the standard procedure for organ harvesting from beating-heart cadavers(!) (the living dead?) – 04min

Posted: January 1, 2012 in Uncategorized
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The benefits of being able to extend another life with the unused parts of your body seem obvious – although I’m not necessarily endorsing that either – we need to work these moral issues out for ourselves. The concern here is if we are sure those ‘parts of your body’ are really unused & unnecessary according to the tests commonly used to certify death?

Becoming an organ donor seems like a win-win situation. Some 3.3 people on the transplant waiting list will have their lives extended by your gift (3.3 is the average yield of solid organs per donor). You’re a hero, and at no real cost, apparently.

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 most likely donors are victims of head trauma (from, say, a car or motorcycle accident), spontaneous bleeding in the head, or an aneurysm – patients who can be ruled dead based on brain-death criteria. But brain deaths are estimated to be just around 1% of the total. Everyone else dies from failure of the heart, circulation and breathing, which leads the organs to deteriorate quickly.

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.

Still, you will have more in common biologically with a living person than with a person whose heart has stopped. Your vital organs will function, you’ll maintain your body temperature, and your wounds will continue to heal. You can still get bedsores, have heart attacks and get fever from infections.

“I like my dead people cold, stiff, gray and not breathing,” says Dr. Michael A. DeVita of the University of Pittsburgh Medical Center. “The brain dead are warm, pink and breathing.”

You might also be emitting brainwaves. Most people are surprised to learn that many people who are declared brain dead are never actually tested for higher-brain activity. The 1968 Harvard committee recommended that doctors use electroencephalography (EEG) to make sure the patient has flat brain waves. Today’s tests concentrate on the stalk-like brain stem, in charge of basics such as breathing, sleeping and waking. The EEG would alert doctors if the cortex, the thinking part of your brain, is still active.

But various researchers decided that this test was unnecessary, so it was eliminated from the mandatory criteria in 1971. They reasoned that, if the brain stem is dead, the higher centers of the brain are also probably dead.

But in at least two studies before the 1981 Uniform Determination of Death Act, some “brain-dead” patients were found to be emitting brain waves. One, from the National Institute of Neurological Disorders and Stroke in the 1970s, found that out of 503 patients who met the usual criteria of brain death, 17 showed activity in an EEG.

Even some of the sharpest critics of the brain-death criteria argue that there is no possibility that donors will be in pain during the harvesting of their organs. One, Robert Truog, professor of medical ethics, anesthesia and pediatrics at Harvard Medical School, compared the topic of pain in an organ donor to an argument over “whether it is OK to kick a rock.”

But BHCs – who don’t receive anesthetics during an organ harvest operation – react to the scalpel like inadequately anesthetized live patients, exhibiting high blood pressure and sometimes soaring heart rates. Doctors say these are simply reflexes.

Source: Wall Street Journal
Audio: AlbertMohler.com – The Briefing. Listen to full audio here.

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