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Posted: 9/16/2010 5:01:57 AM EST
I am not a donor, even though I work in the medical field. I have worked in OR's and been in harvestings. Some weird shit happens (Pt's scream out occasionally, so they began using pain meds during harvesting). I do believe in organ donation, I just believe they are to willing to harvest and not save. I know that the majority will still die but, we have been seeing an increase in cardiac arrest save rates with good neurological outcomes over the last few years with many different techniques. Also, there are approx. 10 different test to confirm brain death in children but there is no standard of how many you have to use. I will look for the article that states that many hospitals use only 1-2 test and say they confirm brain death when just those few should not be enough. Anyways I think this is a good disscusion.


Story

Families of donors misled on death: MDs

Fotolia
Harvesting organs from people whose hearts have stopped but are not yet brain dead is becoming increasingly important to the transplant system.

Comments Twitter LinkedIn Digg Buzz Email Tom Blackwell, National Post · Tuesday, Sept. 14, 2010

A group of ICU doctors is calling for a moratorium on harvesting transplant organs from people whose hearts have stopped but are not yet brain dead, reviving controversy around a process that is becoming increasingly important to the transplant system.

Family members are essentially being misled into believing patients are dead when they may not be, and in some rare cases people’s hearts could actually start beating again after being silent for the required two to five minutes, the physicians say.

In most instances it may still be appropriate to remove organs — if the family consents — but relatives need to be better informed about their loved one’s state, said Dr. Ari Joffe, an intensive-care specialist at Stollery Children’s Hospital in Edmonton who signed a letter urging the moratorium.

“I think that we’re being less than entirely honest about when the patient is truly dead,” he said in an interview. “We’re not trying to deny the parent the choice to donate … The point we’re making is ‘what if they’re almost dead and we’re not sure if they’re dead, and it’s not at the point of irreversibility yet?’ ”

The letter by Dr. Joffe and seven U.S. pediatric intensivists in the journal Pediatric Critical Care Medicine calls specifically for a moratorium on donation after cardiac death (DCD) in children, but the Alberta physician said the arguments apply equally to adult patients.

The medical community has grown to generally accept the procedure and even Dr. Joffe acknowledged that he and his colleagues are in the minority. He argued, however, that many physicians don’t understand the issues well and both they and the public need to learn more and debate the questions extensively.

Supporters of donation after cardiac death, however, say the issues have been discussed and settled, especially in Canada. A “consensus conference” of 120 medical, ethical and legal experts issued a report in 2006 that concluded the idea was appropriate and set out clear guidelines, noted Dr. Sam Shemie, a Montreal intensive-care physician.

Criticism is healthy, but those who continue to raise objections often seem to be motivated by ideology, he charged.

“The real question is why aren’t more hospitals providing DCD, or providing the option to patients,” Dr. Shemie said. “There are a minority of people in this world who fundamentally do not believe in [organ] donation or transplantation. ... It’s hard to change the hearts and minds of some people.”

Most transplant organs are taken from patients declared brain dead. Those people account for only about 10% of hospital deaths, leaving a shortage of donors, and hundreds of gravely ill Canadians languishing and dying on transplant waiting lists.

In response, the medical community has recently embraced the new protocol — which was actually employed decades ago but abandoned in the 1960s — based on death occurring after the patient’s heart has stopped beating for a period of at least five minutes.

The procedure was revived in Canada in 2006 and since then organs have been removed from more than 120 such patients in Ontario, Quebec, Nova Scotia, Alberta and B.C., said Dr. Shemie. They include five patients at Toronto’s Hospital for Sick Children.

In Ontario alone, the donated lungs, kidneys, livers and pancreases helped save 246 lives, the province’s Trillium Gift of Life Network says.

“DCD is a success story,” said Trillium’s Dr. Sonny Dhanani. “The ability of families to donate where they weren’t able to in the past, we see as a huge benefit to society.”

Emile Therien, whose daughter Sarah Beth’s organs were donated after her cardiac death in 2006, said patients are well informed, and appreciate the opportunity. “In death, something very positive happened,” he said about his daughter’s case.

The moratorium letter, though, raises several concerns about cardiac death donation and whether it complies with the basic rule that organ donors must be dead. The issues include the so-called Lazarus effect, isolated incidents where patients’ hearts have independently started beating again after having halted for as long as seven minutes.

There is also the question of whether cardiac death can really be defined as end of life, said Dr. Joffe. Loss of blood circulation due to a non-beating heart is generally considered irreversible only if CPR could not restart the heart, the letter says. With donation after cardiac death, the decision is made to not try to revive the heart. Also, brain death does not occur until as long as 15 minutes after the heart has stopped, meaning some patients declared heart dead could still have brain functions, the doctors argue.

Dr. Chip Doig, a University of Calgary critical care professor who is skeptical about the DCD concept, noted that death is declared anywhere from 75 seconds to 10 minutes after the heart stops, depending on the jurisdiction.

“Dead in Cleveland should be the same as dead in Calgary and dead in Brussels,” he said.

The article also suggests that intensive-care physicians caring for severely ill patients are in a potential conflict of interest. Knowing well that a donated organ could save someone else’s life, they might, unconsciously at least, decide prematurely to withdraw life support, which leads to cardiac death and organ removal, the authors argue.

The decision to unplug patients is not always a straightforward one; Dr. Doig said he has seen a number of cases where some of the treating doctors recommended patients be removed from life support — which would have led to cardiac death — but the individuals were kept hooked up and eventually recovered.


Read more: http://www.nationalpost.com/news/Families+donors+misled+death/3525136/story.html#ixzz0zhUwSMGL
Link Posted: 9/16/2010 5:06:53 AM EST
My wife pestered me to become an organ donor til I signed up just to shut her up, lol. My fear was not being saved to harvest my good organs. She acted like I was retarded. Now it seems my worst fears are true. oh noes!!!1!1!!
Link Posted: 9/16/2010 5:07:28 AM EST
As George Carlin once said:

"They see that organ donor card in your wallet and they're not looking to save, they're looking for PARTS!!"
Link Posted: 9/16/2010 5:15:04 AM EST
Well, I guess I made one good choice when I was 16
Link Posted: 9/16/2010 5:15:53 AM EST
What was the "Modest Proposalesque" essay written on organ harvesting? Basically stating that all safety laws should be done away with in order to provide more viable organs for transplant.
Link Posted: 9/16/2010 5:16:42 AM EST
Originally Posted By BIG_PAPA:
As George Carlin once said:

"They see that organ donor card in your wallet and they're not looking to save, they're looking for PARTS!!"


Being a paramedic, I can honestly say I have never thought, "Oh, let me try to save this person for organ donation." . Most organ donation patients occur in hosp. We do not transport dead
bodies. Although, there might have been a few we pronounced onscene that might have been good donors. The reality is that even if you don't have a donor card they will still go after the family for a consent. Just be informed.

Link Posted: 9/16/2010 5:16:55 AM EST
[Last Edit: 9/16/2010 5:18:32 AM EST by DragoMuseveni]
I say they need to spend more money on research that will allow for the growing of organs that match the DNA of the receiving. Such replacement parts are more desirable for a number of reasons.

BTW, didn't some politician in PA have the plug pulled on some guy because he(the political) needed the guys liver or something?
Link Posted: 9/16/2010 5:23:52 AM EST
[Last Edit: 9/16/2010 5:30:22 AM EST by AJ_Dual]
I'm willing to bet that over the entire history of organ donation in America, the number of cases where organ harvesting was "rushed" in any way, and the donor might have survived as something other than in a persistent vegetative state, or with extremely severe brain damage where most Arfcommers would not want to live anyway can probably be counted on the fingers of one hand, and leaving more than half the fingers left over.

Also, note that this is really about medical ethicist splitting hairs over heart death and brain death, because without a beating heart, but not yet being "brain dead" is a pretty moot point in normal pragmatic terms to you and I. You're already unconscious due to oxygen starvation and not having a pulse. The surgery to hook someone up to a heart-pump or whatever and save them does not exist. Currently, that kind of thing can only be done to someone who has a still beating (but diseased) heart. So there's still no way to save someone in that situation.

This is about the medical profession arguing the technicalities and semantics of "death". Not about stealing organs from people who "might have a chance".
Link Posted: 9/16/2010 5:26:17 AM EST
[Last Edit: 9/16/2010 5:31:00 AM EST by AGW]
Link Posted: 9/16/2010 5:31:13 AM EST


I deal with this several times a day at least.
A donor card does not mean your organs will be harvested. It's like a living will. It really means nothing except that under certain condition you woudn't mind this or that happening to you. Although a doctor may respect a living will if you're all fucked up and no family is around....like a nursing home ppatient that's 200 years old.
It is ultimately up to your family. They will be called or spoken to even if you don't have a "donor card". Now that I think of it, a donor card is probably available to boost awareness for donation.
Whenever you met a certain criteria, in Louisiana and many, if not all other states, in the ICU a call is made to the area organ procurment organization.
You will be screened regardless of whether your family is even approached.
Whenever you die in the ED or on a regular unit, the same organization will be called.
We have NOT harvested after getting the OK due to a family member merely not being sure.
I'm almost certain even the coroner has to call about every death whether he's holding the body or not.
Before an ICU pt is judged dead, anything that can sedate is turned off for as long as the neuroligist believes it would take to get out of the system, then several test including EEG's are undertaken to insure death.
Beating heart donors are kind of creepy. I don't believe my facility has done those, but what's the diffrerence? Your life support would be turned off anyway.
My wife would donate me and I her, before a cremation.
Oh yeah, everybody has a local eye bank. They're looking at you too!
Link Posted: 9/16/2010 5:32:50 AM EST

...and off we go.

IBT doctor bashing, and true stories from a "friend of a friend who is a housekeeper for a neighbor of a hospital janitor who misunderstood something he only partially heard in the hallway."

This has been discussed over & over here.

Posted Via AR15.Com Mobile
Link Posted: 9/16/2010 5:34:19 AM EST
That would suck to have happen.
Link Posted: 9/16/2010 5:35:23 AM EST
Why would anyone donate anything to Oregon? Buncha commies out there.
Link Posted: 9/16/2010 5:35:28 AM EST
[Last Edit: 9/16/2010 5:35:44 AM EST by patio87]
Precisely why I will never be an organ donor. At least knowingly.
Link Posted: 9/16/2010 6:07:21 AM EST
Aren't the best donors the ones with hearts still beating?

My organs are toast anyway.
Link Posted: 9/16/2010 6:09:30 AM EST
Not a donor. Will never be one.
Link Posted: 9/16/2010 6:13:49 AM EST
Originally Posted By ttushooter:
Not a donor. Will never be one.


You'd take one, right?
Link Posted: 9/16/2010 6:21:35 AM EST
I think this is probably *INCREDIBLY* rare. I also think that hey, if my heart has stopped for 3 to 5 minutes, it's my time. take it and give someone else a life. yes there is a very very small statistical chance that it starts again but the number of people who die because we let all those hearts go to waste because we wait too long to harvest offsets this by a mile.

I am an organ donor and I feel that those who aren't are somewhat selfish and a little odd. If I can help other people in my death, vs letting perfectly good organs rot away like yesterdays garbage, I will do so.
Link Posted: 9/16/2010 6:27:49 AM EST
Well, as somebody that has actually worked in an ER and has a good nose for smelling bullshit...I'm going to call this one.
Link Posted: 9/16/2010 6:29:11 AM EST
Yawn. I'm still signed up to be a donor, it's also so listed in my will.
Link Posted: 9/16/2010 6:29:20 AM EST
I knew sooner or later theyd be killing people for their organs so I am not a donor
Link Posted: 9/16/2010 7:08:51 AM EST
[Last Edit: 9/16/2010 7:19:53 AM EST by ttushooter]
Originally Posted By HELOBRAVO:
Originally Posted By ttushooter:
Not a donor. Will never be one.


You'd take one, right?


I meant that more to the fact that due to other medical conditions of mine, I take medications that make me a less than desireable donor.
I would never be selected even if i were registered.

eta: same reason Uncle Sam Said "No, thanks" when I Tried to join up for the military.
Link Posted: 9/16/2010 8:18:06 AM EST

Originally Posted By SIG-shooter:
I knew sooner or later theyd be killing people for their organs so I am not a donor


I think killing people for bio-diesel will be more mainstream. You can't do much with the organs of 60 year old like you can of a 20 something.
Link Posted: 9/16/2010 1:22:20 PM EST
bump for night
Link Posted: 9/16/2010 1:43:24 PM EST
Link Posted: 9/16/2010 1:52:07 PM EST
[Last Edit: 9/16/2010 1:53:03 PM EST by Dale007]
I will never be an organ donor.

ETA: oh post 1911, I have one of these things
Link Posted: 9/16/2010 1:54:15 PM EST
I already have a modified DNR, the only exception from a full DNR is it allows the Dr/Nrs to maintain perfusion of my organs for donation, if i come out after CPR then fine but if I don't...slice, slice.
Link Posted: 9/16/2010 2:01:55 PM EST
[Last Edit: 9/16/2010 2:04:25 PM EST by Mosin_Nagant]
When my mom died of a stroke, I saw the organ donation process first hand. There are so many tests and procedures the hospitals have to go through, I don't really see how it can be abused. It's not like, "He's flatlining, quick cut 'em open while they're fresh!"
Link Posted: 9/16/2010 2:04:42 PM EST
he is (was) on to something.. and i am no organ donor.
I would never give them away, they should have "organs for sale upon death" option.
then at least my family picks up a few grand for my parts.
Originally Posted By BIG_PAPA:
As George Carlin once said:

"They see that organ donor card in your wallet and they're not looking to save, they're looking for PARTS!!"


Link Posted: 9/16/2010 2:08:24 PM EST
This is why I never did it.

My Grandmother always said they didn't want to save 1.
They wanted to save 6 .
Link Posted: 9/16/2010 2:09:08 PM EST
Originally Posted By Isenhelm:
he is (was) on to something.. and i am no organ donor.
I would never give them away, they should have "organs for sale upon death" option.
then at least my family picks up a few grand for my parts.


Isn't that illegal?
Link Posted: 9/16/2010 2:11:19 PM EST
I plan on pickling mine first
Link Posted: 9/16/2010 2:35:55 PM EST
Never volunteered and never will consider until the financial system is straighten out. Currently, the supply is free to the profit makers. Therefore, the market-up rate, or profit margin is astronomically high. That, in itself, sets up a ripe environment for fraud.
Link Posted: 9/16/2010 3:27:44 PM EST
Link Posted: 9/16/2010 3:32:30 PM EST
Originally Posted By AGW:
Does not reflect donation practices in this country.

Patients screaming out in pain during an organ harvest... in a Euro hostel maybe. In the US...





This does happen. One I was in the patient made a loud noise and spooked everyone in the room. We were actually giving pain meds. Ever wonder why there is an anesthesiologist in harvesting?

Link Posted: 9/16/2010 3:32:38 PM EST
Originally Posted By 74HC:
Never volunteered and never will consider until the financial system is straighten out. Currently, the supply is free to the profit makers. Therefore, the market-up rate, or profit margin is astronomically high. That, in itself, sets up a ripe environment for fraud.


Show statistics to back up your accusations. It's expensive, but that doesn't mean it's an "astronomically high profit margin." Do you think that insurance companies haven't looked transplantation over under a microscope? Do you think that they would, even for a nanosecond, tolerate huge profits in excess of actual costs?
Link Posted: 9/16/2010 3:33:38 PM EST
Originally Posted By joker581:
Originally Posted By skid2041:
Originally Posted By BIG_PAPA:
As George Carlin once said:

"They see that organ donor card in your wallet and they're not looking to save, they're looking for PARTS!!"


Being a paramedic, I can honestly say I have never thought, "Oh, let me try to save this person for organ donation." . Most organ donation patients occur in hosp. We do not transport dead
bodies. Although, there might have been a few we pronounced onscene that might have been good donors. The reality is that even if you don't have a donor card they will still go after the family for a consent. Just be informed.



I don't think I've ever dug out someone's wallet on a call, unless they were conscious and gave me permission to get it because they couldn't.

I can't think of any reason that would cause me to give a shit about what was in someone's wallet during a cardiac arrest.


I agree. I honestly never thought about organ donation during calls.

Link Posted: 9/16/2010 3:34:48 PM EST
I do not like to share my stuff.
Link Posted: 9/16/2010 3:37:28 PM EST
[Last Edit: 9/16/2010 3:40:05 PM EST by thorm001]
Originally Posted By skid2041:
Originally Posted By AGW:
Does not reflect donation practices in this country.

Patients screaming out in pain during an organ harvest... in a Euro hostel maybe. In the US...





This does happen. One I was in the patient made a loud noise and spooked everyone in the room. We were actually giving pain meds. Ever wonder why there is an anesthesiologist in harvesting?



Was this patient intubated?
I have taken plenty of organ harvest patients to the OR. The anesthesiologists job is to maintain hemodynamic stability. There is no reason to use analgesics or volatile anesthetics. Only need muscle relaxant.
This is almost as retarded as the "vaccines cause autism" arguement.
Link Posted: 9/16/2010 3:49:26 PM EST
w
Originally Posted By skid2041:
A group of ICU doctors is calling for a moratorium on harvesting transplant organs from people whose hearts have stopped but are not yet brain dead, reviving controversy around a process that is becoming increasingly important to the transplant system.

Family members are essentially being misled into believing patients are dead when they may not be, and in some rare cases people’s hearts could actually start beating again after being silent for the required two to five minutes, the physicians say.

In most instances it may still be appropriate to remove organs — if the family consents — but relatives need to be better informed about their loved one’s state, said Dr. Ari Joffe, an intensive-care specialist at Stollery Children’s Hospital in Edmonton who signed a letter urging the moratorium.

“I think that we’re being less than entirely honest about when the patient is truly dead,” he said in an interview. “We’re not trying to deny the parent the choice to donate … The point we’re making is ‘what if they’re almost dead and we’re not sure if they’re dead, and it’s not at the point of irreversibility yet?’ ”


this article is so poorly written that I have no clue WTF they are getting at. i can't imagine a situation where someone 's heart has stopped and they proceed on to harvest organs if the person is viable or not brain dead. the pre-harvest testing takes several hours so you'd have to have already run the tests that are mandated which I've NEVER seen run pre-brain death. I've never even been in a hospital that calls life bank if here isn't a suspicion of serious neurological damage.
Link Posted: 9/16/2010 3:55:47 PM EST
Originally Posted By thorm001:
Originally Posted By skid2041:
Originally Posted By AGW:
Does not reflect donation practices in this country.

Patients screaming out in pain during an organ harvest... in a Euro hostel maybe. In the US...





This does happen. One I was in the patient made a loud noise and spooked everyone in the room. We were actually giving pain meds. Ever wonder why there is an anesthesiologist in harvesting?



Was this patient intubated?
I have taken plenty of organ harvest patients to the OR. The anesthesiologists job is to maintain hemodynamic stability. There is no reason to use analgesics or volatile anesthetics. Only need muscle relaxant.
This is almost as retarded as the "vaccines cause autism" arguement.



Actually, we do give some narcs & volatiles. There are still some spinal/subcortical reflex pain responses, and evidence that reducing those will cut down on "evil humors," as I call them, released during surgical stress.

Posted Via AR15.Com Mobile
Link Posted: 9/16/2010 3:56:50 PM EST
I came into this world whole, and I'm going out whole. I don't want to be considered used parts.
Link Posted: 9/16/2010 4:00:34 PM EST
Won't donate any, won't take any either.....

When your time is up, your time is up. Seen enough folks exixt in a living hell with meds, tests, etc. after transplant to know it's not for me. Seriously looking into an ironclad DNR that prohibits them from even touching me. When it's over I want to stay dead, not be brought half back and semi-retarded only to live with the indignity of some half assed, semi-damned lurching existence. If you can't have the same quality of life then why bother breathing ??
Link Posted: 9/16/2010 4:24:25 PM EST
[Last Edit: 9/16/2010 4:25:33 PM EST by AGW]
Link Posted: 9/16/2010 4:25:52 PM EST
When the doctors and hospitals start donating time and service to install the free parts they get....... then I might think about being an Organ Donor.
Link Posted: 9/16/2010 4:46:22 PM EST
Originally Posted By crashburnrepeat:
I think this is probably *INCREDIBLY* rare. I also think that hey, if my heart has stopped for 3 to 5 minutes, it's my time. take it and give someone else a life. yes there is a very very small statistical chance that it starts again but the number of people who die because we let all those hearts go to waste because we wait too long to harvest offsets this by a mile.

I am an organ donor and I feel that those who aren't are somewhat selfish and a little odd. If I can help other people in my death, vs letting perfectly good organs rot away like yesterdays garbage, I will do so.


^
Link Posted: 9/16/2010 4:53:15 PM EST
Link Posted: 9/16/2010 4:57:23 PM EST
My wife died while in the ICU unit at the Baylor Medical Center in Dallas. She died at 6AM one hour after the transplant nurse called me and told me they had a liver and she was scheduled for surgery at 1PM that day. I'm an organ donor (if anything is worth having) and I wish more people would choose to be one.
Link Posted: 9/16/2010 5:00:17 PM EST
[Last Edit: 9/16/2010 5:03:44 PM EST by SlowOne]

Originally Posted By Mattsb2010:
Originally Posted By Isenhelm:
he is (was) on to something.. and i am no organ donor.
I would never give them away, they should have "organs for sale upon death" option.
then at least my family picks up a few grand for my parts.


Isn't that illegal?

That's his point. I suspect that most of Arfcom gets free market economics. Want to end the shortage of donors? Make legal a way for the potential donors to profit from the deal prior to donation or to arrange for their bereaved to profit after their demise. Problem solved.
Link Posted: 9/16/2010 5:01:42 PM EST
I think my desire to be a donor disappeared the first time i heard it referred to as "harvesting"
Link Posted: 9/16/2010 5:06:45 PM EST
Originally Posted By SlowOne:

Originally Posted By Mattsb2010:
Originally Posted By Isenhelm:
he is (was) on to something.. and i am no organ donor.
I would never give them away, they should have "organs for sale upon death" option.
then at least my family picks up a few grand for my parts.


Isn't that illegal?

That's his point. I suspect that most of Arfcom gets free market economics. Want to end the shortage of donors? Make legal a way for the potential donors to profit from the deal prior to donation or to arrange for their bereaved to profit after their demise. Problem solved.


Yep. It would be a nearly impossible battle with the medical establishment to get it going, but several economists and Libertarians (Mark Stossel) have made the argument that basic economics being what it is, that if survivors were to benefit financially from harvested organs, transplants, and the number of actual lives saved, would be much, much higher.
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