This has to be one of the most intellectually backwards arguments I have ever heard. It is almost on par with arguments presented by christian fundamentalists.
Being brain-dead is essentially being dead. Hospitals and surgeons will not operate on you unless you are not expected to recover, or regain consciousness. Being brain-dead, it is also very unlikely that you feel pain. Reflexes can easily still be active even with brain-death, leading to convulsions during surgery. If the author had ever seen a serious car-accident victim in a coma, he wouldn't have second thoughts about organ donation. In his blog post, he is insinuating that you are still a normal, living, conscious human being. You aren't.
Having grown up in a family of medical doctors, I find this blog post appalling.
EDIT: As thebigshane pointed out, my wording is indeed terrible, I wrote my response in a hurry, and I will not edit it to avoid confusion. I do not have any professional medical education, all I know in this field is derived from in-depth conversations and discussions with my parents, whom are both medical doctors. Brain death is indeed classified by the Harvard criteria, but these also include the patient being non-responsive to external stimuli, such as pain (which contradicts the blog post's claim of convulsions during surgery due to the lack of anesthesia).
While I agree with you overall, I have to nitpick your wording...
Being brain-dead, it is also very unlikely that you feel pain
Very unlikely? This seems like something that should demand complete[0] confidence.
[0]: Ok, ok, maybe not 100% provability, but I want to know more about this surely subjective determination by the doctors. Or is there an automated reading from some machine that can objectively say "Patient is 95% likely to not feel you operating on him alive"?
(Also, this is "deeply interesting" according to HN standards but lots of potential for irrational discourse -- my comment probably included)
If you are brain dead you cannot feel pain because your brain is not there to receive the signals.
In computer speak, imagine you had a sensor that had external power and continued transmitting input to the CPU- the signals keep coming in, but the CPU is switched off. No processing of pain, no sensation of pain.
End of story
If I'm brain dead and there is zero chance of me feeling pain, they can take my organs. I just want them to be sure I'm brain dead. How is that determined?
(oh and my brain is not an electrical cpu, I understand your analogy but I'm not sure it applies given the complexity of a human brain, for example certain parts of a brain can be "off" while the others are "on")
When your brain is 'working' it gives off signals, these are measured by an electroencephalograph (EEG). When those signals stop, you know the brain isn't functioning.
not even a serious car crash, even someone who has had a major heart attack. talking from personal experience, they can look just fine, but if their brain was without oxygen long enough, there's no chance that brain's coming back, even though certain reactions will still be present.
>Hospitals and surgeons will not operate on you unless you are not expected to recover, or regain consciousness.
Except when they can cut corners, because "ok, the guy is badly injured, there's some other patient that needs that organ", etc. It's not like they are gonna be extra thorough each time. Humans are known to do that...
It's my impression that Doctors are generally very conservative about this, for 2 major reasons:
- they take the Hippocratic oath very seriously. It's a big part of the culture and indoctrination of medical students.
- they've seen enough examples of people dying from seemingly minor conditions and others of people recovering from seemingly irrecoverable situations to know that their predictive powers are quite fallible
So sure, I expect Doctors to cut corners and make mistakes, after all, they are human. But this is one area where I expect that they're much more likely to err by not declaring death soon enough...
The people who would be cutting the corners see the people whose lives they're giving up on, but they never meet the people who would be using their organs. Doctors and nurses still make mistakes and get lazy, but I don't think it has anything to do with organ donation.
My wife is an operating room nurse. She sometimes participates in organ transplants. She tells me that there is an anesthesiologist present and giving anesthesia drugs, contradicting the article. The way she describes it they open you up and cut your abdominal aorta, at which point the anesthesiologist leaves the room because you are fully dead. Then they harvest organs and tissues as fast as they can. The people being harvested are clearly, permanently beyond help. The harvests are scheduled to coincide with major surgeries for the recipients. They usually take place in the very early morning as preparation for the transplant later that day.
If I am on a respirator, and will be for the rest of my life, go ahead and harvest me.
I disagree with the conclusion and implications of this article. I also dislike how it implies that organ harvesting doctors have evil motives without coming out and saying it. The factual error that I saw, just as a husband of a transplant worker, also detract from the validity of the article.
Without commenting on the rest of the article: The claim being made, as I understand it, is that the anesthesiologist is there and administers drugs to paralyze but not to anesthetize. So the presence of an anesthesiologist administering drugs does not necessary contradict the claims of the article unless you wife can confirm that the drugs both paralyze and anesthetize the patient. </pedantry>
This article is terribly manipulative. If there are valid points to be made here, I'm not going to be convinced by an essay that is full of phrases like "an ivory tower decision made by a bunch of men playing God at Harvard". The cited sources are either questionable (as in the website with the statue depicting crucifiction dominating the banner) or do not support the author's conclusions (as in the NEJM article).
The big detection of 'bullshit' was at the end of the article, in 2 places.
1. " As to all the rest, I cannot but conclude that they are nothing but legal euthanasia, and should be opposed by anyone who identifies themselves as pro-life."
Pro-life? As in Christian anti-abortion buzzword? That's awfully strange to see in a "fact based policy paper".
2. Dr. Paul Byrne, a Christian doctor trying to raise public awareness of this issue. (links to renewamerica.com )
So now we get to the root of the matter. Non-religious (cough CHRISTIAN) superPAC sponsoring messages. It even mentions of a strong Christian bent towards policy discussion.
I dismiss this whole article with extreme prejudice.
The bottom line is still that many lives are saved by organ donors. From a moral point of view it's also pretty clear cut. If you want to accept an organ when you fall ill then you should also be willing to donate your organs.
The concept of organ donation is a little freaky, and the idea admittedly makes me a bit uncomfortable. Especially as I visualize it. But surely selfishly hanging on to something I don't need anymore (being dead and all) isn't the right solution.
I think this article is essentially some elaborate rationalization. The author can't reconcile being against organ donation knowing it saves lives. Hence the absurd stuff about doctors cackling evilly as they chop up their live patients to harvest the organs for fun and profit. Right.
Anesthesia is always used during organ harvests. Anesthesiologists treat the donor just as they would any other patient undergoing surgery. This account by a Georgia anesthesiologist rebuts many of the points made by the article, and does so much better than I would do.
In my opinion this takes an ethical grey area that a very small number of donors would fall into, blows it up, and pretends nothing else exists.
Pain in brain death? Ascending pathways still work but your brain lacks the capacity to feel it.
Heart rate spike? Autonomic nervous system releases adrenaline, again, automatic; a physiological reaction.
Is the authour hoping that this will lead to a change in brain death definitions? Is he suggesting that the donor is capable of recovery, of a mormal life given time and our modern miracles? Not going to happen.
If this blog is influential enough to lead to people declining organ donation, or withdrawing from the registry, then I believe he is responsible for the impaired lives of potential recipients
Oh gosh. For every one of the 'miracles' of full recovery from brain death, there are thousands more about people being kept alive waiting for a miracle.
It disgusts me how okay people are with mechanical respirators, TPN feeds, and the like even when there is a <.01% chance of recovery. The family says 'do everything you can.' We don't want to pull the plug, we are playing God if we decide if someone lives or dies. Except we already are playing God. This is a person that left alone to God (sans medicine) would be dead! We simple can keep a brain dead person alive indefinitely and essentially take away their option for death.
As far as heart rate spiking when organ donation operations are performed? You do know this happens during normal operations. Pain medication is given not to help control your pain, but to help control this reflex. In a normal operation pain meds are technically necessary as when you are under the gas your body either doesn't experience or doesn't remember pain. The actual mechanism of action for anesthetic gas is not fully understood. My point is the pian medication is not given for the brain.
yes organ donation can be shady, but that doesn't necessitate boycott.
I'm not an organ donor mostly because I think that some Doctor somewhere might give me up for dead since there are 3 people waiting for organs even though there is a slim chance I will live. That might not even be a bad decision on the part of the doctor (1 cripple vs 3 healthy people) but I don't want him to make that choice for me. If I'm alive and explained the situation for myself there is a good chance I would say "sure go for it, I'll be a brain dead cripple anyways" but I don't want that choice taken from me and given to some doctor with a few seconds to make a decision while he holds a knife over my still breathing body.
I don't know how it works elsewhere but here in sweden they don't check if you're a donor until they have already taken the decision to take you off the respirator ("killing" you either way).
So it's not like the surgeon walks into the ICU, scalpel in hand, looking for anyone too slow to run away.
There are quite a lot of misguided statements in this article, like you are "alive" because your heart is beating, or you feel pain if they don't give you pain killers. You should be "brain dead" to be an organ donor. And brain dead means dead, no chance or recovery, I am sure there are cases that mistakes happen but that is a mistake, you need to be confirmed brain dead by quite a lot of doctors to get harvested!
Yeah, I would like to see some actual numbers before coming to any conclusion. Something along the lines of the number of people that have recovered from the state wherein they could legally take your organs. Not sure if those numbers would be easy to come by.
I don't know if it is easy to come up with these numbers (legal and policy maters aside from a purely medical stand point). Still as someone who have been around transplant teams, I can say at least in the state of Maryland, things are very well under control and I for one would not worry too much about been taken advantage of. But definitely there are places that things are not handled as they should.
And brain dead means dead, no chance or recovery...
The key point of the article is that the test allegedly used to determine brain death isn't a very good one. I'd be curious to know whether the test described (pulling the patient off a respirator for two minutes) is indeed the actual criterion used. It sounds suspiciously simplistic.
No, this is what is disturbing about this article, you can be alive and not able to breath, this is not the test used anywhere in the world, there are tones of tests that they do including EEG that needs to be flat (I think it is repeated a few times with intervals and they make sure the patient is not on any drugs that suppresses the brain and flattens the EEG and ...
"Deeper still one finds the profit motive behind the organ donation scam."
The author suggests that misinformation and a philosophical problem is to blame. This is the premise of the article. Then he writes a statement like this. For his assertion he needs to find proof that there's a deliberate campaign to mislead the public.
The author offers nothing of the sort in his citations. His inference is lazy and sensationalist, even before getting into whether his premise is actually true.
I worry this may be little too politicly provocative for HN, it liable to start an argument between two very passionate sides. (http://ycombinator.com/newsguidelines.html)
Does anyone have a link to a none biased look at the science of this? I would like to know a little more.
Let's not gloss over the fact that the sole purpose of organ transplants is to save lives. I have a hard time believing his argument about financial motivation for organ donation - a surgeon's salary should preclude the temptation of "making a quick buck" through questionable organ transplant practices.
On the other hand, I absolutely think that potential donors need to give INFORMED consent when they fill out their donor card - whether advised by a medical professional or with their own research. Obviously, no one should ever be coerced or manipulated into consenting based on false pretenses. I'm aware that I will still be "alive" - at least physiologically - at the time an organ is harvested, but I trust that my family can make the right decision if I'm unconscious, and I'd prefer to have a shot at saving someone's life when I'm on my way out.
Not that I agree with this, but a book written on the subject recently was a fascinating read - "The Undead: Organ Harvesting, the Ice-Water Test, Beating Heart Cadavers--How Medicine Is Blurring the Line Between Life and Death by" Dick Teresi. Check out this NPR story about it too: http://www.npr.org/2012/03/19/148296627/blurring-the-line-be...
What a brave author. I have to commend their duty to publish this, since there is a good chance it will be quite unpopular. There's been such a homogeneity to Internet published articles recently (whichever factor you wish to interpret, if you agree with this claim). It was refreshing to read someone's perspective on this touchy subject from a completely different perspective. Bravo, author.
Being brain-dead is essentially being dead. Hospitals and surgeons will not operate on you unless you are not expected to recover, or regain consciousness. Being brain-dead, it is also very unlikely that you feel pain. Reflexes can easily still be active even with brain-death, leading to convulsions during surgery. If the author had ever seen a serious car-accident victim in a coma, he wouldn't have second thoughts about organ donation. In his blog post, he is insinuating that you are still a normal, living, conscious human being. You aren't.
Having grown up in a family of medical doctors, I find this blog post appalling.
EDIT: As thebigshane pointed out, my wording is indeed terrible, I wrote my response in a hurry, and I will not edit it to avoid confusion. I do not have any professional medical education, all I know in this field is derived from in-depth conversations and discussions with my parents, whom are both medical doctors. Brain death is indeed classified by the Harvard criteria, but these also include the patient being non-responsive to external stimuli, such as pain (which contradicts the blog post's claim of convulsions during surgery due to the lack of anesthesia).