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....
March 12, 2012
"What You Lose When You Sign That Donor Card."
"Most people are surprised to learn that many people who are declared brain dead are never actually tested for higher-brain activity."
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27 comments:
First! I am happy to be use for whatever is consonant with Jewish law - I give blood, platelets and (once so far) marrow as it is - but this has always been the suspicion - if you sign it it is the express route to being turned off. Once I'm well and truly dead, take what you want, but do give me a fighting chance.
OT: Althouse, yay for you, you're so big you get spammed. I accept Turings and even, sigh, captcha. But. Once we've logged in and passed it do we have to keep logging in and passing again and again, EVERY time?
See, it doesn't even take a Death Panel.
Too bad we can't do that for politicians: "Hey, this one's been brain dead for the last three terms. Term limit her immediately."
Obligatory Monty Python reference.
I negotiated a lot of deals and wrote a lot of contracts during my business life. The principle that always worked was to maintain an alignment of economic interest. Sign the donor card and you become worth more as parts. Cynical? Yes, but why give them any incentive other than providing the best care for you.
If you are taken into a trauma center hospital with a brain injury, it is amazing how fast the respirators are turned off within hours and the organs, especially a young man's, are implanted in others all over town.
If instead you go into a hospital that does not get the flow of young brain injured men from accidents and shootings, then the family has several days to assess the situation first.
Well, that's interesting. Follow the money, as they say. I suspect there's not much demand for research on whether the brain dead are well and truly dead because it would snuff out a cash flow.
Gee whiz, Ann, thanks a quart.
One more thing for The Blonde to worry about - yeah, I have apnea.
I don't sign the donor card. I should have the right to sell my organs; until I do, nobody gets 'em.
I've always been against organ donation because it reduces you to a series of commodities waiting to be 'harvested'. The language is ghoulish, the methodology is ghoulish. The whole transplant industry is ghoulish. You don't get compensated and mistakes are made with no recourse. I'm proudly not an organ donor and frankly, if little Timmy dies because he can't have some of my insides, well, too bad.
What? No Monty Python reference?
Here you go:
http://www.youtube.com/watch?v=aclS1pGHp8o
This is horrific, from the article:
"What if there is sound evidence that you are alive after being declared brain dead? 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."
This was a very, very pernicious article, by an author peddling a book which, at least based on its title and the inference that it's consistent with the article, is a very pernicious book. The author is playing on deep-rooted and only partly rational fears in order to make money, and in the process he's going to end up discouraging organ donors -- thereby condemning countless should-be organ transplant recipients.
With the current procedures in place, there is essentially no risk that your organs are going to be harvested while you are conscious or even capable of being healed/cured/returned to consciousness (much less health).
This is a manufactured panic, an ugly one with real victims but an imaginary risk. Doctors, including neurologists who are expert in brains and brain function, routinely sign their organ donor cards and become organ donors. If this was anything but a phony issue, they wouldn't.
Jim S: It's entirely possible that the lower brain and brainstem functions continue to work even if the higher brain is destroyed. That a patient who was expected not to breathe on his own does so does NOT mean that he would ever have been able to regain consciousness, no more than when you hooked up electrical wires to the frog cadaver in high school, the twitching legs meant the frog would come back to life.
You're being played by a guy who would like you to buy his book.
@ Methadras: You have the right to be selfish, and you certainly have the right to be proud of it, but if you came here looking for validation, you won't find it from me. I think your attitude stinks -- and that's MY prerogative.
What a disgusting article! I have worked in the field for over a decade and this "author" is simply spreading untruths to sell books. Are you all so gullible that you believe everything any writer gets published?
You ought to be able to sell organs.
Nothing will make sense until that happens.
The first thing that happens is that waiting lists disappear.
Whenever there's a line, government is involved.
This bogus article makes a great case for the new Israeli model of organ allocation. If you aren't a registered organ donor and you need an organ, you go to the bottom of the wait list.
It is unfair to those waiting for transplants and who are life-long registered donors to have to wait in line behind patients who don't register because they believe the foolishness in this article.
I find this hard to believe. Although I haven't been involved in any cases recently, it was always my experience that EEG's were done to confirm brain death before organs were harvested.
Follow the money indeed. Thanks, Beldar.
Why wouldn't the WSJ note that the author of the Opinion Piece has a book on this subject matter coming out -- today -- at the very start of the piece. Certainly it colors how you should interpret the writing.
I suspect there's not much demand for research on whether the brain dead are well and truly dead because it would snuff out a cash flow.
Peculiar that all the Schiavo meddlers did not followup their convictions with a research foundation dedicated to developing an accurate test for brain death.
A good friend of mine told me her brother, an Emergency Room Physician, has recommended that they NOT sign the donor card. He said that he has seen people 'taken' uncomfortably early. He believes in donating your organs - but tell your family so that they are in control - don't sign the driver's license, because your family won't be in control of the decisions or the timing of the decisions.
He said the doctors are busy people and they will want to harvest the organs when they have the time - not necessarily when all hope is gone.
Lily Bart said,
"He said the doctors are busy people and they will want to harvest the organs when they have the time - not necessarily when all hope is gone."
As an RN with years of experience in ER, ICU, and OR, I can say with near certainty that your "friend's brother" would not appreciate you attributing this ridiculous comment to him.
As always, folks are free to keep quiet if they don't understand the subject matter.
Does the Althouse portal to Amazon sell newly harvested organs? Why should strangers get the money?
To paraphrase Blago, "... a new heart is a valuable thing." Or was that the Apostle Paul?
Seriously, the bad feelings among family members arises when a brain injured Donor is declared brain dead and harvested without waiting for the family to arrive at the hospital, much less get a second opinion.
As an RN with years of experience in ER, ICU, and OR, I can say with near certainty that your "friend's brother" would not appreciate you attributing this ridiculous comment to him.
Thank you for your "years of experience". This was advice given by a doctor to his extended family. And my friend (not "friend") is not inclined to exaggerate or dramatize.
Um, no.
The declaration of brain death is a diagnosis that can only be made once, and I can tell you from 20+ years of experience as a neurologist, everyone involved in brain death protocols is intensely serious about it.
EEG testing is still routinely done - more importantly is cerebral blood flow testing. In the absence of CBF and in the presence of no discernible cortical and brain stem function, (and often the brain death protocol will mandate two examinations and sometimes by two different examiners) then and only then will the diagnosis of brain death be made.
In most states I believe, once a patient is declared brain dead, they are also declared legally dead and that is the time put on the death certificate.
And no, once the ventilator is reattached, the person does not breathe. The chest rises and falls because the ventilator is doing the work.
If one were to try to keep someone alive in such a state, one could do so, but for only so long - this is the concept of coma depasse - once CBF is lost, recovery is impossible.
And no again, patients' organs are not harvested without anesthesia - and presuming that this is true, if so, those involved would be severely disciplined.
All testing for brain death that I have ever witnessed, participated in, was always done with the utmost care.
I concur with much of what Belder wrote about - feh.
Beldar wrote:
"With the current procedures in place, there is essentially no risk that your organs are going to be harvested while you are conscious or even capable of being healed/cured/returned to consciousness (much less health)."
I find the addition of "(much less health)" curious. It reads like a quality of life bit tacked on to an existence of life discussion. Curious.
Then metoothenmail wrote an in depth clarification of how death is determined. Then, supporting the book excerpt suggestion of anesthesia, metoo writes
"And no again, patients' organs are not harvested without anesthesia - and presuming that this is true, if so, those involved would be severely disciplined."
Wait..they're dead but anesthesia is mandatory. Do they require it for autopsy as well?
Curious indeed.
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