3/11/2012

What happens when shortages of organs make doctors desparate

The shortage of organs makes people to undesirable things. In particular, doctors will ignore signs of recovery. Wouldn't it be better if we let patients get paid for their organs? From the WSJ:

But what are you giving up when you check the donor box on your license? Your organs, of course—but much more. You're also giving up your right to informed consent. Doctors don't have to tell you or your relatives what they will do to your body during an organ harvest operation because you'll be dead, with no legal rights. . . . .

The current criteria on brain death were set by a Harvard Medical School committee in 1968, at a time when organ transplantation was making great strides. In 1981, the Uniform Determination of Death Act made brain death a legal form of death in all 50 states.

The exam for brain death is simple. A doctor splashes ice water in your ears (to look for shivering in the eyes), pokes your eyes with a cotton swab and checks for any gag reflex, among other rudimentary tests. It takes less time than a standard eye exam. Finally, in what's called the apnea test, the ventilator is disconnected to see if you can breathe unassisted. If not, you are brain dead. (Some or all of the above tests are repeated hours later for confirmation.)

Here's the weird part. If you fail the apnea test, your respirator is reconnected. You will begin to breathe again, your heart pumping blood, keeping the organs fresh. Doctors like to say that, at this point, the "person" has departed the body. You will now be called a BHC, or beating-heart cadaver. . . .

In a 1999 article in the peer-reviewed journal Anesthesiology, Gail A. Van Norman, a professor of anesthesiology at the University of Washington, reported a case in which a 30-year-old patient with severe head trauma began breathing spontaneously after being declared brain dead. The physicians said that, because there was no chance of recovery, he could still be considered dead. The harvest proceeded over the objections of the anesthesiologist, who saw the donor move, and then react to the scalpel with hypertension. . . . .

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1 Comments:

Blogger Rick Boatright said...

It's not quite actually that simple. See http://www.braindeath.org/clinical.htm for a more accurate and more complete version. Note that the WSJ had to go back more than a decade to find a claimed case of harvesting from someone who might NOT be brain dead.

Note also that transplant surgeons are now forbidden to have any input whatsoever in the determination of brain death.

Anyway, it's more like nine criteria.

3/12/2012 2:51 AM  

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