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Last hours of an organ donor
- ghotli 2y agoThis is well written and insightful. Worth reading through to the end, at least in my opinion.
- eknkc 2y agoI find this type of writing tiring to be honest. The subject is interesting enough but I feel like I’m trying to find a recipe in one of those cooking sites also acting as chef’s diary.
- ghotli 2y agoThe danger of commenting like I did at all is that it's not a universal experience. I found it insightful sitting in an airport killing time. Perhaps consider accentuating the positive ¯\_(ツ)_/¯
- jessriedel 2y agoI’m glad eknkc commented negatively because now I know the sort of article it is and can avoid it. We should not just focus on the positive.
- ghotli 2y agoI left my comment when it was at risk of falling off the front page with no comments. Utilitarian, to hopefully see an insightful discussion from those more informed. I see where you're coming from and perhaps what I meant is something closer to 'build things up rather than tear them down'. You've got two conflicting opinions. Theirs and mine. Inquire inside the article to see which of us is a worthy recommender of casual content to consume on the internet
- jessriedel 2y agoI think in this case it’s a long-running question of taste. Some people like this style of writing, and some people do not.
- deleted 2y ago[deleted]
- saurik 2y agoThe entire point of Aeon is to write "longform explorations of deep issues". Not all--maybe not even most--content exists merely to transfer some tiny bit of information.
- Barrin92 2y agoThe point isn't really the length. It's the overly sentimental tone that blurs subjective perspective and the matter being reported on. There's a point in the piece were the author asserts that everyone in the operating room seemingly stared at each other not knowing why they were there followed by the author fantasizing if the patient may rise from the dead. That's almost certainly not what happened in the room but is the author blurring his almost literary account with reality. It's a very common almost manipulative style in newer journalism when writers want to contrast their emotional state vs an allegedly harsh reality.
- saurik 2y agoDoes this claim to be "journalism"?
- throwanem 2y agoYou're reading it wrongly, and I say that as one who 99 times out of a hundred has no use whatsoever for the nonsense Aeon typically peddles. This is the exception, even to the repeated fears over AI, which while technologically footless for the foreseeable future nonetheless express something real and worth considering.
- 587846 2y agoI thoroughly agree; I enjoyed the read. The brief discussion about the coldness of this being performed through AI and machines gave me a feeling of loneliness, of being just a number in this big old world. What a “cold” future it could be.
- DoreenMichele 2y agoIt's a good read. It's very pro organ donation but also talks about the dark side of this practice, of potentially killing patients to harvest their organs, among other things. I am more familiar with the emotional toll organ donation takes on potential recipients who are basically waiting and hoping for someone young and healthy to die in a tragic accident that they might live. Because of the focus of this piece, I will leave this link to two previous comments of mine: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&query=DoreenMichele%20heart%20lung%20beer&sort=byDate&type=comment https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
- XorNot 2y agoI can find absolutely no mention of this, anywhere, of this event happening from a quick Googling of those words, nor references to it either. However a German study in 1992 of 47 heart transplant patients found no substantial personality changes[1]. If this was a real thing, then you would expect to find it fairly commonly. [1] https://pubmed.ncbi.nlm.nih.gov/1299456/ https://pubmed.ncbi.nlm.nih.gov/1299456/
- DoreenMichele 2y agoI see zero reason to assume that it needs to be common in order for one woman to be telling the truth about her experiences.
- bitzun 2y agoI guess the idea is that the psychological burden of having received a donated heart caused the woman to have hallucinations? I don't know what to do with that information, but I wanted to look at a charitable interpretation of the suggestion.
- justinclift 2y ago> ... caused the woman to have hallucinations? Wonder if it could be prion transfer instead? https://en.wikipedia.org/wiki/Prion https://en.wikipedia.org/wiki/Prion
- nynx 2y agoThis is worth reading, but the anti-AI theme doesn’t really fit and I’m not sure why they added it.
- analyte123 2y agoThe author is an anesthesiologist. I don’t think we’re going to see the transplant surgeons writing with such concern any time soon.
- didgeoridoo 2y agoYeah it was jarring — wouldn’t be surprised if the first draft didn’t contain it at all, and the editor forced it in there so the piece would have a “hook” to current events.
- consf 2y ago[dead]
- oefrha 2y agoYeah that’s really weird. On the one hand, certain precision operations are already carried out by robots guided by surgeons on a computer screen, and experienced surgeons in certain domains can even oversee multiple robotic operations simultaneously.[1] On the other hand, unless you’re willing to put up with failed organ retrievals to save a little bit of money, I can’t imagine humans out of the loop any time soon. [1] Source: A family member recently retired after working in the OR for more than three decades.
- isoprophlex 2y agoAn impending sense of doom wrt. job security, because apparently this engages readers of the magazine this was published in.
- throwanem 2y agoIt reminded me a lot of some of the stories told by that poor fellow currently blogging his way through late-stage neck cancer, and whose posts lately have often reached the front page - specifically, it reminded me of his posts that talk in detail of what it's been like for him and his partner trying to negotiate the modern medical industry, and which would read like something out of Terry Gilliam's most darkly comedic fever dreams were it not for the literally life-and-death import of their subject matter. I doubt anything like that was the author's intent, but who cares? Theirs is the first, not the last, of the hands which shape the text.
- smeej 2y agoHonestly one of my biggest hangups about becoming an organ donor is the fact that the final decision is made by doctors. I have not had good experiences with doctors. More often than not, I have experienced doctors' being wrong about my health status, and recommending treatment that ultimately does me more harm than good. How could I trust that same class of people to make as important a decision as this, knowing it'll be luck of the draw which one I get the day of some fateful accident? Even if I can name the person finally responsible for authorizing taking my organs, they're going to be doing it trusting the judgment of whichever doctor happens to be on shift. We also can't know if--and if so, how often--they get it wrong. As the author mentions repeatedly, we can't know when "brain death" is "real death," or whether the medications given to preserve organs prior to cardiac death actually cause "real death." It's the most important set of dice I can possibly roll. How can I make that bet? How can I bet that these people will accurately assess when I'm dead, even if I were to remove potential conflicts of interest from calculation entirely and grant that they were purely well-meaning? Even if the chance of being wrong were miniscule, the consequence to me of being on the wrong end of it is total. I wish we could find a way to revive organs after death rather than having to keep them in a quasi-alive state. I would love to donate parts of myself so other people can live, after I'm done using them to live. After.
- lr4444lr 2y agoI cannot strongly enough recommend you find and build a relationship with a Direct Primary Care doctor. It will totally change your relationship with modern medicine. Not only will that doctor actually care about your health continuously, but he will connect you with specialists in his own referral network, who will treat your issues with similar care once you mention that Dr. SoAndSo referred you as his patient. At the end of the day, for better or worse, doctors are people too.
- 01HNNWZ0MV43FF 2y agoMy PCP is great but he isn't going to be the one deciding whether I'm dead enough or not dead enough.
- smeej 2y ago
- ProllyInfamous 2y agoBackground: I helped my mother die, and in the process decided NOT to be an organ donor anymore. tl;dr: you cannot crank the painkillers up to eleven and still donate. What I'm doing instead: donating my body to a medical school, which they can then chop up (either the students, or to sell off pieces "for science"). This allows me to implement a custom and pain-free exit regiment (an organ-destroying cocktail of fentanyl, morphine, and ketamine). -- Sweet dreams, ya'll.
- ggoo 2y agoEver read about that guy who’s mother got exploded for science?
- ProllyInfamous 2y agoI used to work (tangently, as a prosector) at one of the USA's "body farms" — it was really cool, but extremely off-puting/stinky. When I first read about donated bodies being exploded, I thought "wow that's really fucking noble of the deceased," cause I knew how many intelligent researchers (and society!) benefitted from this "abhorrent stuff." I still believe it's beneficial (and not disrespectful), however horrid. My only real gripe is that third-party hackers make all the money off the cadaver parts, and not the begrieved family..." people should also IMHO be paid for their blood donations.
- schneems 2y agoAre you talking of a long exit or a one and done? If it’s the longer variety I’m curious how you arranged that. I know hospice is about easing the pain to a certain degree but my understanding was that they wouldn’t go to the next level (accelerating the process) as that would seem to violate the Hippocratic oath. Likewise I know there are places where assisted suicide is possible but that’s more the one-and-done variety. Also since I’ve used the S word and had a (young and healthy) friend die by suicide, I’ll also say please reach out to a hotline if someone reading this is feeling suicidal.
- ProllyInfamous 2y ago
- resolutebat 2y ago> Using AI machines rather than doctors to harvest organs also promises to save money. What? AI does indeed "loom over" many parts of medical practice, but dissecting cadavers is not one of them. However, the author is apparently an anesthesiologist, which does seem like one of those roles that could be mostly replaced by an AI (read signals in, write output out).
- wl 2y agoAn AI-controlled robot isn’t going to be intubating, placing 14 gauge lines, or doing blocks anytime soon. And even for algorithmic-type things, the reason you have anesthesiologists around is for all those times when the standard algorithms stop working or are inappropriate to begin with. Anesthesia is probably one of the last specialties that would be replaced by robots and AI.
- lr4444lr 2y agoA touching essay, but to my mind, the bioethics of organ donation that have become law (in most Western countries) are the major culprit behind organ scarcity, treating economic realities of supply, demand, and risk as taboo. I would 100% sign up for organ donation if it could either add a score bonus to me or my immediate family if we should ever find ourselves on the waiting list. Heck, I'd even donate blood or plasma more often too if they'd have some minor bumps.
- renewiltord 2y agoI would do it on a straight marketplace. As it is, I'm not sitting around giving up my bodily parts so that an organ procurement organization, a hospital, and a transplant surgeon are going to make a lot of money on. All of them have one thing to say to people who need organs: "pay me". So I'll join the line. If you want my organs "pay me". NOTA ruined the ability for an organ marketplace and created the resulting shortage. A lot of people have a visceral dislike for the idea of this stuff. They rationalize this with arguments that are easily rebuked. Here's Matt Yglesias on the subject https://www.slowboring.com/p/solving-problems-by-letting-people https://www.slowboring.com/p/solving-problems-by-letting-peo...
- lr4444lr 2y agoYou're preaching to the choir, my friend. But I didn't feel like courting that battle today. Everyone in the organization transplant process except the donor benefits. And what do we have to show for that injustice? 8000 people a year dying waiting as the article states, not to mention insane costs alone due to dialysis.
- renewiltord 2y agoI had a suspicion I'd met a fellow mind.
- komali2 2y agoIsn't this an indictment of the profitization of healthcare, rather than an argument for increasing it by paying people to donate organs? Selling organs sounds ghoulish and horrible to most people for a reason. They likely don't realize that's exactly what's happening behind the scenes - if they did, they'd think that was ghoulish and horrible as well.
- denkmoon 2y agoGood article but just reinforces to me that we need organ printing technologies and anything else is just a stop gap. Maybe between articles like this and consuming a little too much body horror fiction, butchering a cadaver to put its organs in another is just unsettling to me even though I see it as good in the utilitarian sense. I continue to be an organ donor however.
- datavirtue 2y agoThere is at least one company raising genetically engineered swine to provide organs for humans.
- kylehotchkiss 2y agoThis whole article made me really uneasy about organ donation. The whole bit about preparing a person on ECMO for organ donation read a bit like medical malpractice to me (not from a medical background). It’s enough of a controversy when to turn those off as it is.
- JKCalhoun 2y agoYeah, couldn't stop thinking about the book/film, "Coma".
- jbandela1 2y ago> When told of my upcoming case, I had mixed feelings. On the one hand, being in perfect health, unaccustomed to suffering and therefore easily disconcerted by the thought of death, I was horrified. My attitude toward death was like that of a young person standing blindfolded and tied to a post, awaiting a volley from a firing squad. The whole concept made my blood run cold. Yet the case also aroused in me a feeling of relief. Simply put, there was no risk of malpractice, as my patient was already dead. Many anaesthesiologists have such self-centred thoughts when taking care of ASA 6 patients. > After we moved her from the gurney to the operating table, the doctors and nurses, so used to taking care of living patients, stared at one another stupidly, as if not knowing why they had come together or why they stood around the table. Sorry this strikes me as embellishing for the case of writing a story. Background: I was a neurosurgery resident at a level 1 trauma center. I was involved in determining brain death (though the final certification was by an attending surgeon). I worked closely with the transplant team. I declared (normal) cardiac death many times. I had many agonizing conversations with families about withdrawal of care. Anesthesia is a 4 year residency. Even the 2nd year anesthesia residents I worked with had more of an awareness and lack of naivety that this author shows. And the OR teams were much more prepared and professional than this. They knew what they had to do and why they had to do it. If there are other physicians here, I would love to hear your opinions, but this whole piece strikes me as overwrought and full of embellishments to make a certain point.
- ViktorRay 2y agoYes I agree with you. This doesn’t add up to me. Especially this part: “On the one hand, being in perfect health, unaccustomed to suffering and therefore easily disconcerted by the thought of death, I was horrified.” When one is a medical student starting anatomy working on cadavers I remember such thoughts being common. But by the time one had gone through years of medical school and then years of residency I would be quite astounded that one would still have such a reaction.
- ec109685 2y agoIt seems different if the person is a living cadaver, especially one without outside indication that they are dead. I could see that affecting someone differently.
- imathew 2y agoI found this a very beautiful story, I was moved to tears and I learnt a lot I didn't know about the process. I would like to assure the author that there is little to no risk that "AI" will perform that job any time soon, though. It's handy for certain things but those of us who use it every day know how limited it is, and will be for a long time.
- deleted 2y ago[deleted]
- lqstuart 2y agoThis doesn’t sound like it was written by a real doctor, or anyone who has worked in a hospital. The way AI is shoehorned in is just bizarre… let’s wait until the medical field has figured out “AI” to unfuck their phone trees before we wring our hands about sci-fi surgery robots.
- deleted 2y ago[deleted]
- yellowapple 2y agoThe article reads a lot like two articles in a trenchcoat: 1. a personal account of the procedural and philosophical weirdness of treating a body with a dead brain but otherwise-alive organs as simultaneously alive and dead 2. a criticism of the anticipated role of artificial intelligence and its perceived lack of bedside manner Article #1 is compelling. One of my relatives is an anesthesiologist and I'm tempted to reach out to her to ask whether she's ever treated an ASA 6 patient and (if so) what her own thoughts are on that procedural and philosophical weirdness. Brain death is something that fascinates me on both those fronts - stark evidence that the line separating life v. death is fuzzier and more context-dependent than a lot of people would want to admit. The possibility for a body to be living while the organ responsible for what we usually call "personhood" is permanently dead is a centrally-shared influence behind my views on everything from abortion to animal rights to artificial intelligence to the afterlife. What even is death if pieces of us continue to live on separate from ourselves? Article #2 doesn't feel as compelling. It seems to come out of nowhere, and I don't think its premises are particularly well-founded. In particular, the conclusion in the last paragraph: > AI promises to elevate healthcare; but, to the degree that it replaces doctors and nurses, it also threatens to depersonalise patients and to wash off their distinctive colours until everyone has the same drab tint. I don't perceive AI as the thing that's doing that. That depersonalization was a foregone conclusion the very moment someone came up the idea of privatizing healthcare. In the case of organ donation specifically, that depersonalization is more than offset by the repersonalization of those organs inside of someone who needs them; organ recipients and the loved ones of organ donors alike express all sorts of feelings of connectedness through those donated organs - as if the donor, at least in some sense, continues to live through the recipient. Indeed, a part of that donor's body does continue to live through the recipient, and there's a poignant beauty there that no amount of corporate-driven distillation of patients into insurance records and HL7 streams can ever hope to "wash off".
- tivert 2y ago>> AI promises to elevate healthcare; but, to the degree that it replaces doctors and nurses, it also threatens to depersonalise patients and to wash off their distinctive colours until everyone has the same drab tint. > I don't perceive AI as the thing that's doing that. That depersonalization was a foregone conclusion the very moment someone came up the idea of privatizing healthcare AI is the apotheosis of that.
- dgan 2y agoI m not a doctor or anything in that sort, so stupid question time: is donated blood labelled by male/female? If not, how come we can transfuse male blood tp women patients, there is a whole bunch of male hormones in excess, and a whole bunch of others missing?
- lanakei 2y agoDonated blood is stored as packed red blood cells, with the plasma removed. The plasma is where most of the hormones reside while being transported, so in packed RBC transfusions, there will almost no transfer of hormones. This makes it so that blood type is pretty much the only important factor when determining whether somebody can receive blood. Sometimes doctors do perform whole blood transfusion which does not have the blood plasma removed. This has the chance of increasing hormonal levels temporarily in the recipient. However, the body will quickly compensate and bring levels back to normal. Even if not, the hormones will still degrade and lose their effectiveness over time. Side note: everybody has both male and female hormones in their body, at different levels. These levels can change a lot depending on your age, genetics, menstrual cycle, or even the time of day. As long as there is no prolonged increase in the levels of a particular hormone, there won't be any abnormal effects.
- dkn775 2y agoUsed to work at a coroners office and the activity I saw on the sign out sheets for each persons autopsy file made me change my status from donor to not. The donor organizations (God bless them) just moved way too quick and came off as too thirsty for my taste. Not to mention (not that people would care) you look like a baseball the way you’re stitched after.
- falcor84 2y ago> I’d like to think that caring for my brain-dead patient satisfied some small part of this need to feel human... I really balked at this and other similar statements. I for one don't want people to waste their time looking after my dead body; I'd prefer that doctors spend their limited time offering care to those still alive.
- krisoft 2y agoI find this article is trying too hard to be poetical. It all starts with the title. What they describe is not the "Last hours of an organ donor". The last hour of the organ donor was spent in a car. They had an accident. After the accident they were in pain, fear and distress. We don't know the exact details but after some time people trying to help arrived. There might have been firefighters extracting her and paramedics trying all they could to save her. They transferred her to a hospital where they might have tried even more advanced things to save her. They failed. That's the end for that person. That was the "last hours of the organ donor". The process described in the article is not the last hour of her. It is beyond that. > Indeed, she might even wake up and look at us, I fantasised. She might be raised from the dead. If this was written by a real doctor I'm concerned that they are not mentally fit to practice this speciality. This article reveals that they don't have the right emotional constitution to perform the job without harming themselves. > Simply put, there was no risk of malpractice, as my patient was already dead. This again is wrong on so many levels. You can still ruin the organs. You can in fact kill many people during this procedure. Not the one under the blade, for that person is already dead. But the ones waiting for the organs. Will they be able to sue you? Probably not. So they are right there is no "risk of malpractice lawsuit" , there is still a high risk of malpractice.
- nerdjon 2y agoI am going to agree with others that the actual reading and tone of the article seems, weird. Not fully sure why the AI parts are thrown in (and I say that as someone who is very against this AI push the last couple of years). But on the topic of being an organ donor, I would be lying if I have not personally struggled with this. I fully understand the struggle and the need for it. But as someone who has a ton of anxiety about death, enough that I take medication to deal with it and it is regular topic with my therapist. I am also an atheist, so I believe that when this body dies I am dead. So I also recognize that any thoughts about, "how will I feel once dead" or "fears of regrets once dead" don't make any sense whatsoverver logically. But I say this because, I still have that voice in the back of my head saying. What if we are wrong about death. What if I am still aware of what is going on even at "brain death". I have the same thoughts about cremation. This causes me to spiral about being an organ donor. I find myself almost every time I need to renew my license debating on switching back and forth, and have even done it a few times with this feeling of shame for even thinking that I wouldn't be one. This feels like one of those things that logic and emotion really don't match up and I can tell myself all day long about how being an organ donor saves lives. Even reading this and writing this is causing me to spiral a bit.
- eszed 2y agoI don't know if this will comfort you or not, but it has me. I experienced "death" a few years ago (I got better!), and it was no big deal. I had a small stroke, made it to the emergency room, and had another (larger) one while they were trying to figure out what the first event had been, and whether or not to admit me. I seized, passed out, and came back to consciousness six or seven days later (it was more complicated than that, but that's the gist). I am really, really grateful for the experience, because I have completely lost my fear of death. If I hadn't woken up, it wouldn't have mattered (to me) at all: I was gone. As an experience, it was easy - because it's a complete absence of experience - and as it relates to my day-to-day experience of life it's like a category error. Naturally, I'm afraid of dying - I mean, like, debilitation; dependence; pain. Those sound unpleasant - and to the extent I've experienced them, really are. But the non-existence part of death? I won't be there to worry about it, so why should I worry about it now? (When I've posted something about this on this board before, I've had push back about how I didn't really die, so my comments aren't relevant. All I can say is that my first-person experience (in contrast to my medical state, which, sure, not the same thing) was, in every way I can think of, indistinguishable from (thankfully temporary) death.) So, I dunno if a third-party trip report would have meant anything to me ahead of time, but I hope it does you. It's caused my own emotion and logic, as you put it, to align. I hope, internet friend, that you can find a way to get to the same place.
- eadmund 2y ago> When the definition of death changed in the late 1960s, making it possible for a person to be ‘brain dead’ but with organs still very much alive and available for donation, a bridge appeared and a sixth class was created in the early 1980s. I am curious about this: what was behind the change in the definition of death? Is brain death actually the death of the brain — or was the definition of death changed in order to justify harvesting organs from the living? Has anyone diagnosed as brain dead recovered? Edit: for that matter, why are we so certain that consciousness and life exist only in the brain? The entire body is full of neurons, and as the article notes the body — which is to say, the human being — reacts to the trauma of organ harvesting in much the same ways one would expect a living human being to do.
- sierra1011 2y agoNot a doctor; previously worked in a lab that matched solid tissue (organs) from donors to recipients. The article has very emotive language, and not in my opinion the mindset of any doctor that has long left in their profession. I can't speak for non-UK donation, but the bar is so high in order to be able to donate tissue. Maximum 4 hours from being declared DBD/DCD and retrieving tissue. Even then, if someone has expressed a lifelong wish to donate, ticked the box on their driving license registration, carries a tissue donor card... Their next of kin can say no, and that's final. 75% of potential donors don't get to be donors. With a growing list of ~3000 kidney recipients, 300 get donated annually. (I'll hold my hands up here, these figures are what it was in 2018 when I left) It's still a morbid topic. The donation specialist nursing team (who do an incredible job) are called vultures as one of the nicer nicknames. Doctors [can] do bias training to improve patient family responses to the donation offer, and most of them haven't, and exhibit unconscious negative reactions when talking about it, putting them off. But that person isn't alive; they're not being murdered. Instead, they have the chance to save lives through the use of a body part they can no longer use. If you want to save lives: talk to your families about your wishes. If you're ever up for the chance to change 10, 15, 20 lives, it will be too late to tell them about it.