Am I a Jerk for Revoking Organ Donor Status?

[AlBell]

I'd say "too often" imo. What does organ donor status have to do with it?

[rocketdodger]

Originally Posted by Yuri Nalyssus

How do you know the medical system makes more from organ harvesting and transplantation than it does from life-saving services?

I don't. But given how much money is made from organ transplants, it seems plausible.

Originally Posted by Yuri Nalyssus

If you didn't think the 'medical system' make money then how did you think it keeps going?

Don't be silly of course I know it makes money. My point was that I thought laws were in place to minimize the financial compensation from things like organ transplantation. The whole "organ trafficking is illegal" thing, right.

It seems obvious to me that charging extreme amounts for the services involved in transplantation is an easy way to sidestep those laws. I refuse to believe that the $990,000 cost of a heart transplant is simply to cover the "costs" of the procedures. Yeah, maybe if you define costs to include huge profits.

Originally Posted by Yuri Nalyssus

How do you make money as a matter of interest?

By making video games, which people don't need to buy to survive, and which are priced based on an extremely competitive and accessible market. Meaning, the money I earn is as honest as money can get.

Originally Posted by Yuri Nalyssus

No idea, I don't know anything about you and it's a very strange question to ask in the context of the wisdom or otherwise of being an organ donor - almost as if you were looking for a confrontation?

No, as I said before I honestly feel bad about it and I want to make sure my concerns aren't stupid. It is looking like they might be. Which is why I ask things here -- I happen to think the JREF forum is the easiest accessible collection of very smart people on the internet. You can ask anything here and a ton of knowledgeable people will respond.

[rocketdodger]

Originally Posted by The Dark Lord

I am guessing that there is no way that insurance companies in the US will pay to keep you on life support indefinitely if the doctors say you are brain dead on the incredibly long shot that you could be revived some day. Also guessing that universal health care programs in other countries would not pay for that. I could be wrong, if so let me know.

Seems to me that the only way this should even be a concern is if you have a lot money to pay for a hospital to keep you on life support indefinitely.

This is a very good point.

[rocketdodger]

Originally Posted by gnome

For example, would you refuse to drive someone to the hospital, knowing that there is significant risk of getting into an auto accident along the way? I would bet winding up on the wrong end of that scenario is far more likely than having someone wrongly triage you as a doomed vessel of spare parts, and yet I also bet you would hardly think twice about doing it.

From a pure statistical standpoint, I agree.

Except I suffer from the same irrational faith in my own driving skillz ( with a z ) that most other humans suffer from, so I can't imagine myself ever being in a deadly accident on the road. In my eyes I have full control of that situation, right. And my 2011 WRX doesn't help matters, that thing has convinced me I'm safer than a baby in a bassinet when I'm in it.

Not so when I'm under full anesthesia at some hospital.

[rocketdodger]

Originally Posted by Criticalist

It is worth emphasising that there is no documented case of a person who fulfills the preconditions and criteria for brain death ever subsequently developing any return of brain function. (This statement was taken from the Australia and New Zealand Intensive Care Society position statement on brain death and donation from 2008. Since then, I seem to recall a single case report in the literature that did seem to contradict this, but I can't remember the details. I'll see if I can find it later.)

Well that isn't a very good argument, because the vast majority of those people just died relatively soon after their diagnosis.

Show me a group of 10,000 brain dead patients that were kept biologically alive for as long as possible and then I will be convinced.

Originally Posted by Criticalist

The cornerstone of brain death testing are the clinical tests which are simple and robust.

Ideally. But is this really the case?

I haven't found any reference to an accepted standard of brain death diagnosis beyond flat EEG and "examination by a neurologist" ( in addition to other superficial checks ).

I said in the OP, if radioisotope blood flow measurement was required, to confirm that the neurons are actually necrotic, then I would feel much better. However I am not aware that such a thing is required.

[Yuri Nalyssus]

Originally Posted by rocketdodger

Don't be silly of course I know it makes money. My point was that I thought laws were in place to minimize the financial compensation from things like organ transplantation.

I think I misinterpreted what you wrote - sorry if that was the case.

Originally Posted by rocketdodger

I refuse to believe that the $990,000 cost of a heart transplant is simply to cover the "costs" of the procedures. Yeah, maybe if you define costs to include huge profits.

You can't make a statement like that without doing or looking at the costings. Again when you say stuff like this it still sounds like you don't expect the medical profession to make money - no one is going to do a heart transplant just to 'cover the costs'. And what is wrong with making profits? That's how corporations keep going and do research and development to help more people.

Originally Posted by rocketdodger

By making video games, which people don't need to buy to survive, and which are priced based on an extremely competitive and accessible market. Meaning, the money I earn is as honest as money can get.

I hope I'm not misunderstanding again but why is you making a living from making video games any more honest than a hospital and its staff making a living from doing heart transplants?

Originally Posted by rocketdodger

No, as I said before I honestly feel bad about it and I want to make sure my concerns aren't stupid.

Not stupid, anymore than you are a jerk but they are certainly founded on some pretty dodgy assumptions, particularly about how much things should cost (eg heart transplants are too expensive in your opinion yet preserving your body until sone as yet unknown technology revives you is cheap).

Originally Posted by rocketdodger

I happen to think the JREF forum is the easiest accessible collection of very smart people on the internet. You can ask anything here and a ton of knowledgeable people will respond.

Me too

Yuri

[Yuri Nalyssus]

Originally Posted by rocketdodger

...if radioisotope blood flow measurement was required, to confirm that the neurons are actually necrotic, then I would feel much better. However I am not aware that such a thing is required.

Once your neurons are necrotic then so is the rest of you and your organs are no use for anything except fertilizer.

The body has to be preserved on life support long before necrosis even starts, that's why there is debate about the 'moment' of death.

Yuri

[ponderingturtle]

Originally Posted by rocketdodger

Yes.



I think it would be fairly cheap to keep people around in such a state, if it were commonplace.

That being said, I don't expect they keep such bodies around right now, because of how expensive it is right now. Admittedly this is one possible flaw in my logic.

And they start to rot in a few weeks anyway

[ponderingturtle]

Originally Posted by rocketdodger

I don't. But given how much money is made from organ transplants, it seems plausible.

We know a lot of money is spent. We do not know how much money is made and how it compares to treatment of the condition leading to death.

Quote:

It seems obvious to me that charging extreme amounts for the services involved in transplantation is an easy way to sidestep those laws. I refuse to believe that the $990,000 cost of a heart transplant is simply to cover the "costs" of the procedures. Yeah, maybe if you define costs to include huge profits.

Depends on who makes the money. There are a lot of highly paid doctors involved and so on. So are you counting their salary as profit or not?

Quote:

By making video games, which people don't need to buy to survive, and which are priced based on an extremely competitive and accessible market. Meaning, the money I earn is as honest as money can get.

And can we talk about the ridiculous over pricedness there as well? No game needs to make a billion in revenue.

[Tatyana]

Originally Posted by Finn McR

Don't pretend that you are some so-called, "random person on the internet." You have come out strong in this thread that people that are not organ donors are jerks. It was not until post #73 that you softened your stance at all.

Quotes from Tatyana's posts:
Tatyna (#3): Yes, yes you are a jerk.

You are also an irrational and condescending jerk.

You can always make a living will that you only want to remain on life support for five years, sucking up medical resources, just to 'make sure', before you donate your organs (if they are of any use by then).

(#19): Organ donation is a no-brainer.

(#26 He asked, and as a medical professional, I gave him my honest opinion, taking yourself off the organ donor list makes you a jerk.

He was an organ donor, but because of 'woo' and mis-information, he took himself off of the organ donor register.

If he had never been an organ donor and had concerns, it would be different.

There are already enough issues with family over-riding organ donation, people do not need to make it any more difficult.

If he really has an issue, then only donate kidneys.

Cadaveric donations are possible with kidneys, so they can wait till he is dead to use them.

(#47): It is a no-brainer in that you either let your organs be pickled and rot in the ground or be burned, or you donate a kidney (which is the most common transplant required) and significantly alter the life of another human being.

And as it has been mentioned several times in this thread, they can use your kidneys even if you have died.



Yes, you can choose to have your organs rots, but the benefits of transplantation are really a no-brainer.

(#73): I can understand not donating all of your organs, I have requested that my eyes and skin are not used, but I have no problem with heart, lungs, kidneys, and liver.

If your sister had diabetes, which is one of the most common causes of renal failure, which eventually requires a kidney, I don't understand why you wouldn't donate at least one kidney.

Renal transplantation is far more cost-effective than dialysis.

I can understand the concern for some liver transplants when we have George Best as a very public example, but there are other congenital reasons that people, typically children, might require a liver (or heart/lungs) transplant.

<End Quotes>
So who's being stroppy? I am trying to relate a human story about a clash between belief and action. I pick you out for your strident opinion so far (admittedly from among others). And when you get upset about that, it turns out that you would not donate your eyes or skin... And I was talking about corneas.

You seem to have missed the point of the tale that I now wish that I had allowed the harvesting of my father's corneas. Almost at the moment that I said no, I had second thoughts. The people that are posting here about the fact that it is all just flesh not needed by the deceased are correct. But their JUDGEMENT about whether a person is a jerk because they shrink from the decision for themselves or their loved ones is pretty hollow if they have not made it themselves.

He asked if he was a jerk.

I answered his question in the terminology he used.

I think Darat made a legitimate point about how it is inappropriate to berate people for the language the OP introduced.

My 'judgments' are not based on any sort of moral code, but medical and economic reasons. Medically and economically, it is a no-brainer. I personally think that ethically it is as well, but people are sometimes squeamish or religious freaks.

If he had just expressed his concerns without asking if he was a jerk, I am certain the discussion would have gone differently.

You shouldn't feel bad about your decision, especially if you had no idea of what your father wanted and if it hadn't been discussed.

It is a completely different situation with the OP, he had been on the organ donation list and removed himself due to irrational, fear based, conspiracy reasons.

PS. There is a multiquote function. It is the " button. It makes things much easier to follow.

[Tatyana]

Originally Posted by rocketdodger

I don't. But given how much money is made from organ transplants, it seems plausible.



Don't be silly of course I know it makes money. My point was that I thought laws were in place to minimize the financial compensation from things like organ transplantation. The whole "organ trafficking is illegal" thing, right.

It seems obvious to me that charging extreme amounts for the services involved in transplantation is an easy way to sidestep those laws. I refuse to believe that the $990,000 cost of a heart transplant is simply to cover the "costs" of the procedures. Yeah, maybe if you define costs to include huge profits.



By making video games, which people don't need to buy to survive, and which are priced based on an extremely competitive and accessible market. Meaning, the money I earn is as honest as money can get.



No, as I said before I honestly feel bad about it and I want to make sure my concerns aren't stupid. It is looking like they might be. Which is why I ask things here -- I happen to think the JREF forum is the easiest accessible collection of very smart people on the internet. You can ask anything here and a ton of knowledgeable people will respond.

This is a bit out of date, but I think it provides more reasonable costs for procedures.

http://news.bbc.co.uk/1/hi/programme...st/4898158.stm

Heart transplant: £31,635
Liver transplant: £77,000 (for a lifetime's care)

I can understand your concern about making money, but the entire American medical system is designed to make money.

I am certain while the hospitals may try and charge what you have stated, and on occasion, the insurance companies might pay that amount, but don't they both negotiate the fee and it often works out to far less?

If you want money for one of your kidneys, then travel to Holland, Israel or Iran.

http://www.freakonomics.com/2008/04/...which-country/

[gnome]

Originally Posted by rocketdodger

From a pure statistical standpoint, I agree.

Except I suffer from the same irrational faith in my own driving skillz ( with a z ) that most other humans suffer from, so I can't imagine myself ever being in a deadly accident on the road. In my eyes I have full control of that situation, right. And my 2011 WRX doesn't help matters, that thing has convinced me I'm safer than a baby in a bassinet when I'm in it.

Not so when I'm under full anesthesia at some hospital.

Well, my comment was speaking to reasons that claim to be rational. I see you admit that your confidence of your safety while driving is irrational, but even if you're the best driver in the world, you can get killed in your car by someone else's driving, in a manner that you would have no control over... and again, far more likely than the scenario you describe.

I am not saying that reasons other than risk management are invalid.. but if risk is what you claim, rigor is called for with lives on the line.

[fuelair]

Originally Posted by rocketdodger

I don't. But given how much money is made from organ transplants, it seems plausible.



Don't be silly of course I know it makes money. My point was that I thought laws were in place to minimize the financial compensation from things like organ transplantation. The whole "organ trafficking is illegal" thing, right.

It seems obvious to me that charging extreme amounts for the services involved in transplantation is an easy way to sidestep those laws. I refuse to believe that the $990,000 cost of a heart transplant is simply to cover the "costs" of the procedures. Yeah, maybe if you define costs to include huge profits.



By making video games, which people don't need to buy to survive, and which are priced based on an extremely competitive and accessible market. Meaning, the money I earn is as honest as money can get.



No, as I said before I honestly feel bad about it and I want to make sure my concerns aren't stupid. It is looking like they might be. Which is why I ask things here -- I happen to think the JREF forum is the easiest accessible collection of very smart people on the internet. You can ask anything here and a ton of knowledgeable people will respond.

And, sometimes, not so....

[rocketdodger]

Originally Posted by Tatyana

He asked if he was a jerk.

I answered his question in the terminology he used.

I think Darat made a legitimate point about how it is inappropriate to berate people for the language the OP introduced.

My 'judgments' are not based on any sort of moral code, but medical and economic reasons. Medically and economically, it is a no-brainer. I personally think that ethically it is as well, but people are sometimes squeamish or religious freaks.

If he had just expressed his concerns without asking if he was a jerk, I am certain the discussion would have gone differently.

You shouldn't feel bad about your decision, especially if you had no idea of what your father wanted and if it hadn't been discussed.

It is a completely different situation with the OP, he had been on the organ donation list and removed himself due to irrational, fear based, conspiracy reasons.

PS. There is a multiquote function. It is the " button. It makes things much easier to follow.

For what it is worth I don't take any offense to being called a jerk based on statements I made in a post.

[rocketdodger]

Originally Posted by Yuri Nalyssus

You can't make a statement like that without doing or looking at the costings. Again when you say stuff like this it still sounds like you don't expect the medical profession to make money - no one is going to do a heart transplant just to 'cover the costs'. And what is wrong with making profits? That's how corporations keep going and do research and development to help more people.

I don't usually have a problem with it. Except in this case, the source materials are someone's organs. Meaning, the system can't make money without someone giving up organs. That is potentially a scary conflict of interest in my opinion.

Originally Posted by Yuri Nalyssus

I hope I'm not misunderstanding again but why is you making a living from making video games any more honest than a hospital and its staff making a living from doing heart transplants?

Because people don't need video games to survive, because there are so many video games that people have a genuine free market choice regarding which ones to buy, and because the industry is largely influenced by reviews and word of mouth.

That means if I get money from someone, it is pretty much guaranteed to be an entirely free choice on their part.

Whether or not to pay a doctor for a heart transplant doesn't satisfy any of those criteria. They need a heart to survive, there isn't really much choice between which hospitals and teams to have it done, and I don't know that you will find the surgeons on Angie's List. In other words, a potential heart transplant patient isn't going to say "well, I want that heart instead of this one" or "I would rather have this surgeon do it, they have higher ratings" or "I'm gonna have this hospital perform the transplant because the cost is $300,000 cheaper."

[rocketdodger]

Originally Posted by ponderingturtle

Depends on who makes the money. There are a lot of highly paid doctors involved and so on. So are you counting their salary as profit or not?

At some point, a person's salary is getting into the "profit" conceptual territory.

Here is one thing that strikes me -- everyone is saying that donating organs is the "right" thing to do.

Might it not also be the "right" thing for surgeons to accept far less compensation for performing a transplant?

Doesn't anyone find it odd how we are expected to give up our organs for free, without our family getting any compensation for it, while the surgeons make tens and hundreds of thousands of dollars off it?

This is really where the $$$ issue bothers me. I don't like the one-sidedness of the system.

Originally Posted by ponderingturtle

And can we talk about the ridiculous over pricedness there as well? No game needs to make a billion in revenue.

Maybe so. But did you know that game developers are under compensated compared to the equivalent skill set positions outside the game industry? I certainly don't see much of the profit games make, and I would even make more as a programmer working in any other industry. That's about as far from a surgeon as you can get.

And on the flip side, buying a video game is just about the most free choice a consumer can make. Almost every other product is more "necessary" than a video game.

Don't get me wrong, I'm not going after doctors here. I only brought this up in response to Yuri's query of "what I do to make money."

[ponderingturtle]

Originally Posted by rocketdodger

At some point, a person's salary is getting into the "profit" conceptual territory.

Here is one thing that strikes me -- everyone is saying that donating organs is the "right" thing to do.

Might it not also be the "right" thing for surgeons to accept far less compensation for performing a transplant?

Sure I think that they are likely somewhat over paid. But that is systemic in the US health care system. And as such not really the issue here.

Quote:

Doesn't anyone find it odd how we are expected to give up our organs for free, without our family getting any compensation for it, while the surgeons make tens and hundreds of thousands of dollars off it?

They likely don't make that much. I do not think anyone does enough of these surgeries to make it the bulk of their practice.

And of course just because you would pay them $20000 does not mean that your insurance will pay them even a tenth of that. And no one with out insurance gets an organ transplant.

See transplant boards really are death panels.

Quote:

This is really where the $$$ issue bothers me. I don't like the one-sidedness of the system.

And what about all the other one sided systems? Like say criminal justice.

Quote:

Maybe so. But did you know that game developers are under compensated compared to the equivalent skill set positions outside the game industry? I certainly don't see much of the profit games make, and I would even make more as a programmer working in any other industry. That's about as far from a surgeon as you can get.

And as a consumer why should I care? You chose to base your decision on things other than pure renumeration. You see that in EMS were you can save lives for $10 an hour. And they don't have the option of refusing you when all you wanted was a free ride to the hospital.

[Jodie]

There is no accepted standard of declaring someone dead because it depends on the circumstances of how they died as to what criteria is used to declare legal death. In my experience on a geriatric floor all it took was cessation of respiration and a lack of a heart beat.

In an organ donor situation , the patient is most likely young, suffered some catastrophic event, and results in the need for artificial ventilation. In that case you would do serial EEG's to declare brain death so that you could legally declare the person dead before harvesting organs. All states require this, but some states require more than just serial EEG's to declare legal death, it varies.

There are a couple of cases where brain death was declared and the person revived but I find these stories very hard to believe. Here are a couple articles describing people who return from brain death if interested:

http://www.lifesitenews.com/news/wom...fter-awakening

http://news.ninemsn.com.au/world/569...eturns-to-life

[Yuri Nalyssus]

Originally Posted by rocketdodger

At some point, a person's salary is getting into the "profit" conceptual territory.

This is pure subjective opinion - are you going to tell a potential organ recipient with terminal failure of a major organ that you are going to deny them the benifit of a transplant of one of your organs because, in your opinion, the surgeon might be over paid?

Originally Posted by rocketdodger

Might it not also be the "right" thing for surgeons to accept far less compensation for performing a transplant?

Think of the amount of time and work, dedication and sheer graft that goes into becoming the sort of person who is able to carry out a heart transplant. Think also of the investment in technology, equipment, intensive nursing before and after the procedure, from the surgeon who will be judged on the outcome of the operation down to the cleaner charged with keeping the MRSA or whatever out of ICU to the manager who has to balance the budgets and basically decide where and upon whom the money gets spent. Who do you think should get the pay cut? How will you enforce that pay cut - surgeons have to do x number of transplants for half price or they lose their jobs, cleaners have to work x number of days in PICU for free? Who is it that's being over paid - what level would you draw an appropriate salary at? And how would you prevent all the really good staff simply stopping if they're not getting paid enough.

Originally Posted by rocketdodger

Doesn't anyone find it odd how we are expected to give up our organs for free, without our family getting any compensation for it, while the surgeons make tens and hundreds of thousands of dollars off it?

No, no, a hundred times no! Do you really think that families standing to profit by the death of a loved one and subsequent sale of their organs would be an improvement to the system? "We're terribly sorry, Mr Nalyssus about the tragic death of your daughter and we greatly appreciate your kindness in allowing her organs to be donated to others... oh, and here's your cheque, or would you prefer cash". I don't think so.

Originally Posted by rocketdodger

This is really where the $$$ issue bothers me. I don't like the one-sidedness of the system.

You could always ask an organ recipient whether they think the system is 'one sided'.

Originally Posted by rocketdodger

That's about as far from a surgeon as you can get.

I think you have really had all the answers you need from this thread. Your misconceptions about biology and life support and organ harvesting have been addressed, your concerns about the cost of the surgical procedures themselves are subjective, your worries about the risk of being declared dead prematurely have been put into perspective and shown to be miniscule./non-existent

If, after all this you still simply "feel" that it is wrong to donate your organs then that is your choice. But don't go looking for some cast iron, copper bottomed scientific, medical or statistical reason for that decision - it's yours, it's emotional and it's subjective. And that's ok, people don't have to make sense - I've been known to get pretty emotional myself about stuff occasionally.

Yuri

[Niggle]

Originally Posted by Skeptic Ginger

Just out of curiosity in keeping with the thread topic, how many total days/months did your mother spend in the hospital before the transplant or was her liver failure rapid?

I don't recall exactly, but she was in a hospital locally (Danbury, CT) for a couple of weeks, then at the transplant center (Pittsburgh, PA) for another two weeks before the transplant.

Of course, this was back in about 1991. I'm assuming things have improved since then.

[Walabio]

Originally Posted by Damien Evans

This is not just wrong, it's offensive.

I have a question for you:

If 2 people need a transplant or they will die, and 1 is a blood/organ-donor, while the other is a freeloader, and we have only 1 organ, ¿who should get the organ?

The fact is that we have an organ-shortage. Our stupid policies mean that organ-donor because they need organs while freeloaders get organs. I say organs for organ-donors only. If one is not willing to give organs, one should not get organs.

[Flo]

Originally Posted by Walabio

I have a question for you:

If 2 people need a transplant or they will die, and 1 is a blood/organ-donor, while the other is a freeloader, and we have only 1 organ, ¿who should get the organ?

The one whose biology is compatible with the given blood/organ.

Quote:

The fact is that we have an organ-shortage. Our stupid policies mean that organ-donor because they need organs while freeloaders get organs. I say organs for organ-donors only. If one is not willing to give organs, one should not get organs.

That might enter into consideration if there wasn't the pesky problem of organ/blood compatibility ...

Besides, I don't think physicians, who are into the business of preserving lives regardless of religion/political opinions/donor status/tastes in music/fondness for foie gras, would appreciate having to let some patients die on such a basis.

[ponderingturtle]

Originally Posted by Flo

The one whose biology is compatible with the given blood/organ.




That might enter into consideration if there wasn't the pesky problem of organ/blood compatibility ...

Besides, I don't think physicians, who are into the business of preserving lives regardless of religion/political opinions/donor status/tastes in music/fondness for foie gras, would appreciate having to let some patients die on such a basis.

Yep it is not something like lack of insurance a truly novel reason to let someone die.

[Darat]

Originally Posted by Walabio

I have a question for you:

If 2 people need a transplant or they will die, and 1 is a blood/organ-donor, while the other is a freeloader, and we have only 1 organ, ¿who should get the organ?

...snip...

The way it is done now (in the UK at least) seems to me to be adequate and fair.

[Criticalist]

Originally Posted by rocketdodger

Well that isn't a very good argument, because the vast majority of those people just died relatively soon after their diagnosis.

Show me a group of 10,000 brain dead patients that were kept biologically alive for as long as possible and then I will be convinced.



Ideally. But is this really the case?

I haven't found any reference to an accepted standard of brain death diagnosis beyond flat EEG and "examination by a neurologist" ( in addition to other superficial checks ).

I said in the OP, if radioisotope blood flow measurement was required, to confirm that the neurons are actually necrotic, then I would feel much better. However I am not aware that such a thing is required.

You are mistaken about this. There are numerous reports of prolonged support of brain dead people, mostly from Japan where there are cultural reasons for continuing support in these circumstances:
see: Iwai A, Sakano T, Uenishi M, Sugimoto H, Yoshioka T, Sugimot0
T. Effects of vasopressin and catecholamines on the maintenance of circulatory stability in brain-dead patients. Transplantation 1989;48:613-617.

Taniguchi S, Kitamura S, Kawachi K, Doi Y, Aoyama N. Effects of hormonal supplements on the maintenance of cardiac function in potential donor patients after cerebral death. Eur J Cardiothorac Surg 1992;6:96-101;

and several others. The record I am aware of is maintenance of a brain dead body for over 14 years. None of these cases ever recovered.

You are also mistaken in suggesting the diagnosis relies on EEG and some kind of casual examination. To be clear, I am an Intensive Care physician who works in a unit with a large amount of neurotrauma -I regularly perform these tests, several times a year. The clinical examination is rigorously performed in a very specific manner. Two senior clinicians perform the tests, and they are independent from the transplant team. EEG has never been required for the diagnosis, although some countries or provinces have added it to their protocols - we do not use it. There are extremely detailed protocols as to how these examinations are carried and they are followed very closely.

[rocketdodger]

Originally Posted by Criticalist

You are mistaken about this. There are numerous reports of prolonged support of brain dead people, mostly from Japan where there are cultural reasons for continuing support in these circumstances:
see: Iwai A, Sakano T, Uenishi M, Sugimoto H, Yoshioka T, Sugimot0
T. Effects of vasopressin and catecholamines on the maintenance of circulatory stability in brain-dead patients. Transplantation 1989;48:613-617.

Taniguchi S, Kitamura S, Kawachi K, Doi Y, Aoyama N. Effects of hormonal supplements on the maintenance of cardiac function in potential donor patients after cerebral death. Eur J Cardiothorac Surg 1992;6:96-101;

and several others. The record I am aware of is maintenance of a brain dead body for over 14 years. None of these cases ever recovered.

You are also mistaken in suggesting the diagnosis relies on EEG and some kind of casual examination. To be clear, I am an Intensive Care physician who works in a unit with a large amount of neurotrauma -I regularly perform these tests, several times a year. The clinical examination is rigorously performed in a very specific manner. Two senior clinicians perform the tests, and they are independent from the transplant team. EEG has never been required for the diagnosis, although some countries or provinces have added it to their protocols - we do not use it. There are extremely detailed protocols as to how these examinations are carried and they are followed very closely.

I will try to get access to those studies, I'll comment on what I find.

As to the rest -- I didn't say casual, I said superficial.

If you are one of the physicians then you can of course correct any misiniformation I have - what sort of tests do you do that actually directly examine the viability of the neuron cells themselves?

FYI I am probably gonna re-enroll, but only because the statistics involved lead me to conclude that my concerns aren't really impactful. However I don't think the concerns have been disproven.

[Criticalist]

If you would like to know more about what sort of tests are conducted I would recommend the Australian and New Zealand Intensive Care Society statement on Death and Organ Donation. Its a 1.4Mb file that can be downloaded here. Pages 16 - 19 document the clinical examination in detail.