11 ms·

Organ donation is based on recently dead people. Heart, liver, kidneys, eyes etc are all up for grabs as soon as possible I learned yesterday that a heart has

Organ donation is based on recently dead people. Heart, liver, kidneys, eyes etc are all up for grabs as soon as possible I learned yesterday that a heart has a shelf life of about 6 hours and liver is 12

jdsully 5y ago
Where I am being on an organ donor list also makes you eligible to be used as a cadaver. I’m not comfortable being prodded by med students but would give an organ.
klipt 5y ago
Fun social engineering fact: countries that make organ donation (on death) opt-out instead of opt-in have much shorter waiting lists for organs. The USA could save thousands of lives by switching to opt-out. https://en.wikipedia.org/wiki/Organ_donation#Opt-in_versus_opt-out https://en.wikipedia.org/wiki/Organ_donation#Opt-in_versus_o...
- njarboe 5y ago
  Funnier social engineering fact: If it's legal for people sell their kidneys, wait lists for kidneys goes to zero[1]. Too bad only one country in the world does that. Another fun fact. The US government spends more on dialysis than the budget for NASA. [1]https://en.wikipedia.org/wiki/Kidney_trade_in_Iran https://en.wikipedia.org/wiki/Kidney_trade_in_Iran
  - whimsicalism 5y ago
    Presumed consent would effectively end waiting lists for most organs.
  - ricardobeat 5y ago
    From news sources I found, it looks like the system in Iran works exactly as one would expect: the poor and desperate end up with one less kidney while not significantly benefitting from the trade. Which is precisely the reason such sales are outlawed worldwide.
    - JamesBarney 5y ago
      Kidney donors in Iran get ~6 month salary, kidney donors in the U.S. get 0 months salary. Are Iranian kidney donors the ones getting scammed?
      - echelon 5y ago
        Kidneys in the US are largely sourced from cadavers. If we enticed poor people to sell their kidneys, some percentage of them would wind up needing kidneys again without an ability to pay for them. This turns into a kidney marketplace where the rich win out over the poor. FCFS with triage based on need, immunocompatibility, and health outcome is the most equitable model.
        avereveard 5y ago
        > FCFS with triage based on need, immunocompatibility, and health outcome is the most equitable model. In theory. In practice rich people can jump ahead the line no matter what system. I.e. Steve Jobs and the liver that went to waste.
        catlikesshrimp 5y ago
        If you legalize selling organs, less rich people will be able to afford them. I don't like the idea of merchandizing humans. It is worse than prostitution. Maybe worse than slavery, as humans become disposable.
        xwdv 5y ago
        The difference is we are talking about saving lives, not prurient interests.
        DennisP 5y ago
        According to CNN, "it is unlikely that someone like Steve Jobs can 'cut the line' of the transplant waiting list. The reason that some people might be able to get transplants more quickly is that they're standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country -- and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy) -- a patient can, in theory, be evaluated by all the transplant centers in the country." https://www.cnn.com/2009/HEALTH/06/24/liver.transplant.priority.lists/ https://www.cnn.com/2009/HEALTH/06/24/liver.transplant.prior...
  - taneq 5y ago
    Surely for the budget of NASA, the U.S. government could just buy or build their own dialysis machines instead of paying for hospitals to do it.
- disabled 5y ago
  Yep. I have type 1 diabetes for 27 years, and so far, no complications. I recently contracted a shiga toxin producing E. coli strain which was cultured from my bowels. I also cultured entericocci (ETEC) but that’s not relevant to the discussion. I am lucky Shiga toxin E. coli (remember this famous Jack In The Box Breakout, FTW https://en.m.wikipedia.org/wiki/1993_Jack_in_the_Box_E._coli_outbreak https://en.m.wikipedia.org/wiki/1993_Jack_in_the_Box_E._coli... ) did not affect my kidneys. I am a dual US|European Union (Croatian) national. Croatia has one of the highest (ethical) transplant rates in the world. Let it be known that I would get it in Croatia over the USA.
ectopod 5y ago
Sure, but "dead" is a Humpty Dumpty word. Some organs need the donor to be legally but not colloquially dead. In other words, you are dead and your heart is still beating.
singlow 5y ago
I learned today that one can be a living heart donor. There is a special type of donation where a person who needs lungs gets a lungs+heart donation from a deceased donor, while the living person's healthy heart is transplanted to another person whose heart needs to be replaced. It seems this has advantages both for the lung recipient and the heart-only recipient and allows for compatibility in cases where the lungs and heart of the deceased person will not work separately for the two recipients.
generalizations 5y ago
Considering that some people have been revived without side effects after multiple hours of being brain-dead (e.g. famous example of women who drowned in icy water), how 'dead' is 'dead', in the context of being an organ donor? I've heard it said that "you're not dead until you're warm and dead", but 6-12 hours doesn't seem like a lot of time, to make sure you're not coming back. e.g., I drown in an icy pond, and I'm found after 5 hours. I might be revived, I might not...but the heart only has an hour before it's toast.
- manquer 5y ago
  Clinical Death != brain dead, Clinical death has a very well defined and nearly irreversible process [1]. The longest human is known to be revived is only in the range 10-15 minutes. Brain damage is quite likely at this point. The longest for an animal is for cat - 1 Hour. Only clinically dead people are eligible for organ transplantation [1] https://en.wikipedia.org/wiki/Clinical_death https://en.wikipedia.org/wiki/Clinical_death
  - generalizations 5y ago
    That's what I'm concerned about. Clinical death is apparently survivable. > Reduced body temperature, or therapeutic hypothermia, during clinical death slows the rate of injury accumulation, and extends the time period during which clinical death can be survived. The decrease in the rate of injury can be approximated by the Q10 rule, which states that the rate of biochemical reactions decreases by a factor of two for every 10 °C reduction in temperature. As a result, humans can sometimes survive periods of clinical death exceeding one hour at temperatures below 20 °C.[20] The prognosis is improved if clinical death is caused by hypothermia rather than occurring prior to it; in 1999, 29-year-old Swedish woman Anna Bågenholm spent 80 minutes trapped in ice and survived with a near full recovery from a 13.7 °C core body temperature. It is said in emergency medicine that "nobody is dead until they are warm and dead."[21] In animal studies, up to three hours of clinical death can be survived at temperatures near 0 °C.[22][23] I'd rather not be harvested too quickly, when I could have been revived without issue.
    - 5y ago
jxramos 5y ago
can you share a link, I'd like to learn more about this "organ shelf life". Very fascinating. Maybe I was mistakenly applying the sudden death of the brain without blood perfusion to hold likewise for every other organ. Like a heart attack when blood ceases to flow into it turns the myocardium to scar tissue. But that must not be an instant process, probably takes some time. I know temperature can keep tissues viable longer too, so that's another variable to consider.
- jxramos 5y ago
  This article is pretty fascinating, never knew about so called preservation solution https://www.livescience.com/how-long-can-donated-organs-last-before-transplant.html https://www.livescience.com/how-long-can-donated-organs-last...
- Someone 5y ago
  The brain doesn’t die suddenly without blood perfusion, either. If it did, heart transplants wouldn’t work at all.
  - rcxdude 5y ago
    For the brain it's pretty damn quick (minutes before significant damage). heart transplants rely on being able to run an artificial heart and lung machine to oxygenate and pump the blood while the heart is stopped, removed, and replaced.

jdsully 5y ago

Where I am being on an organ donor list also makes you eligible to be used as a cadaver. I’m not comfortable being prodded by med students but would give an organ.

klipt 5y ago

Fun social engineering fact: countries that make organ donation (on death) opt-out instead of opt-in have much shorter waiting lists for organs. The USA could save thousands of lives by switching to opt-out. https://en.wikipedia.org/wiki/Organ_donation#Opt-in_versus_opt-out https://en.wikipedia.org/wiki/Organ_donation#Opt-in_versus_o...

njarboe 5y ago
Funnier social engineering fact: If it's legal for people sell their kidneys, wait lists for kidneys goes to zero[1]. Too bad only one country in the world does that. Another fun fact. The US government spends more on dialysis than the budget for NASA. [1]https://en.wikipedia.org/wiki/Kidney_trade_in_Iran https://en.wikipedia.org/wiki/Kidney_trade_in_Iran
- whimsicalism 5y ago
  Presumed consent would effectively end waiting lists for most organs.
- ricardobeat 5y ago
  From news sources I found, it looks like the system in Iran works exactly as one would expect: the poor and desperate end up with one less kidney while not significantly benefitting from the trade. Which is precisely the reason such sales are outlawed worldwide.
  - JamesBarney 5y ago
    Kidney donors in Iran get ~6 month salary, kidney donors in the U.S. get 0 months salary. Are Iranian kidney donors the ones getting scammed?
    - echelon 5y ago
      Kidneys in the US are largely sourced from cadavers. If we enticed poor people to sell their kidneys, some percentage of them would wind up needing kidneys again without an ability to pay for them. This turns into a kidney marketplace where the rich win out over the poor. FCFS with triage based on need, immunocompatibility, and health outcome is the most equitable model.
      - avereveard 5y ago
        > FCFS with triage based on need, immunocompatibility, and health outcome is the most equitable model. In theory. In practice rich people can jump ahead the line no matter what system. I.e. Steve Jobs and the liver that went to waste.
        catlikesshrimp 5y ago
        If you legalize selling organs, less rich people will be able to afford them. I don't like the idea of merchandizing humans. It is worse than prostitution. Maybe worse than slavery, as humans become disposable.
        xwdv 5y ago
        The difference is we are talking about saving lives, not prurient interests.
        DennisP 5y ago
        According to CNN, "it is unlikely that someone like Steve Jobs can 'cut the line' of the transplant waiting list. The reason that some people might be able to get transplants more quickly is that they're standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country -- and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy) -- a patient can, in theory, be evaluated by all the transplant centers in the country." https://www.cnn.com/2009/HEALTH/06/24/liver.transplant.priority.lists/ https://www.cnn.com/2009/HEALTH/06/24/liver.transplant.prior...
- taneq 5y ago
  Surely for the budget of NASA, the U.S. government could just buy or build their own dialysis machines instead of paying for hospitals to do it.
disabled 5y ago
Yep. I have type 1 diabetes for 27 years, and so far, no complications. I recently contracted a shiga toxin producing E. coli strain which was cultured from my bowels. I also cultured entericocci (ETEC) but that’s not relevant to the discussion. I am lucky Shiga toxin E. coli (remember this famous Jack In The Box Breakout, FTW https://en.m.wikipedia.org/wiki/1993_Jack_in_the_Box_E._coli_outbreak https://en.m.wikipedia.org/wiki/1993_Jack_in_the_Box_E._coli... ) did not affect my kidneys. I am a dual US|European Union (Croatian) national. Croatia has one of the highest (ethical) transplant rates in the world. Let it be known that I would get it in Croatia over the USA.

ectopod 5y ago

Sure, but "dead" is a Humpty Dumpty word. Some organs need the donor to be legally but not colloquially dead. In other words, you are dead and your heart is still beating.

singlow 5y ago

I learned today that one can be a living heart donor. There is a special type of donation where a person who needs lungs gets a lungs+heart donation from a deceased donor, while the living person's healthy heart is transplanted to another person whose heart needs to be replaced. It seems this has advantages both for the lung recipient and the heart-only recipient and allows for compatibility in cases where the lungs and heart of the deceased person will not work separately for the two recipients.

generalizations 5y ago

Considering that some people have been revived without side effects after multiple hours of being brain-dead (e.g. famous example of women who drowned in icy water), how 'dead' is 'dead', in the context of being an organ donor? I've heard it said that "you're not dead until you're warm and dead", but 6-12 hours doesn't seem like a lot of time, to make sure you're not coming back. e.g., I drown in an icy pond, and I'm found after 5 hours. I might be revived, I might not...but the heart only has an hour before it's toast.

manquer 5y ago
Clinical Death != brain dead, Clinical death has a very well defined and nearly irreversible process [1]. The longest human is known to be revived is only in the range 10-15 minutes. Brain damage is quite likely at this point. The longest for an animal is for cat - 1 Hour. Only clinically dead people are eligible for organ transplantation [1] https://en.wikipedia.org/wiki/Clinical_death https://en.wikipedia.org/wiki/Clinical_death
- generalizations 5y ago
  That's what I'm concerned about. Clinical death is apparently survivable. > Reduced body temperature, or therapeutic hypothermia, during clinical death slows the rate of injury accumulation, and extends the time period during which clinical death can be survived. The decrease in the rate of injury can be approximated by the Q10 rule, which states that the rate of biochemical reactions decreases by a factor of two for every 10 °C reduction in temperature. As a result, humans can sometimes survive periods of clinical death exceeding one hour at temperatures below 20 °C.[20] The prognosis is improved if clinical death is caused by hypothermia rather than occurring prior to it; in 1999, 29-year-old Swedish woman Anna Bågenholm spent 80 minutes trapped in ice and survived with a near full recovery from a 13.7 °C core body temperature. It is said in emergency medicine that "nobody is dead until they are warm and dead."[21] In animal studies, up to three hours of clinical death can be survived at temperatures near 0 °C.[22][23] I'd rather not be harvested too quickly, when I could have been revived without issue.
  - 5y ago

jxramos 5y ago

can you share a link, I'd like to learn more about this "organ shelf life". Very fascinating. Maybe I was mistakenly applying the sudden death of the brain without blood perfusion to hold likewise for every other organ. Like a heart attack when blood ceases to flow into it turns the myocardium to scar tissue. But that must not be an instant process, probably takes some time. I know temperature can keep tissues viable longer too, so that's another variable to consider.

jxramos 5y ago
This article is pretty fascinating, never knew about so called preservation solution https://www.livescience.com/how-long-can-donated-organs-last-before-transplant.html https://www.livescience.com/how-long-can-donated-organs-last...
Someone 5y ago
The brain doesn’t die suddenly without blood perfusion, either. If it did, heart transplants wouldn’t work at all.
- rcxdude 5y ago
  For the brain it's pretty damn quick (minutes before significant damage). heart transplants rely on being able to run an artificial heart and lung machine to oxygenate and pump the blood while the heart is stopped, removed, and replaced.