One of the more difficult things in life is to admit to having been wrong.
Not just a little bit wrong, but stridently so.
I had the privilege of having dinner yesterday with a distinguished doctor; a Catholic of unimpeachable ethics, and a good chap to boot.
We discussed heart transplants, and he told me that I was wrong.
Given that I have blogged (and as I say, stridently) on this, on more than one occasion, it is important that I correct this error.
He is very clear that brain stem death is an acceptable and reliable indication of death; that the heart may continue to beat beyond death if a patient is on a ventilator, and that the removal of that beating heart is ethically quite acceptable. Indeed, if it is done to save another life, it is clearly a moral good.
Once the brain stem is dead (which is verifiable) there is no prospect of any recovery. The brain is irreversibly damaged, and consciousness is forever gone. This is most common in people with severe trauma to the head (eg as a result of road traffic accidents) and whilst their heart may be kept going by extraordinary technical means, they really are dead.
I raised the query about the need to anaesthetise before removing the beating heart (which I have to confess is the bit that really brings me up short) and he said that is done as there may still be nerve activity from (eg) the spinal cord that might cause movements, which could impede the operation (as well as needlessly distress the medical staff).
The other instances that have caused concern have been where doctors have failed in their duty of diagnosis etc. Clearly that is very wrong, but it does not call into question the practice of heart (or liver etc) transplants per se.
I am now going back over my old posts about this, adding an update, directing people to this post, to minimise any further risk of misleading people.
UPDATE
I should make it clear that we were discussing the situation in the UK. I understand that different and more dangerous ideas and practices may be prevalent elsewhere, including the US.
Showing posts with label Organ donation. Show all posts
Showing posts with label Organ donation. Show all posts
Sunday, 9 February 2014
Friday, 23 November 2012
Not surprised...
Why am I not surprised at the story emerging from Denmark that a young woman, 19-year old Carina Melchior, deemed to be dying and whose family were asked to agree to having her organs transplanted, was not in fact dying.
In fact, she is lucky to be alive, as her respirator was turned off by the doctors, once they had the family's consent to use her vital organs. 'Those bandits in white coats gave up too quickly because they wanted an organ donor,' her enraged father protested - and one can sympathise with his outrage.
However she did survive; as has happened before, the doctors' diagnosis of imminent death, whilst convenient for their desire to harvest her organs, was in fact incorrect.
The problem lies in the fact that for transplants of vital organs (eg the heart) there is a desperate urgency, which drives calamitous decision-making. In fact, as I have blogged before, doctors cannot afford to wait until somebody is dead to remove their heart. Once the heart stops beating, it deteriorates too quickly to be available for transplant.
That is why the diagnosis of 'brain-dead' has been invented: to legitimise the removal of organs from 'heart-beating donors'. Of course, in order to do that, you frequently have to anaesthetise the 'dead' person too, or they wince when they are cut open, which is distressing for the medical staff... One who was not anaesthetised put his arm around a nurse, just before they were about to remove his heart. That saved his life, but had he been anaesthetised, of course, the outcome would have been very different.
Curiously, after the documentary about the Danish girl, many Danish people tore up their donor cards.
But my bet is that most donor-card carriers in this country are completely unaware that they may be sedated and have their hearts removed while their hearts are still beating, their flesh is warm - but someone has decided (and not infallibly, as so many cases prove) that they are dead.
IMPORTANT UPDATE: here
In fact, she is lucky to be alive, as her respirator was turned off by the doctors, once they had the family's consent to use her vital organs. 'Those bandits in white coats gave up too quickly because they wanted an organ donor,' her enraged father protested - and one can sympathise with his outrage.
However she did survive; as has happened before, the doctors' diagnosis of imminent death, whilst convenient for their desire to harvest her organs, was in fact incorrect.
The problem lies in the fact that for transplants of vital organs (eg the heart) there is a desperate urgency, which drives calamitous decision-making. In fact, as I have blogged before, doctors cannot afford to wait until somebody is dead to remove their heart. Once the heart stops beating, it deteriorates too quickly to be available for transplant.
That is why the diagnosis of 'brain-dead' has been invented: to legitimise the removal of organs from 'heart-beating donors'. Of course, in order to do that, you frequently have to anaesthetise the 'dead' person too, or they wince when they are cut open, which is distressing for the medical staff... One who was not anaesthetised put his arm around a nurse, just before they were about to remove his heart. That saved his life, but had he been anaesthetised, of course, the outcome would have been very different.
Curiously, after the documentary about the Danish girl, many Danish people tore up their donor cards.
But my bet is that most donor-card carriers in this country are completely unaware that they may be sedated and have their hearts removed while their hearts are still beating, their flesh is warm - but someone has decided (and not infallibly, as so many cases prove) that they are dead.
IMPORTANT UPDATE: here
Sunday, 22 January 2012
At what price?
It’s what every parent dreads: the arrival of the police at the door, with bad news about your child.
‘She was on a caving trip from University and there’s been accident. A flash flood has caused a small rockfall, and one student is trapped in a narrow passage. Your daughter is behind her, and there is no way to get her out. The student in front of her is in a bad way, with a spinal injury, and can’t be moved without risk to her life. But we can keep her alive at least for a while, with food and water. But your daughter simply can’t be reached, so will not hold out for long. I’m sorry. The tragedy is that there’s no chance of the student who is blocking the passage living. She’s on borrowed time and heavily sedated. The only way we could save your daughter is actually to kill the student in front of her. And even though we know she’s not going to survive, we obviously can’t do that.’
Obviously; and rightly.
None of this has happened, of course: so what is this about?
This morning I heard an exchange on the radio (the Sunday Programme, I think) about organ donation and presumed consent. For balance, they had someone from each side of the debate; that is each side of the 'presumed consent' debate. But both were clear their goals were the same: to increase the number of organ donors.
I am against presumed (= involuntary) consent - for the obvious reasons.
Further, for me, consent is meaningless if uninformed; but how may people know that when they donate a vital organ, it will be taken from them while their heart is still beating?
Finally, I am against the whole business of vital organ donation: that is the removal of organs, whose removal will cause the death of the donor. Non-vital donation is fine and noble: the donor will live on healthily. But vital organs can only be donated by living patients: once the heart stops beating, they deteriorate too quickly. So medics have had to re-define 'death' to justify taking organs from living donors. I have blogged about this before, at more length, here.
And also about the case of the ‘dead’ donor who woke up just in time here.
But Ben, Ben, if it was your child who needed a new heart...!
That’s why I started this post with the caving story. If my daughter were trapped behind someone, even if they were dying, I would not sanction their being murdered to save my child. Likewise, I would not accept the premature killing, even of an (apparently) dying patient so that my child could live longer. Indeed, the medics should never put me in the position to make such a choice. One of the tragic things about the retreat from proper Medical Ethics in favour of a utilitarian culture of abortion, cloning, embryo experimentation, euthanasia, transplanting organs from living patients etc, is the corruption of the medical profession.
Friday, 23 December 2011
Just in time
A young man in an 'irreversible coma' woke just in time. That is, just before the doctors were about to remove his vital organs for transplant, thus killing him. Lifesite News carries the story.
When the death penalty was abolished in this country, it was done because there was a political consensus that the risk of killing an innocent person, small though it was, was not a risk that a civilised country ought to take. This young man was 'thought to be' 'brain dead.'
Of course he was not dead: his heart was beating, his body was functioning at some level. But that is necessary for vital organ donation: truly dead donors are of no value, as the vital organs deterioriate too quickly once the circulation of blood has stopped. (See previous posts tagged Organ donation for a fuller discussion and links...)
It is that necessity for what are called 'heart-beating donors' which has led to the redefinition of death so that vital organs may be taken from patients who (until recently) any doctor would have certified as still alive.
This case, along with many others, proves how costly that utilitarian re-definition is in reality.
We have come a long way since then - but I would not call it progress.
H/t Blondpidge on Twitter
IMPORTANT UPDATE: here
When the death penalty was abolished in this country, it was done because there was a political consensus that the risk of killing an innocent person, small though it was, was not a risk that a civilised country ought to take. This young man was 'thought to be' 'brain dead.'
Of course he was not dead: his heart was beating, his body was functioning at some level. But that is necessary for vital organ donation: truly dead donors are of no value, as the vital organs deterioriate too quickly once the circulation of blood has stopped. (See previous posts tagged Organ donation for a fuller discussion and links...)
It is that necessity for what are called 'heart-beating donors' which has led to the redefinition of death so that vital organs may be taken from patients who (until recently) any doctor would have certified as still alive.
This case, along with many others, proves how costly that utilitarian re-definition is in reality.
We have come a long way since then - but I would not call it progress.
H/t Blondpidge on Twitter
IMPORTANT UPDATE: here
Monday, 19 December 2011
Organ Donation: another assault on life
I have decided to re-post on the subject of Organ Donation, as it is some years since I last mentioned this important and misunderstood subject, and I have rather more readers now than I did have then...
Until I researched it a bit, I had not realised that for hearts (and certain other vital organs) to be transplanted successfully, they must be taken from a living body, as they deteriorate beyond usefulness on death. And that in order to facilitate that, the medical profession has introduced the notion of ‘brain death’ to legitimise the practice.
This has disturbed many nurses and others, as they cannot believe that the donor is dead when his or her heart is beating, flesh is warm, and (in one case) when he put his arm around the nurse just before they were about to remove his heart.
So what do our medical professionals do? Inject a drug that paralyses the donor - and then proceed.
The parallels with the murderous assaults on the unborn in the womb are extraordinary: the start of life re-defined contrary to the evidence, the injection of tranquilisers or anaesthetics prior to the killing...
A good source of information is the Anscombe Centre (formerly the Linacre Centre). In their article on criteria for death, they comment on the problems with the (relatively) recent notion of 'brain death' as the determining criterion:
The Anscombe Centre's own view is that `brain death' protocols are insufficient for establishing the death of the body: we have become increasingly convinced by evidence suggesting that integrated bodily activity can continue after `brain death' has been diagnosed. There have been documented cases of `brain dead' patients maintaining bodily functions for months or even years: pregnant women have gone through pregnancy, children have grown up and passed through puberty, etc. 3 Moreover, it is well-known to transplant teams that heartbeating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made. It is worth noting that some anaesthetists recommend that the supposed `cadaver' be anaesthetised when his/her organs are retrieved. Most organ donors are unaware that their hearts may be beating when their organs are taken, and that they may be pink, warm, able to heal wounds, fight infections, respond to stimuli, etc.
(Link here, and see also their 'Definition of Death' comments)
In 2008 a government commissioned report, after studying a huge body of evidence, came to the 'wrong' conclusion that the consent of organ donors should be explicit not presumed: however, the political class did not want that answer, and are positioning themselves to ignore it. The BBC, of course, will be involved in a campaign to soften up public opinion.
We have another fight on our hands…
IMPORTANT UPDATE: here
Until I researched it a bit, I had not realised that for hearts (and certain other vital organs) to be transplanted successfully, they must be taken from a living body, as they deteriorate beyond usefulness on death. And that in order to facilitate that, the medical profession has introduced the notion of ‘brain death’ to legitimise the practice.
This has disturbed many nurses and others, as they cannot believe that the donor is dead when his or her heart is beating, flesh is warm, and (in one case) when he put his arm around the nurse just before they were about to remove his heart.
So what do our medical professionals do? Inject a drug that paralyses the donor - and then proceed.
The parallels with the murderous assaults on the unborn in the womb are extraordinary: the start of life re-defined contrary to the evidence, the injection of tranquilisers or anaesthetics prior to the killing...
A good source of information is the Anscombe Centre (formerly the Linacre Centre). In their article on criteria for death, they comment on the problems with the (relatively) recent notion of 'brain death' as the determining criterion:
The Anscombe Centre's own view is that `brain death' protocols are insufficient for establishing the death of the body: we have become increasingly convinced by evidence suggesting that integrated bodily activity can continue after `brain death' has been diagnosed. There have been documented cases of `brain dead' patients maintaining bodily functions for months or even years: pregnant women have gone through pregnancy, children have grown up and passed through puberty, etc. 3 Moreover, it is well-known to transplant teams that heartbeating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made. It is worth noting that some anaesthetists recommend that the supposed `cadaver' be anaesthetised when his/her organs are retrieved. Most organ donors are unaware that their hearts may be beating when their organs are taken, and that they may be pink, warm, able to heal wounds, fight infections, respond to stimuli, etc.
(Link here, and see also their 'Definition of Death' comments)
In 2008 a government commissioned report, after studying a huge body of evidence, came to the 'wrong' conclusion that the consent of organ donors should be explicit not presumed: however, the political class did not want that answer, and are positioning themselves to ignore it. The BBC, of course, will be involved in a campaign to soften up public opinion.
We have another fight on our hands…
IMPORTANT UPDATE: here
Wednesday, 19 November 2008
The Wrong Answer...
Elizabeth Buggins got it wrong. Despite the fact that her committee had examined 400 pages of evidence and considered experience from across the world, thair recommendation - that consent for organ donation should be explicit, not presumed - was not the answer that the Prime Minister wanted.
Ms Buggins said: "We found from recipient families and donor families that the concept of gift was very important to them and presumed consent would undermine that concept.
"We also found that it has the potential to erode trust in doctors, and we know that is very important to the levels of donation."
Instead, Ms Buggins said a rise in organ donations was more likely to be achieved by increasing in the number of donor coordinators who work with bereaved families, and the number of specialists who retrieve organs, and by launching public information campaigns.
However the Prime Minister is already preparing to ignore this advice and press on with what he has clearly decided is the right answer, despite the committee’s thorough investigation. He said: “"I'm not ruling out a further change in the law.”
Ms Buggins further added: "There is lots of fear out there that organs are taken from patients before they are dead - that is absolutely not true."
Here she is both right and wrong: there is such fear - and it is well-merited. The fact that a new definition of death has been created to allow the removal of organs from living people does not disguise (or excuse) that reality.
To their shame, Patient Concern on their campaign site, say “We also believe that giving general anaesthetic should be mandatory before organs are removed from donors who are still breathing.” I would prefer for them to campaign for no removal of vital organs prior to death - but that would bring large parts of the transplant industry to a complete standstill, as only organs from living donors are any good to them in many cases (see my previous posts on this).
IMPORTANT UPDATE: here
Ms Buggins said: "We found from recipient families and donor families that the concept of gift was very important to them and presumed consent would undermine that concept.
"We also found that it has the potential to erode trust in doctors, and we know that is very important to the levels of donation."
Instead, Ms Buggins said a rise in organ donations was more likely to be achieved by increasing in the number of donor coordinators who work with bereaved families, and the number of specialists who retrieve organs, and by launching public information campaigns.
However the Prime Minister is already preparing to ignore this advice and press on with what he has clearly decided is the right answer, despite the committee’s thorough investigation. He said: “"I'm not ruling out a further change in the law.”
Ms Buggins further added: "There is lots of fear out there that organs are taken from patients before they are dead - that is absolutely not true."
Here she is both right and wrong: there is such fear - and it is well-merited. The fact that a new definition of death has been created to allow the removal of organs from living people does not disguise (or excuse) that reality.
To their shame, Patient Concern on their campaign site, say “We also believe that giving general anaesthetic should be mandatory before organs are removed from donors who are still breathing.” I would prefer for them to campaign for no removal of vital organs prior to death - but that would bring large parts of the transplant industry to a complete standstill, as only organs from living donors are any good to them in many cases (see my previous posts on this).
IMPORTANT UPDATE: here
Friday, 12 September 2008
Taking Organs from the living...
I've been asked for more information on organ transplants, brain death, and so on.
A good source is the Linacre Centre (who have a link in my sidebar). In their article on criteria for death, they comment on the problems with the (relatively) recent notion of 'brain death' as the determining criterion:
The Linacre Centre's own view is that `brain death' protocols are insufficient for establishing the death of the body: we have become increasingly convinced by evidence suggesting that integrated bodily activity can continue after `brain death' has been diagnosed. There have been documented cases of `brain dead' patients maintaining bodily functions for months or even years: pregnant women have gone through pregnancy, children have grown up and passed through puberty, etc. 3 Moreover, it is well-known to transplant teams that heartbeating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made. It is worth noting that some anaesthetists recommend that the supposed `cadaver' be anaesthetised when his/her organs are retrieved. Most organ donors are unaware that their hearts may be beating when their organs are taken, and that they may be pink, warm, able to heal wounds, fight infections, respond to stimuli, etc.
(from http://www.linacre.org/humbod.html see also http://www.linacre.org/death.html)
The Times has reported that even this flawed measure is to be ignored in the drive to harvest spare parts from people who may (or may not) be dead. See http://www.timesonline.co.uk/tol/life_and_style/health/article4232319.ece
IMPORTANT UPDATE: here
A good source is the Linacre Centre (who have a link in my sidebar). In their article on criteria for death, they comment on the problems with the (relatively) recent notion of 'brain death' as the determining criterion:
The Linacre Centre's own view is that `brain death' protocols are insufficient for establishing the death of the body: we have become increasingly convinced by evidence suggesting that integrated bodily activity can continue after `brain death' has been diagnosed. There have been documented cases of `brain dead' patients maintaining bodily functions for months or even years: pregnant women have gone through pregnancy, children have grown up and passed through puberty, etc. 3 Moreover, it is well-known to transplant teams that heartbeating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made. It is worth noting that some anaesthetists recommend that the supposed `cadaver' be anaesthetised when his/her organs are retrieved. Most organ donors are unaware that their hearts may be beating when their organs are taken, and that they may be pink, warm, able to heal wounds, fight infections, respond to stimuli, etc.
(from http://www.linacre.org/humbod.html see also http://www.linacre.org/death.html)
The Times has reported that even this flawed measure is to be ignored in the drive to harvest spare parts from people who may (or may not) be dead. See http://www.timesonline.co.uk/tol/life_and_style/health/article4232319.ece
IMPORTANT UPDATE: here
Wednesday, 10 September 2008
Re-defining Death
I have been reading a lot about brain death and organ transplants recently. I had not realised that for hearts or livers to be transplanted successfully, they must be taken from a living body, as they deteriorate beyond usefulness on death. And that in order to facilitate that, the medical profession has introduced the notion of ‘brain death’ to legitimise the practice.
This has disturbed many nurses and others, as they cannot believe that the donor is dead when his or her heart is beating, flesh is warm, and (in one case) when he put his arm around the nurse just before they were about to remove his heart.
So what do our medical professionals do? Inject a drug that paralyses the donor - and then proceed.
The parallels with the murderous assaults on the unborn in the womb are extraordinary: the start of life re-defined contrary to the evidence, the injection of tranquilisers or anaesthetics prior to the murder…
IMPORTANT UPDATE: here
This has disturbed many nurses and others, as they cannot believe that the donor is dead when his or her heart is beating, flesh is warm, and (in one case) when he put his arm around the nurse just before they were about to remove his heart.
So what do our medical professionals do? Inject a drug that paralyses the donor - and then proceed.
The parallels with the murderous assaults on the unborn in the womb are extraordinary: the start of life re-defined contrary to the evidence, the injection of tranquilisers or anaesthetics prior to the murder…
IMPORTANT UPDATE: here
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