like church and the donation plate, only they purport to provide a genuine service in the health care field.
Are there studies bearing this out? I and many of my friends have been part of them at various points and have had tens of thousands of dollars of care provided through them.
I've also had both experiences that correspond to and directly oppose your take on the church donation plate, so I'm curious if you're aware of data about this, or if we're just comparing personal experiences.
There's a quasi-religious aspect that's developed about the whole thing.
Culturally, we have made "science" and "scientists" everything (apparently losing sight of the fact that "science" used to describe a method for testing hypotheses, not a set of conclusions about the world that result). "Trust 'the science.'" "Scientists say..."
We also do not want to talk about death, ever, for any reason. We only make it through the day by ignoring the fact that we will all die.
If we tell ourselves the expertiest experts will be the ones who will take our lives into their hands, we can just barely stop worrying about death long enough to get on with life.
But if you point out that these are smart, methodical, but also fallible, ordinary humans who get things wrong sometimes and make mistakes when they're tired or hungry, it shakes people a lot more viscerally than when you say the same about, say, an accountant. You're questioning the dogma of the day, and you're shunned like a heretic.
My biggest issue with organ donation is that 'brain death' still isn't terribly well understood. There are sensors that can be used to determine blood flow, fine grained brain activity, etc, but they aren't universally widespread. Reading the accounts of patients with 'locked in' syndrome really spooked me. I wouldn't want to live like that, but I'd want to be anesthetized the same as any other surgery before organ donation.
Every doctor I've asked about this has dismissed my concern out of hand as if I'd just said vaccines cause autism. I simply cannot trust that my wishes would be honored, and thus my answer on the 'organ donor' question is no.
Brain death presents differently than locked-in syndrome. It’s diagnosed by weaning a patient off drugs that could impair breathing and then seeing if the patient breathes on their own. If they don’t breathe on their own, the assumption is that the brainstem is no longer functioning and that’s what’s meant by “brain death.”
My grandfather had a stroke which affected his ability to breathe on his own. He was placed on life support for a little while. I was told he finally indicated he did not wish to remain on it (somehow, I wasn't there), and he was disconnected and allowed to pass. My point isn't that he was 'brain dead', but that higher order cognitive function can remain even after someone loses the ability to breathe on their own. I'd have no desire to cling to life in his condition, but I'd want to avoid any possibility of being around for the final harvesting operation.
Please define what you mean by "real death" in terms of objective clinical criteria. Are there any recorded cases of a brain dead patient who later recovered consciousness?
In the end we are all expendable, and whether we live another day doesn't really matter. I think some people forget that reality and get too wrapped up in their own survival. That's not to say we should just give up, but at some point it's time to move on.
See but you've hit on exactly the problem, and the article mentions it. It is impossible to know when someone is really dead when some systems critical to life are still operational. Sure, there's a difference between a living person and a corpse, but there's not always a bright line that tells you when the change from one to the other happens.
There are several patients who have been declared brain dead--and even scheduled for organ harvesting--who later recovered. [0]
People who believe as a premise that brain death is real death can reply all day that these people were just misdiagnosed and were never actually brain dead--and maybe that's true!--but when I'm considering myself as potentially the person on the table, we're back to my original point, that we're trusting the doctor to decide whether I'm actually dead, and the risks are way too high that the doctor will be wrong for me to roll those dice.
I found this a very beautiful story, I was moved to tears and I learnt a lot I didn't know about the process.
I would like to assure the author that there is little to no risk that "AI" will perform that job any time soon, though. It's handy for certain things but those of us who use it every day know how limited it is, and will be for a long time.
The article reads a lot like two articles in a trenchcoat:
1. a personal account of the procedural and philosophical weirdness of treating a body with a dead brain but otherwise-alive organs as simultaneously alive and dead
2. a criticism of the anticipated role of artificial intelligence and its perceived lack of bedside manner
Article #1 is compelling. One of my relatives is an anesthesiologist and I'm tempted to reach out to her to ask whether she's ever treated an ASA 6 patient and (if so) what her own thoughts are on that procedural and philosophical weirdness. Brain death is something that fascinates me on both those fronts - stark evidence that the line separating life v. death is fuzzier and more context-dependent than a lot of people would want to admit. The possibility for a body to be living while the organ responsible for what we usually call "personhood" is permanently dead is a centrally-shared influence behind my views on everything from abortion to animal rights to artificial intelligence to the afterlife. What even is death if pieces of us continue to live on separate from ourselves?
Article #2 doesn't feel as compelling. It seems to come out of nowhere, and I don't think its premises are particularly well-founded. In particular, the conclusion in the last paragraph:
> AI promises to elevate healthcare; but, to the degree that it replaces doctors and nurses, it also threatens to depersonalise patients and to wash off their distinctive colours until everyone has the same drab tint.
I don't perceive AI as the thing that's doing that. That depersonalization was a foregone conclusion the very moment someone came up the idea of privatizing healthcare. In the case of organ donation specifically, that depersonalization is more than offset by the repersonalization of those organs inside of someone who needs them; organ recipients and the loved ones of organ donors alike express all sorts of feelings of connectedness through those donated organs - as if the donor, at least in some sense, continues to live through the recipient. Indeed, a part of that donor's body does continue to live through the recipient, and there's a poignant beauty there that no amount of corporate-driven distillation of patients into insurance records and HL7 streams can ever hope to "wash off".
>> AI promises to elevate healthcare; but, to the degree that it replaces doctors and nurses, it also threatens to depersonalise patients and to wash off their distinctive colours until everyone has the same drab tint.
> I don't perceive AI as the thing that's doing that. That depersonalization was a foregone conclusion the very moment someone came up the idea of privatizing healthcare
No, the way AI is used is the apotheosis of that. There is nothing inherent in AI that makes it automatically serve the interests of capitalism, for the same reason there is nothing inherent in any other technology that makes it automatically serve the interests of capitalism. Rather, capitalists exploit such technologies and wield them to those ends.
The shovel that digs a mass grave is, at the end of the day, just a shovel.
Good article but just reinforces to me that we need organ printing technologies and anything else is just a stop gap. Maybe between articles like this and consuming a little too much body horror fiction, butchering a cadaver to put its organs in another is just unsettling to me even though I see it as good in the utilitarian sense. I continue to be an organ donor however.
Used to work at a coroners office and the activity I saw on the sign out sheets for each persons autopsy file made me change my status from donor to not. The donor organizations (God bless them) just moved way too quick and came off as too thirsty for my taste. Not to mention (not that people would care) you look like a baseball the way you’re stitched after.
I m not a doctor or anything in that sort, so stupid question time: is donated blood labelled by male/female? If not, how come we can transfuse male blood tp women patients, there is a whole bunch of male hormones in excess, and a whole bunch of others missing?
Donated blood is stored as packed red blood cells, with the plasma removed. The plasma is where most of the hormones reside while being transported, so in packed RBC transfusions, there will almost no transfer of hormones. This makes it so that blood type is pretty much the only important factor when determining whether somebody can receive blood.
Sometimes doctors do perform whole blood transfusion which does not have the blood plasma removed. This has the chance of increasing hormonal levels temporarily in the recipient. However, the body will quickly compensate and bring levels back to normal. Even if not, the hormones will still degrade and lose their effectiveness over time.
Side note: everybody has both male and female hormones in their body, at different levels. These levels can change a lot depending on your age, genetics, menstrual cycle, or even the time of day. As long as there is no prolonged increase in the levels of a particular hormone, there won't be any abnormal effects.
This whole article made me really uneasy about organ donation. The whole bit about preparing a person on ECMO for organ donation read a bit like medical malpractice to me (not from a medical background). It’s enough of a controversy when to turn those off as it is.
Not a doctor; previously worked in a lab that matched solid tissue (organs) from donors to recipients.
The article has very emotive language, and not in my opinion the mindset of any doctor that has long left in their profession.
I can't speak for non-UK donation, but the bar is so high in order to be able to donate tissue. Maximum 4 hours from being declared DBD/DCD and retrieving tissue. Even then, if someone has expressed a lifelong wish to donate, ticked the box on their driving license registration, carries a tissue donor card... Their next of kin can say no, and that's final. 75% of potential donors don't get to be donors. With a growing list of ~3000 kidney recipients, 300 get donated annually. (I'll hold my hands up here, these figures are what it was in 2018 when I left)
It's still a morbid topic. The donation specialist nursing team (who do an incredible job) are called vultures as one of the nicer nicknames.
Doctors [can] do bias training to improve patient family responses to the donation offer, and most of them haven't, and exhibit unconscious negative reactions when talking about it, putting them off.
But that person isn't alive; they're not being murdered. Instead, they have the chance to save lives through the use of a body part they can no longer use.
If you want to save lives: talk to your families about your wishes. If you're ever up for the chance to change 10, 15, 20 lives, it will be too late to tell them about it.
I am going to agree with others that the actual reading and tone of the article seems, weird. Not fully sure why the AI parts are thrown in (and I say that as someone who is very against this AI push the last couple of years).
But on the topic of being an organ donor, I would be lying if I have not personally struggled with this. I fully understand the struggle and the need for it. But as someone who has a ton of anxiety about death, enough that I take medication to deal with it and it is regular topic with my therapist.
I am also an atheist, so I believe that when this body dies I am dead. So I also recognize that any thoughts about, "how will I feel once dead" or "fears of regrets once dead" don't make any sense whatsoverver logically.
But I say this because, I still have that voice in the back of my head saying. What if we are wrong about death. What if I am still aware of what is going on even at "brain death". I have the same thoughts about cremation. This causes me to spiral about being an organ donor.
I find myself almost every time I need to renew my license debating on switching back and forth, and have even done it a few times with this feeling of shame for even thinking that I wouldn't be one.
This feels like one of those things that logic and emotion really don't match up and I can tell myself all day long about how being an organ donor saves lives.
Even reading this and writing this is causing me to spiral a bit.
I don't know if this will comfort you or not, but it has me. I experienced "death" a few years ago (I got better!), and it was no big deal. I had a small stroke, made it to the emergency room, and had another (larger) one while they were trying to figure out what the first event had been, and whether or not to admit me. I seized, passed out, and came back to consciousness six or seven days later (it was more complicated than that, but that's the gist).
I am really, really grateful for the experience, because I have completely lost my fear of death. If I hadn't woken up, it wouldn't have mattered (to me) at all: I was gone. As an experience, it was easy - because it's a complete absence of experience - and as it relates to my day-to-day experience of life it's like a category error.
Naturally, I'm afraid of dying - I mean, like, debilitation; dependence; pain. Those sound unpleasant - and to the extent I've experienced them, really are. But the non-existence part of death? I won't be there to worry about it, so why should I worry about it now?
(When I've posted something about this on this board before, I've had push back about how I didn't really die, so my comments aren't relevant. All I can say is that my first-person experience (in contrast to my medical state, which, sure, not the same thing) was, in every way I can think of, indistinguishable from (thankfully temporary) death.)
So, I dunno if a third-party trip report would have meant anything to me ahead of time, but I hope it does you. It's caused my own emotion and logic, as you put it, to align. I hope, internet friend, that you can find a way to get to the same place.
The entire point of Aeon is to write "longform explorations of deep issues". Not all--maybe not even most--content exists merely to transfer some tiny bit of information.
The point isn't really the length. It's the overly sentimental tone that blurs subjective perspective and the matter being reported on. There's a point in the piece were the author asserts that everyone in the operating room seemingly stared at each other not knowing why they were there followed by the author fantasizing if the patient may rise from the dead.
That's almost certainly not what happened in the room but is the author blurring his almost literary account with reality. It's a very common almost manipulative style in newer journalism when writers want to contrast their emotional state vs an allegedly harsh reality.
The danger of commenting like I did at all is that it's not a universal experience. I found it insightful sitting in an airport killing time. Perhaps consider accentuating the positive ¯\_(ツ)_/¯
I left my comment when it was at risk of falling off the front page with no comments. Utilitarian, to hopefully see an insightful discussion from those more informed.
I see where you're coming from and perhaps what I meant is something closer to 'build things up rather than tear them down'. You've got two conflicting opinions. Theirs and mine. Inquire inside the article to see which of us is a worthy recommender of casual content to consume on the internet
You're reading it wrongly, and I say that as one who 99 times out of a hundred has no use whatsoever for the nonsense Aeon typically peddles. This is the exception, even to the repeated fears over AI, which while technologically footless for the foreseeable future nonetheless express something real and worth considering.
I thoroughly agree; I enjoyed the read. The brief discussion about the coldness of this being performed through AI and machines gave me a feeling of loneliness, of being just a number in this big old world. What a “cold” future it could be.
A touching essay, but to my mind, the bioethics of organ donation that have become law (in most Western countries) are the major culprit behind organ scarcity, treating economic realities of supply, demand, and risk as taboo.
I would 100% sign up for organ donation if it could either add a score bonus to me or my immediate family if we should ever find ourselves on the waiting list. Heck, I'd even donate blood or plasma more often too if they'd have some minor bumps.
Medicine has a long history of being associated with things like the military and religion ("medicine man" being a term for a shaman, both spiritual leader and healer in tribal cultures). The military emphasizes values like honor and the good of the group over the individual while also typically making strong promises to do right by those who make sacrifices.
Profit motive seems to generally be counterproductive to health.
If people will donate plasma etc to get "points," this potentially encourages people to donate bad blood into the blood supply because they expect to need an organ someday.
I don't know how we might a/b test something like this to see what actually works, but people have good reason to be skeptical of profit-driven or personal-gain driven processes for things of this sort.
It is probably a mistake to reply to this but there are bloodborne pathogens we don't keep stats on which are challenging to test for, so good luck with that.
It's possible for an individual to have a pretty good idea they aren't in good health and shouldn't really be donating without necessarily having affirmative tests for specific infections.
It's a meme that homeless people sell plasma and are also alcoholic. You see jokes about stuff like that in TV shows or whatever.
I don't know about you, but I don't really want my blood supply to primarily come from homeless people or relatives of people with genetic disorders at high risk of needing an organ transplant. The relatives may not have the disorder but may be carriers and may have health issues they aren't disclosing if their goal is to get points for their deathly ill loved one.
I call BS. The reason blood donation isn't compensated is to avoid addicts polluting the supply for a $50 drug fix - these are not people who plan well long term about their health.
> I would 100% sign up for organ donation if it could either add a score bonus to me or my immediate family if we should ever find ourselves on the waiting list.
> If you donate at a transplant center that partners with the National Kidney Registry and for any reason, need a kidney after donation, you will be given priority for a living donor kidney.
I can't find info about it now, but I'm pretty sure in the 60s in South Africa, if you regularly donated blood you got to be bumped up the system for various ops and waiting lists, and if you had to stay in hospital you were offered a better bed/room.
Sure I remember my relatives talking about that in some long ago conversation.
I would do it on a straight marketplace. As it is, I'm not sitting around giving up my bodily parts so that an organ procurement organization, a hospital, and a transplant surgeon are going to make a lot of money on. All of them have one thing to say to people who need organs: "pay me". So I'll join the line. If you want my organs "pay me".
NOTA ruined the ability for an organ marketplace and created the resulting shortage. A lot of people have a visceral dislike for the idea of this stuff. They rationalize this with arguments that are easily rebuked.
Isn't this an indictment of the profitization of healthcare, rather than an argument for increasing it by paying people to donate organs?
Selling organs sounds ghoulish and horrible to most people for a reason. They likely don't realize that's exactly what's happening behind the scenes - if they did, they'd think that was ghoulish and horrible as well.
Selling organs for a reasonable markup over direct costs seems perfectly fine to me.
Hospitals don’t build and staff themselves any more than grocery stores or utilities do. Organs don’t harvest and fly themselves to the point of need unaided…
If people can make a living (pun was accidental) doing this, it’s more likely to exist in a vibrant way when I or someone I love is in need of it.
You're preaching to the choir, my friend. But I didn't feel like courting that battle today.
Everyone in the organization transplant process except the donor benefits. And what do we have to show for that injustice? 8000 people a year dying waiting as the article states, not to mention insane costs alone due to dialysis.
Background: I helped my mother die, and in the process decided NOT to be an organ donor anymore.
tl;dr: you cannot crank the painkillers up to eleven and still donate.
What I'm doing instead: donating my body to a medical school, which they can then chop up (either the students, or to sell off pieces "for science"). This allows me to implement a custom and pain-free exit regiment (an organ-destroying cocktail of fentanyl, morphine, and ketamine).
Most organ donation is from traumatic brain injuries resulting brain death. I have no idea how you could be in long-term hospice care and still be an organ donor, because if you're conscious and awake no one is going to do it.
No one is denying painkillers in order to produce organ donors, nor is it even practical: you would have to be on intensive life support at the time of brain death in order for it to be even considered.
EDIT: Like your statement seems to read as though your mother wanted to donate, but couldn't have voluntary euthanasia if she did (except again, if she was that awake then it wasn't going to happen unless she suffered brain death and was on life support) so your conclusion was...in the event of a sudden, traumatic brain death on your part you instead don't want organ donation to be an option?
Then I'm still confused about what happened here. If you're on life-support, and brain dead, then either you become an organ donor or they turn the machine off and you just die (because otherwise you wouldn't need to be on life support). Of course if you're brain dead, you also don't need painkillers and people who are brain dead or in a coma aren't on them.
They don't crank the painkillers up - in fact no doctor will do this because it's legally murder.
People in comas aren't on painkillers unless they're medically induced (i.e. burn victims in recovery) because the goal is for the patient to wake up. You can always push morphince once they do.
Her [sudden, at 60] stroke was massive, but confined to only her left hemisphere. She was intubated (against her DNR). Through prior agreement, this was a "terminate me" condition. She was not in hospice care at the time, and still worked 50+ hours per week. "If you make me retire [because of my health], you might as well kill me," she had recently told me.
>if you're brain dead, you don't need painkillers and ... aren't on them
False. Prior to my arrival (as pre-arranged death angel), the hospital had induced knockout via massive sedatives. My first action (before viewing the PET scan) was to stop these, which caused her right brain to "wake up" — which is terrifying because she still knew who I was (her son, there to kill her), but could not speak. Upon reviewing her imaging, I decided that "she had met her criteria [to die]."
>they turn the machine off and you just die
I further helped this by instructing attending physician to turn up the fentanyl ("to eleven"), remove her breathing systems, and then I smothered her with my bare hands.
>They don't crank the painkillers up - in fact no doctor will do this because it's legally murder.
False. See above. Jurisdiction may very, as will each situation.
--
I wish you well in your enjoyment of life; Mom lived well, and you (and I) should try to, too.
> Background: I helped my mother die, and in the process decided NOT to be an organ donor anymore.
Do you distinguish between "helping to die" and "killing (with consent)"? Or is the former a nicer way to say the latter?
I ask because I think most people would be viscerally uncomfortable making a statement like, "I killed my mother," even if "at her request" was added to the statement, but the way you say "smothered her with my bare hands" suggests you might not be as uncomfortable with such a statement, so I'm curious if there's a reason you framed it that way or if you just use a variety of descriptions interchangeably.
I used to work (tangently, as a prosector) at one of the USA's "body farms" — it was really cool, but extremely off-puting/stinky.
When I first read about donated bodies being exploded, I thought "wow that's really fucking noble of the deceased," cause I knew how many intelligent researchers (and society!) benefitted from this "abhorrent stuff." I still believe it's beneficial (and not disrespectful), however horrid.
My only real gripe is that third-party hackers make all the money off the cadaver parts, and not the begrieved family..." people should also IMHO be paid for their blood donations.
If it’s the longer variety I’m curious how you arranged that. I know hospice is about easing the pain to a certain degree but my understanding was that they wouldn’t go to the next level (accelerating the process) as that would seem to violate the Hippocratic oath.
Likewise I know there are places where assisted suicide is possible but that’s more the one-and-done variety.
Also since I’ve used the S word and had a (young and healthy) friend die by suicide, I’ll also say please reach out to a hotline if someone reading this is feeling suicidal.
> I’d like to think that caring for my brain-dead patient satisfied some small part of this need to feel human...
I really balked at this and other similar statements. I for one don't want people to waste their time looking after my dead body; I'd prefer that doctors spend their limited time offering care to those still alive.
> When the definition of death changed in the late 1960s, making it possible for a person to be ‘brain dead’ but with organs still very much alive and available for donation, a bridge appeared and a sixth class was created in the early 1980s.
I am curious about this: what was behind the change in the definition of death? Is brain death actually the death of the brain — or was the definition of death changed in order to justify harvesting organs from the living?
Has anyone diagnosed as brain dead recovered?
Edit: for that matter, why are we so certain that consciousness and life exist only in the brain? The entire body is full of neurons, and as the article notes the body — which is to say, the human being — reacts to the trauma of organ harvesting in much the same ways one would expect a living human being to do.
This doesn’t sound like it was written by a real doctor, or anyone who has worked in a hospital.
The way AI is shoehorned in is just bizarre… let’s wait until the medical field has figured out “AI” to unfuck their phone trees before we wring our hands about sci-fi surgery robots.
> Using AI machines rather than doctors to harvest organs also promises to save money.
What? AI does indeed "loom over" many parts of medical practice, but dissecting cadavers is not one of them.
However, the author is apparently an anesthesiologist, which does seem like one of those roles that could be mostly replaced by an AI (read signals in, write output out).
An AI-controlled robot isn’t going to be intubating, placing 14 gauge lines, or doing blocks anytime soon. And even for algorithmic-type things, the reason you have anesthesiologists around is for all those times when the standard algorithms stop working or are inappropriate to begin with.
Anesthesia is probably one of the last specialties that would be replaced by robots and AI.
> After we moved her from the gurney to the operating table, the doctors and nurses, so used to taking care of living patients, stared at one another stupidly, as if not knowing why they had come together or why they stood around the table.
Sorry this strikes me as embellishing for the case of writing a story.
Background: I was a neurosurgery resident at a level 1 trauma center. I was involved in determining brain death (though the final certification was by an attending surgeon). I worked closely with the transplant team. I declared (normal) cardiac death many times. I had many agonizing conversations with families about withdrawal of care.
Anesthesia is a 4 year residency. Even the 2nd year anesthesia residents I worked with had more of an awareness and lack of naivety that this author shows.
And the OR teams were much more prepared and professional than this. They knew what they had to do and why they had to do it.
If there are other physicians here, I would love to hear your opinions, but this whole piece strikes me as overwrought and full of embellishments to make a certain point.