Ship of Fools: Organ Donation

Thread: Organ Donation Board: Oblivion / Ship of Fools.

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Posted by Patdys (# 9397) on :

I have just read that as a result of a tragedy, organ donation is being considered for a much loved shipmate. There is often confusion re organ donation so I though I would put in some thoughts.

I have posted this to identify if anybody has any concerns re what the process involves and whether it involves taking life.

It is not a harvest. It is a donation, a retrieval or a gift. There is more respect in this process than anything else in medicine that I can think of.

Organ donation is only done after brain death is confirmed. Brain death is a clinical condition where the brain no longer has activity supporting life. The heart has its own pacemaker and will continue to beat despite brain death for a period of time. But the lungs will not function independently and the patient cannot live off a ventilator. Even with ventilation, the body will develop kidney failure and other problems over time leading to death, despite support.

Brain death is irreversible. And it is truly death.

Organ retrieval occurs when the body is supported for a period of time to enable an operation for the selected organs to be donated from the deceased patient for implantation in somebody to save their life or improve their quality of life.

After retrieval, the ventilator is stopped and the body no longer supported in any way.

It follow trauma usually as disease and illness means donation is not possible.

Doctors are macabre beings and make jokes about almost anything.

Not this. Not ever.

There is enormous solemnity and respect in this process. There is respect for the deceased patient and the grieving family. There is respect for the gifts to others. And there is respect for the staff, all of whom are affected by this process.

It is truly a gift.
It comes from a truly awful situation.
There is enormous respect through the entire process.
It truly changes lives.

And I have no doubt that our shipmate, who gave so much on board, continues to give, even in death.

[Votive]

[please delete or move this thread if deemed inappropriate]

Posted by comet (# 10353) on :

thank you.

Posted by Nicolemrw (# 28) on :

No words, just [Votive]

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by Nicolemrw:
No words, just

Yes.

Posted by orfeo (# 13878) on :

quote:
Originally posted by Patdys:
I have posted this to identify if anybody has any concerns re what the process involves and whether it involves taking life.

I have stumbled into this debate once before, on the other side of it.

You'll be happy to know that most Shipmates don't have a problem with it.

I do, but I've no inclination to enter into the debate again. The only person affected by my views is me, and if it's ever relevant I won't be in a position to discuss it here on the Ship.

Posted by lily pad (# 11456) on :

Identified as organ donor on driver license: check
Family told of my preference in this matter: check
Doctor made aware of both of the above: check

If you are able, please do likewise.

Posted by art dunce (# 9258) on :

This is a subject of great interest to me. I hope that at a less difficult moment a discussion of Dick Teresi's book might be attempted. After he was on NPR I know people who decided to no longer be donors. I think there is a great deal of misinformation on the subject and it is difficult for those not in the medical field to suss out the truth.

[ 05. May 2012, 00:50: Message edited by: art dunce ]

Posted by Campbellite (# 1202) on :

My doctors told me I only had six months to live.

That was in 1987.

Thanks to a kidney transplant, I am still here. The kidney transplant was a living related donor (my mother) and the kidney survived and functioned for 18 years. The doctors said I squoze my good out of it.

After a time on dialysis, I was gifted with a liver and kidney transplant in June 2006. I will forever be grateful that Allen* signed his donor card. Thanks to his generosity, not only am I still here, but a man in Richmond received his other kidney, and a woman in Va Beach now has his heart.

I am a firm believer in organ donation.

*Gary Allen Agee: May his memory be eternal. [Votive]

[ 05. May 2012, 01:28: Message edited by: Campbellite ]

Posted by PaulBC (# 13712) on :

If you can do it . There are reasons people maybe rejected , in my case its the fact I have a systemn that is fulkl of residual medications . Without which I may add I would be posting from another place .
But if your doctor says you would be considered as a donor do it [Votive]

Posted by Pine Marten (# 11068) on :

Yes, I agree, if you can do it, then please consider it.

The first Mr Marten carried a donor card for years, but, because he died of cancer, none of his organs was usable. I think that would have saddened him.

I also carry a donor card. For years I was a blood donor, but when I started taking medication for high blood pressure I was taken off the register, which I felt rather frustrated about as my blood type was always welcomed - if you can physically do these things, and have no reason or belief against organ or blood donation, do it.

Posted by North East Quine (# 13049) on :

I would have died in July 1998 if I hadn't had a blood transfusion. My children were 4 and 2; the younger one probably wouldn't have remembered me. Donating was half-an-hour of several peoples lives; it's been almost fourteen years of life (so far!) for me.

I was a blood donor up to that point, but have been unsuitable since. I'm on the Anthony Nolan register and I carry an organ donor card.

Posted by Evensong (# 14696) on :

If you don't believe there are spiritual consequences to organ donation then I see no reason not be a donor.

Posted by RuthW (# 13) on :

quote:
Originally posted by Patdys:
Organ donation is only done after brain death is confirmed.

According to this 2007 article in the New England Journal of Medicine,

quote:
The most rapid increase in the rate of organ recovery from deceased persons has occurred in the category of donation after “cardiac death” — that is, a death declared on the basis of cardiopulmonary criteria (irreversible cessation of circulatory and respiratory function) rather than the neurologic criteria used to declare “brain death” (irreversible loss of all functions of the entire brain, including the brain stem). Organs were recovered from 645 donors after cardiac death in 2006, as compared with 189 in 2002; these donors accounted for 8% of all deceased donors in 2006 (see bar graph
Distribution of Deceased Organ Donors in the United States, 1995–2006.
).

Here's a brochure about donation after cardiac death from the Southwest Transplant Alliance, a large organ procurement organization in Texas.

And here is a brief discussion of ethical issues involved in declaring death, from a UCDavis bioethicist.

Posted by Spiffy (# 5267) on :

quote:
Originally posted by PaulBC:
If you can do it . There are reasons people maybe rejected , in my case its the fact I have a systemn that is fulkl of residual medications . Without which I may add I would be posting from another place .
But if your doctor says you would be considered as a donor do it

Pretty much all of my internal organs would be rejected because I'm obese. But I'm still signed up as an organ donor, because my bones and bone marrow, my blood, my skin, and my corneas could help people.

Posted by leo (# 1458) on :

Freely you have received. Freely give.

The medics can have my whole body to do with as they see fit.

That is what my donor card says.

Posted by Palimpsest (# 16772) on :

I used to be signed up for being an organ donor. Now that I've had cancer and am a homosexual I'm not usefully eligible. However it's a good thing to do for others or for research. If I was eligible I'd be a bit fussy aobout not being used for proprietary for profit research.

I am however quite disgusted at the Orthodox Jews in Israel who are firmly against organ donation but are opposed to the new proposal that potential organ donors have priority over non donors when it comes time to consider who is an organ recipient.

Posted by Augustine the Aleut (# 1472) on :

A lapsed Orthodox acquaintance, when a medical student at a certain Ontario university, was charged with accompanying donated organs from extraction site to donation site, and became acquainted with helicopters and police cruisers in the process. During a very wine-sodden dinner, when young doctors were making all sorts of inappropriate jokes about their trade, she created a brief zone of silence by saying that, while she will always be an agnostic, she always crossed herself when the organs came on board.

A few days later, I asked her how the ambulance people and the other medicals reacted to this, she told me that the two Muslim students said that they liked it.

At our local medical school, they have an annual memorial service for cadaver donors and organ donors, and the students turn up en masse. The RCs do a Mass for them as well, and many of the non-Xn students turn up for this event as well. When I told my medical friends I was going to the local anatomy school in the fulness of time, the most profane of them assured me that the bodies were treated with respect-- they were given fierce lectures at the beginning of the session and were carefully supervised. They said there was no need for this, because they were all grateful to be able to work on the bodies.

Posted by comet (# 10353) on :

my friend's mother was killed in a horrific accident with a train almost 2 years ago. She had always wanted to be a donor and carried a card - and while the wreck was bad, she wasn't... mangled. but we found out that unless you say something pretty damn quick, it may be too late for them to use the organs. in the chaos of a traumatic death, it can be put on the backburner and if 24 hours go by, they can't use the organs. so, something to keep in mind. if we had known how it worked, we would have spoken up fairly quickly. it was a very important wish of hers that we were not able to follow through with and her daughter is still sad about that.

Posted by rhflan (# 17092) on :

Please be an organ donor. Sign the back of your driver's license...tell your family, friends, loved ones, doctor, and whoever else that will listen that you want to be an organ donor.

My wife's aunt Deb had a double-lung transplant 18-ish months ago. Organ donation is a 'second chance' at life for so many people.

Posted by Poptart22 (# 17096) on :

quote:
Originally posted by rhflan:
Please be an organ donor. Sign the back of your driver's license...tell your family, friends, loved ones, doctor, and whoever else that will listen that you want to be an organ donor.

My wife's aunt Deb had a double-lung transplant 18-ish months ago. Organ donation is a 'second chance' at life for so many people.

She died waiting for her second, because the first one rejected. I've heard people get really defensive and say they don't want to be donors, but I'm not really sure why. If you've got viable organs, I don't think there's any excuse. Lungs are hard to come by, as there are few ways you can die and provide usable lungs, so it gets personal, and I often find it hard to be quiet.

She died 2 months ago today. I wish I believed in heaven.

Posted by Kitten (# 1179) on :

I have carried a donor card since I was 17 when they sent one with my provisional driving licence, although I will admit that originally it was not for altruistic reasons but because I have a fear of being buried alive.

Posted by rhflan (# 17092) on :

Don't forget you can also be a living donor. You can donate one of your kidneys or part of your liver (your liver will regenerate). It's also possible to donate a lobe of one of your lungs, though I don't think that that's very common.

Posted by RuthW (# 13) on :

I've signed the organ donor card as well. But is there really NO debatable point here?

Is there no chance that the fact that there are more people who need organs than there are organs available will influence some of the unbelievably difficult decisions made at the end of some people's lives? Do we think that every doctor empowered to pronounce the time of death gets it right every single time? Is medical science entirely deserving of our trust that they know exactly when life ends? Or when life can't be sustained? Or when someone can't be revived? Does everyone here entirely trust the system of deciding who gets an organ when one becomes available? The School of Medicine at the University of Missouri outlines the controversies involved in that.

Finally, it's good to hear that donated organs are treated with respect and that donors are honored. But people are people, and I don't believe for a moment that no one involved ever makes a joke about it. And it doesn't bother me in the least to think that the guy toting the heart cut out of my body might make a joke about it, as long as he gets it to its designated recipient as fast as possible.

Posted by Bean Sidhe (# 11823) on :

I know someone who administers EEG's in a hospital. Sometimes, she is monitoring a patient close to death, checking brain activity. At such times, when the patient has agreed that their organs can be used, there will be frequent calls from transplant teams wanting to know if they can have the bits yet.

She was emphatic that she has never seen any evidence that this influences any decision about the patient. But the pressure was there.

Posted by Bean Sidhe (# 11823) on :

As for jokes, well, people doing stressful jobs need the relief. The things teachers say about their students in the staffroom!

Posted by Patdys (# 9397) on :

I can only speak from the Australian viewpoint.

quote:
Originally posted by RuthW:
Is there no chance that the fact that there are more people who need organs than there are organs available will influence some of the unbelievably difficult decisions made at the end of some people's lives?

This is where the difference between a donation and a harvest. There is a duty of care to the donor until such time as death is certified. Certification only occurs after brain death is confirmed. There are clearly defined criteria for brain death. And only after donation, does the duty of care shift to the recipients.

quote:
Do we think that every doctor empowered to pronounce the time of death gets it right every single time? Is medical science entirely deserving of our trust that they know exactly when life ends? Or when life can't be sustained? Or when someone can't be revived?

From the Australian experience, I am happy to answer this. Clinical brain death testing is performed by two experienced separate examiners independently at different times and only after the ICU team has recognised the irretrievable clinical picture.
There are no confounding drugs etc as there must be a certain time period to allow them to leave the body. And the testing is of sufficient breadth of systems to detect issues even if drugs were on board. You must fail every test to be declared brain dead.

The other diagnostic process involves cerebral perfusion testing and this is performed if clinical testing is not able to be fully performed. (ie trauma preventing some of the tests). Simply the brain is scanned for a blood supply. With no viable blood supply, the patient is pronounced dead.

quote:
Does everyone here entirely trust the system of deciding who gets an organ when one becomes available? The School of Medicine at the University of Missouri outlines the controversies involved in that.

I have and had no involvement in this. I suspect there are controversies, but this is a secondary consideration for the donor. At the end of the day, there are still recipients. How you rank them in order of deservedness, I do not know. (other than medical tissuetyping etc)

quote:
Finally, it's good to hear that donated organs are treated with respect and that donors are honored. But people are people, and I don't believe for a moment that no one involved ever makes a joke about it. And it doesn't bother me in the least to think that the guy toting the heart cut out of my body might make a joke about it, as long as he gets it to its designated recipient as fast as possible.

Fair enough. I think, overall, there is greater respect in this area of medicine. But all generalisations crumble under a case by case examination.

Of note, the time of death is recorded as the time when the diagnosis of brain death is made. This recognises that all higher functions have stopped. This may be some hours before the donation.

Posted by Patdys (# 9397) on :

quote:
Originally posted by Bean Sidhe:
I know someone who administers EEG's in a hospital. Sometimes, she is monitoring a patient close to death, checking brain activity. At such times, when the patient has agreed that their organs can be used, there will be frequent calls from transplant teams wanting to know if they can have the bits yet.

She was emphatic that she has never seen any evidence that this influences any decision about the patient. But the pressure was there.

I would answer this by saying there is a pressure of coordination. Theatres, transport and tissue downtime are all valuable and have to be factored in for successful donation. I suspect the questions are around future planning rather than hurry up and give us the patient already.

Posted by maleveque (# 132) on :

Frankly, I don't care if anyone makes a joke about my body, or bits of it, after I die.
- Anne L.

Posted by bib (# 13074) on :

I find most of the Australian public is ignorant of the fact that brain dead donors need to be on life support in an ICU so that their organs can be preserved for harvesting. Being declared dead at a car accident or in bed at home will not fulfill these conditions.

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by Bean Sidhe:
As for jokes, well, people doing stressful jobs need the relief. The things teachers say about their students in the staffroom!

Further, I'm not sure the concerns being raised here are addressed simply by not becoming an organ donor.

If you are at deaths door and linger there too long, there may be some who will be impatient for you to move it along, for whatever reasons. They need the bed, it's costing a lot to keep you alive, the family has been living at the hospital for three weeks already... All sorts of reasons why there might be subtle pressure to cut corners.

Similarly, as noted, people will make jokes, and they'll make jokes whether you're an organ donor or not-- for all the reasons mentioned-- whether to relieve tension in a stressful job, or because they're jerks. Stuff happens. I confess I've given quite small chuckle at a few of the grim but oh-so-obvious jokes surrounding Dick Cheney's heart transplant, although those were directed at the recipient, not the donor.

Bottom line is still going to come down to do you take the opportunity to bring some good out of tragedy?

[ 06. May 2012, 23:30: Message edited by: cliffdweller ]

Posted by Evensong (# 14696) on :

quote:
Originally posted by RuthW:
I've signed the organ donor card as well. But is there really NO debatable point here?

Nobody has brought up cellular memory. Or is that just quackery?

Is neurocardiology quackery too?

quote:
DR Rollin MacCraty from California’s Hearthmath University has developed research started by DR Andrew Armour. DR Armour has claimed that there is a system of living neurons on the heart. MacCraty states that the heart must have a memory because such a function is vital to the organ. It must be able to store when the last heart beat occurred. Such a function is by its very nature a memory and therefor is a type of function normally associated with the brain.

DR Rollin MacCraty has developed this research. He has devised tests which show how the heart must be able to process information. Tests were carried out. People were shown a series of pictures which were meant to provoke strong emotional reactions. His tests showed that the heart responded before the brain. So the heart must have an ability to process emotional data.

So we are left with the conclusion that the heart has an ability to process and create emotions. This has been tested scientifically. Also the recipients of the transplants have been shown to take on the personality of the donors in ways which have astounded scientists. So we are left with the inevitable conclusion that the heart contains neurons and can retain and process emotions and memories.

I dunno.

*shrug*

Posted by Lynn MagdalenCollege (# 10651) on :

quote:
Originally posted by RuthW:
I've signed the organ donor card as well. But is there really NO debatable point here?

Is there no chance that the fact that there are more people who need organs than there are organs available will influence some of the unbelievably difficult decisions made at the end of some people's lives? Do we think that every doctor empowered to pronounce the time of death gets it right every single time? Is medical science entirely deserving of our trust that they know exactly when life ends? Or when life can't be sustained? Or when someone can't be revived? Does everyone here entirely trust the system of deciding who gets an organ when one becomes available? The School of Medicine at the University of Missouri outlines the controversies involved in that.

Finally, it's good to hear that donated organs are treated with respect and that donors are honored. But people are people, and I don't believe for a moment that no one involved ever makes a joke about it. And it doesn't bother me in the least to think that the guy toting the heart cut out of my body might make a joke about it, as long as he gets it to its designated recipient as fast as possible.

Oh yeah, definitely debatable points. I think part of why folks aren't diving in is that, right now, we're invested in getting the tiny bit of goodness surrounding Geneviève's death - and that's related to her organ donation, the fact that her death will help perhaps a half-dozen people live and live better lives.

I too am concerned by the 'slippery slope' surrounding cardiac death versus brain death (I suppose one could specify brain death in the permissions?).

quote:
Nonetheless, some physicians and nurses at the bedside “continue to have concerns about the ethical propriety of the practice” that “are numerous, complex and related to the specific roles they play.” Some feel uncomfortable about participation in medical practices that may be required during the transition from end-of-life care to organ donation. For example, in multidisciplinary ICUs, doctors and nurses who care for both potential organ donors and organ recipients may have conflicting interests.

...Concerns were raised by a February 2006 case in San Luis Obispo, California, that was publicized earlier this year by the Los Angeles Times. Two transplant surgeons were allegedly in the same room with a potential donor, and one of the surgeons allegedly ordered massive doses of morphine and lorazepam in an attempt to hasten the patient's death and thereby obtain his organs more quickly. The patient did not die for several hours, and his organs were not recovered because they were no longer usable for transplantation. The case, which has been investigated by local law-enforcement authorities, is a sobering reminder that organ-donation efforts can go terribly wrong if appropriate procedures are not followed. (from the New England Journal of Medicine article RuthW noted.

For myself, I think it presumes too much to think that God isn't *doing* something in the dying patient's life, even when we say, "there's no chance for recovery."

quote:
After the decision has been made that the patient has no chance of survival and the family has decided to withdraw treatment, the family is offered the option of Donation After Cardiac Death. If the family agrees, the patient is moved to an operating room where support is withdrawn. In some situations, support may be withdrawn in the intensive care unit/ICU. Once the patient’s heart stops beating, the physician declares death. Following an additional five minutes of waiting to ensure the heart does not start beating again, organ recovery begins. The organs are then recovered. (from the brochure RuthW cited).

And the article by the bioethicist from UC Davis is fascinating (and chilling):

quote:
The fact that the organ transplants in the Denver pediatric cases involved hearts rather than other solid organs vividly highlights the controversy surrounding the deaddonor rule. How can the organ donor be legitimately declared dead if, shortly thereafter, their heart will be transplanted into another patient and successfully restarted?

I've been an organ donor for decades but, I must say, it does make me think about qualifying it in some way... [Frown]

Posted by Hairy Biker (# 12086) on :

As a motorcycle commuter on some of London's busiest motorways, some people already (jokingly?!) refer to me as an organ donor. I do carry a signed card - though one of my colleagues recently had a nasty bike accident and almost destroyed most of his internal organs. He almost became an organ recipient. (He's back on his feet again now, but it's been months.)

The film Jesus of Montreal uses organ donation as a parallel for healing the sick and restoring sight to the blind. Great film!

Posted by catthefat (# 8586) on :

It seems to me that there are serious issues about what and when death is, and when it occurs, and it nust be a matter for serious debate.
As for no jokes, surely everyone has heard the one about the man who received an arse transplant, but the arse rejected him?

Posted by Think² (# 1984) on :

Surely cardiac death donation is basically like trusting ones relatives or doctors to make ethically informed do not resuscitate decisions - which is often determined by quality of life likelihood if resussed and previously expressed wishes of the person concerned. Not sure why it should be any more problematic or ethically dodgy than that. (Not to say that that is easier, just that the dilemmas involved can be honestly navigated - if you see what I mean.)

Just because your heart is functioning doesn't mean you might not end up quadraplegic, tube dependent and brain damaged for example.

[ 07. May 2012, 15:06: Message edited by: Think² ]

Posted by maleveque (# 132) on :

Coincidentally, I just saw this: article on organ donor status on Facebook.
It's not an app (which I despise), just a status like 'married' or 'single.'
I firmly believe that as those of us who are donors share that information with others, more people will be inclined to check that box on their driver's license.
- Anne L.

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