4 ms·

Err why is "delivering organs " good for a doctors career - and most organ donors (90% in the UK) are dead

candiodari 8y ago
Can we once and for all get that myth out of the air ? Organ donors are not dead. That'd be great ... but it's just not how the world works [1]. They are either "brain dead", or in "circulatory death" (usually referred to as "awaiting cardiac arrest" internationally) (definitions here [2]), which is not entirely unrelated but very different from dead. Most are not brain dead (if they didn't have injuries they would be expected to recover), and there is, for example, a significant chance they'd wake up if left without sedation (they have however been diagnosed with essentially a serious blood leak and cannot reasonably be expected to survive an operation. But for several hours, all that will happen is a slow and steady drop in the oxygen content of their blood (and I'm not even mentioning that at times the problem with the operation is that the infrastructure and/or personnel for an operation is not available rather than it being impossible to execute)). You cannot transplant organs that have not been oxygenated (meaning heart beats, lungs work) for ~20 seconds. That has essentially zero chance of success. (and no, oxygenation doesn't stop when they take out the organ, obviously that's one thing they prevent from happening) You cannot transplant most organs that have been in a body that's "brain dead" for ~2 hours. That has near zero chance of success. So transplanting an organ from a person that has stopped breathing 20 seconds before the organ was taken out, or that stopped controlling their body 2 hours before the organ was taken out ... is no more than a death sentence for the organ receiver (even in the case of a not-immediately-critical organ, a failed organ donation procedure will weaken a receiver so much that their survival is in doubt. Kidneys ... perhaps you can suvive 2 failed donations. Anything else ... no way). In practice, in most cases doctors need to make the decision to proceed with organ donation at least 1 hour before the organs are actually taken out, and the donor body needs to function during that time (meaning heart beating, lungs pumping, at least partially operational spinal cord). [1] https://tonic.vice.com/en_us/article/zmv853/exactly-what-happens-when-an-organ-donor-dies https://tonic.vice.com/en_us/article/zmv853/exactly-what-hap... [2] https://en.wikipedia.org/wiki/Non-heart-beating_donation https://en.wikipedia.org/wiki/Non-heart-beating_donation
- jtbayly 8y ago
  > You cannot transplant most organs that have been in a body that's "brain dead" for ~2 hours. That has near zero chance of success. I'd be very interested in any links (especially papers) that discuss this.
  - refurb 8y ago
    So would I. That runs counter to everything I've heard about the subject.
    - Bartweiss 8y ago
      This is certainly false, and a lot of that comment is completely incoherent. Per the original Harvard Med rules, brain death for beating-heart donors couldn't even be declared without 24 hours of ventilated observation of the patient. Per DCI Donor Services (a large organ donation org), brain-dead patients today are regularly ventilators for several days while maintaining transplant-worthy status. The minimum turnaround for a donor is about 12 hours from brain death, since a full disease screen takes around 8 hours. And the maximum turnaround time after removal for even the shortest-lived organs like lungs is 4+ hours. Possibly the commenter is trying to say that patients who enter unventilated brain death will cease to be viable donors within two hours? But that position is even more incoherent; the problem with unventilated brain death is that it promptly becomes cardiac death also.
      - candiodari 8y ago
        That's only possible in cases of very limited braindead. "Mostly" a braindead person will have a slowly lowering heartbeat, and once it hits 20 or so, they die. This usually takes hours, not days. Now, there's a gazillion different ways to be braindead. It can be that the spine is disconnected somewhere (in fact this is the most common reason, thank you traffic), and on the other end there is no sharp cutoff between braindead and in coma, where we see no damage whatsoever and can even be brought on by a normally unrelated disease (but often some form of poisoning is suspected). Therefore there can be very weird phenomena in a significant number of cases. Also the symptoms depend on the exact point the disconnection occurs. If it's deep in your back (10th vertebra or lower), you're dead in minutes, unless it's very, very deep (18+). But mostly, you don't survive braindead for very long. Even an artifical "braindead" state (which is what barbiturate overdose patients die from) normally doesn't last more than 3-4 hours before death occurs, including the period where activity slows (so starting from the point the overdose was administered).

Can we once and for all get that myth out of the air ? Organ donors are not dead. That'd be great ... but it's just not how the world works [1]. They are either "brain dead", or in "circulatory death" (usually referred to as "awaiting cardiac arrest" internationally) (definitions here [2]), which is not entirely unrelated but very different from dead. Most are not brain dead (if they didn't have injuries they would be expected to recover), and there is, for example, a significant chance they'd wake up if left without sedation (they have however been diagnosed with essentially a serious blood leak and cannot reasonably be expected to survive an operation. But for several hours, all that will happen is a slow and steady drop in the oxygen content of their blood (and I'm not even mentioning that at times the problem with the operation is that the infrastructure and/or personnel for an operation is not available rather than it being impossible to execute)). You cannot transplant organs that have not been oxygenated (meaning heart beats, lungs work) for ~20 seconds. That has essentially zero chance of success. (and no, oxygenation doesn't stop when they take out the organ, obviously that's one thing they prevent from happening) You cannot transplant most organs that have been in a body that's "brain dead" for ~2 hours. That has near zero chance of success. So transplanting an organ from a person that has stopped breathing 20 seconds before the organ was taken out, or that stopped controlling their body 2 hours before the organ was taken out ... is no more than a death sentence for the organ receiver (even in the case of a not-immediately-critical organ, a failed organ donation procedure will weaken a receiver so much that their survival is in doubt. Kidneys ... perhaps you can suvive 2 failed donations. Anything else ... no way). In practice, in most cases doctors need to make the decision to proceed with organ donation at least 1 hour before the organs are actually taken out, and the donor body needs to function during that time (meaning heart beating, lungs pumping, at least partially operational spinal cord). [1] https://tonic.vice.com/en_us/article/zmv853/exactly-what-happens-when-an-organ-donor-dies https://tonic.vice.com/en_us/article/zmv853/exactly-what-hap... [2] https://en.wikipedia.org/wiki/Non-heart-beating_donation https://en.wikipedia.org/wiki/Non-heart-beating_donation

jtbayly 8y ago
> You cannot transplant most organs that have been in a body that's "brain dead" for ~2 hours. That has near zero chance of success. I'd be very interested in any links (especially papers) that discuss this.
- refurb 8y ago
  So would I. That runs counter to everything I've heard about the subject.
  - Bartweiss 8y ago
    This is certainly false, and a lot of that comment is completely incoherent. Per the original Harvard Med rules, brain death for beating-heart donors couldn't even be declared without 24 hours of ventilated observation of the patient. Per DCI Donor Services (a large organ donation org), brain-dead patients today are regularly ventilators for several days while maintaining transplant-worthy status. The minimum turnaround for a donor is about 12 hours from brain death, since a full disease screen takes around 8 hours. And the maximum turnaround time after removal for even the shortest-lived organs like lungs is 4+ hours. Possibly the commenter is trying to say that patients who enter unventilated brain death will cease to be viable donors within two hours? But that position is even more incoherent; the problem with unventilated brain death is that it promptly becomes cardiac death also.
    - candiodari 8y ago
      That's only possible in cases of very limited braindead. "Mostly" a braindead person will have a slowly lowering heartbeat, and once it hits 20 or so, they die. This usually takes hours, not days. Now, there's a gazillion different ways to be braindead. It can be that the spine is disconnected somewhere (in fact this is the most common reason, thank you traffic), and on the other end there is no sharp cutoff between braindead and in coma, where we see no damage whatsoever and can even be brought on by a normally unrelated disease (but often some form of poisoning is suspected). Therefore there can be very weird phenomena in a significant number of cases. Also the symptoms depend on the exact point the disconnection occurs. If it's deep in your back (10th vertebra or lower), you're dead in minutes, unless it's very, very deep (18+). But mostly, you don't survive braindead for very long. Even an artifical "braindead" state (which is what barbiturate overdose patients die from) normally doesn't last more than 3-4 hours before death occurs, including the period where activity slows (so starting from the point the overdose was administered).