Organ Donors

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So I had a rather frustrating conversation with my dad about organ transplantation and being an organ donor (I am, he is not). I generally consider him to be pretty reasonable, so I was surprised that he was vehemently opposed to organ donation.

His points:
1. It twists the doctors incentives so that they have an incentive to harvest your organs rather than to save you.
2. You are giving the organs for free, and the hospital system makes a lot of money off of them. He wants to see a cut of it.
3. Scared of potential for pain during organ transplantation, scared that he will be harvested while still alive.
4. An inane point about how he thought that bodies were kept in some secret room indefinitely, circulated with blood and plasma, and he thought that this could happen over the course of months.

SDN, respond! I had counterpoints of course, but I was curious as to how you would address these concerns.

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1. It twists the doctors incentives so that they have an incentive to harvest your organs rather than to save you.
This isn't Nazi Germany.
2. You are giving the organs for free, and the hospital system makes a lot of money off of them. He wants to see a cut of it.
Lol, wow.
3. Scared of potential for pain during organ transplantation, scared that he will be harvested while still alive.
Yah, US hospitals misdiagnose death pretty often.
4. An inane point about how he thought that bodies were kept in some secret room indefinitely, circulated with blood and plasma, and he thought that this could happen over the course of months.
The importance of education, folks.

For perspective, don't show him this video (watch the entire thing to get to the organ donation part):



With all of that being said I am not an organ donor either.
 
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In the US, being an organ donor is fine. Nothing bad will happen to you, doctor's won't harvest your organs while you are still alive or try to kill you for them.

China's a different story.
 
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China's a different story.
This is untrue. Modern China's healthcare is remarkably state-regulated for its population and cases of abduction/forced organ donation only happen in the rarest of the rarest backwoods cases. Once arrested, offenders are immediately put to death via firing squad as well. Organ trafficking and offering money for donations is also illegal, and once again punished by death via direct warden rule w/o a trial or jury.
 
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These are points that have been voiced before and you could probably google more eloquent explanations than those I give below.

As far as incentive to procure organs, this is mostly mitigated by the fact that the physicians taking care of you prior to your death are not the ones that would be doing the transplant. From the eyes of the physicians taking care of you, they have no incentive as they would not be ones doing the surgery, or making money off of it, or taking care of the recipient.

In the United States it is illegal to sell organs. Of course, the hospital charges the recipient a large amount for all the services that are needed to do such a procedure. The patient donating the organs of course would not be charged for anything but they by law cannot be reimbursed. If you want to talk about incentive as you were for your first point, if families were to be reimbursed the moral dilema there would be ovious. "well do we pull the plug on dad and donate his organs and get the $$$ or do we keep going and hope he wakes up and incur all the extra bills?" Too many families would donate organs out of greed and that is the last thing we need our organ donation programs tainted with.

To be eligible for organ donation other than kidney (which you could voluntary donate without health consequences) you must be declared dead. Brain death counts. If you are in a position to donate your organs, you are beyond the point of feeling pain. Either your heart has stopped and you are dead in every sense of the word that you can understand, or your brain has stopped higher functioning such as pain beyond all hope of recovery.

There is a finite period of time from when death is declared to when the organs are no longer suitable for transplantation. This varies by organ and state of the individual before death but someone would not be kept on artificial measures longer than a day or so. Longer than that and the organs won't be used for transplantation and that was the whole point of this right?

Look into your local organ procurement organization (OPO) and their website for more information. I've always liked the resources on Indiana's website as succint and to the point.

http://indianadonornetwork.org/gift-life-learning-center/donation-faqs/
 
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So I had a rather frustrating conversation with my dad about organ transplantation and being an organ donor (I am, he is not). I generally consider him to be pretty reasonable, so I was surprised that he was vehemently opposed to organ donation.

His points:
1. It twists the doctors incentives so that they have an incentive to harvest your organs rather than to save you.
2. You are giving the organs for free, and the hospital system makes a lot of money off of them. He wants to see a cut of it.
3. Scared of potential for pain during organ transplantation, scared that he will be harvested while still alive.
4. An inane point about how he thought that bodies were kept in some secret room indefinitely, circulated with blood and plasma, and he thought that this could happen over the course of months.

SDN, respond! I had counterpoints of course, but I was curious as to how you would address these concerns.
1. The transplant coordinators and procurement team are separate from the team currently taking care of you. There is no incentive, financial or otherwise, for the team that is working to save you to contact the transplant team.
2. Organ procurement companies do make a lot of money, especially on tissue as opposed to solid organs. The National Organ Transplant Act outlawed the interstate sale of human organs, and states followed with bans. The law allows people who recover organs and tissues, handle or use them to collect “reasonable” fees, but it doesn't specify what that means. While understandable that the family of the donor might want to see a "cut" of the money, by paying people to donate, you will open all sorts of ethical concerns.
3 and 4. He's watching too many Hollywood movies.
 
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In the United States it is illegal to sell organs. Of course, the hospital charges the recipient a large amount for all the services that are needed to do such a procedure. The patient donating the organs of course would not be charged for anything but they by law cannot be reimbursed. If you want to talk about incentive as you were for your first point, if families were to be reimbursed the moral dilema there would be ovious. "well do we pull the plug on dad and donate his organs and get the $$$ or do we keep going and hope he wakes up and incur all the extra bills?" Too many families would donate organs out of greed and that is the last thing we need our organ donation programs tainted with.


And there's the "grandma's on hospice, should we move her to a state where we can get more for her organs?" dilemma.
 
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For religious reasons, I could understand . Because some people think they should go into the ground the same way they came up .. Thats what got bob marley . Rasta man dont cut off their toe !!
 
In the US, being an organ donor is fine. Nothing bad will happen to you, doctor's won't harvest your organs while you are still alive or try to kill you for them.

China's a different story.

Please double check the credibility of your source.
 
I actually worked in transplant billing for a while. Even though they do charge an insane amount of money, the United Network for Organ Sharing (UNOS) regulates every step of the process and how much can be billed. If the hospital charges you 40k for a liver (pretty standard for a liver, not counting the surgery, hospital bills, etc), they must provide documentation of every cost they incurred that made it cost that much. They can take no profit on the organ itself. They can profit from the hospital stay, but procuring the organ and getting it to the hospital is done "at cost". All that said paying for the private jet flight a liver may have to take to get to where it is needed can be VERY EXPENSIVE
 
So I had a rather frustrating conversation with my dad about organ transplantation and being an organ donor (I am, he is not). I generally consider him to be pretty reasonable, so I was surprised that he was vehemently opposed to organ donation.

His points:
1. It twists the doctors incentives so that they have an incentive to harvest your organs rather than to save you.
2. You are giving the organs for free, and the hospital system makes a lot of money off of them. He wants to see a cut of it.
3. Scared of potential for pain during organ transplantation, scared that he will be harvested while still alive.
4. An inane point about how he thought that bodies were kept in some secret room indefinitely, circulated with blood and plasma, and he thought that this could happen over the course of months.

SDN, respond! I had counterpoints of course, but I was curious as to how you would address these concerns.
I think your dad is right about #2...everyone makes money on the transaction but the person giving the organ. I get that the argument is a pandora's box of people trying to set up situations artificially to make that money.....but it's their body part, their choice. But no one is going to change anyone's mind in here. FWIW, I'm an organ donor despite it not being profitable to me ;)
 
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This is untrue. Modern China's healthcare is remarkably state-regulated for its population and cases of abduction/forced organ donation only happen in the rarest of the rarest backwoods cases. Once arrested, offenders are immediately put to death via firing squad as well. Organ trafficking and offering money for donations is also illegal, and once again punished by death via direct warden rule w/o a trial or jury.
http://www.smh.com.au/world/chinas-...t-exposed-in-documentary-20150407-1mgabb.html
 
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Western propaganda.

This is coming from a conservative, second generation voting member of the GOP. Like it or not, Communist states are not the only ones to use the power of media for political purposes. Chinese citizens dissatisfied w/ the current gov't will say pretty much anything to vilify their rule, and make up whatever is necessary to get into all too willing overseas publications.
 
I actually worked in transplant billing for a while. Even though they do charge an insane amount of money, the United Network for Organ Sharing (UNOS) regulates every step of the process and how much can be billed. If the hospital charges you 40k for a liver (pretty standard for a liver, not counting the surgery, hospital bills, etc), they must provide documentation of every cost they incurred that made it cost that much. They can take no profit on the organ itself. They can profit from the hospital stay, but procuring the organ and getting it to the hospital is done "at cost". All that said paying for the private jet flight a liver may have to take to get to where it is needed can be VERY EXPENSIVE
The primary source of money to be made is not in the harvest and transplant of solid organs. It's tissue donation. Have you seen the cost of a single sheet of AlloDerm or what the CEOs of such companies like LifeCell make?
 
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Western propaganda.

This is coming from a conservative, second generation voting member of the GOP. Like it or not, Communist states are not the only ones to use the power of media for political purposes. Chinese citizens dissatisfied w/ the current gov't will say pretty much anything to vilify their rule, and make up whatever is necessary to get into all too willing overseas publications.
Well, their rule does deserve to be vilified, what with the religious persecution and mass-scale human rights violations. Even if they weren't taking organs from live donors, they were still violating the rights of every executed prisoner they harvested organs from.

http://onlinelibrary.wiley.com/stor...mr&s=dd52cb9091670fd4bfdb4df084230908fec7682c
 
Well, their rule does deserve to be vilified, what with the religious persecution and mass-scale human rights violations. Even if they weren't taking organs from live donors, they were still violating the rights of every executed prisoner they harvested organs from.
Agreed. But there's enough legitimate things they do that we can talk about (like cyberhacking, political oppression) etc etc that there is no need for outlandish stories such as live organ harvesting (which, as anyone credible that has experienced healthcare in China will agree, is absolutely ludicrous). If anything it detracts from the actual point and issues about the CCP.

Alas this is SDN, so my political posts will end here.
 
Is your father African American? Then, some of his points are valid. Black history in medicine was horrifying and some points he made were valid. Read about it if you have some time. It's called Medical Apartheid. However, it's 2015 and a lot has changed. Get him to watch an old episode of Oprah were she had folks on her show that donated their organs and the families met each other. It was then, I also signed up to become an organ donor.
 
If this was China, it'd be a different story . . .
 
Yes, the doctors who are trying to take care of you in the ER will let you die so that they can prevent some other patient from dying. This paranoid nonsense is a headache.
 
I'm a transplant coordinator, and I can tell you that 1) In order to be an organ donor, you need to be on a ventilator and brain dead or extremely close to brain dead and in a situation where your legal next of kin has already decided to withdraw care. If the medical professionals do not try to save you, you cannot be a donor anyway. You have to be able to be kept hemodynamically stable. 2) yes there is a fee for the organs. That fee is paid by the recipient's health insurance and goes to pay the costs of the many people involved in making the transplant happen. This includes both the surgeon that recovers the organ as well as the surgeon that puts it in the recipient (often two different surgeons) as well as the nurses and techs at both hospitals/ORs, the donation coordinators, the pre- and post-transplant coordinators, the HLA lab techs, and in some states a whole host of other people like grief counselors. It also goes to pay the medical bills of the donor/pays everyone who keeps the donor stable while the coordinators are finding recipients for the organs - aka ICU nurses, radiologists, pulmonologists, etc. Transplants don't just happen. They take many people who can't work for free. 3) even brain dead donors are administered narcotics before and during recovery. There is always an anesthesiologist in the OR to manage the donor. There is extensive testing to make sure the donor is not alive. It comes down to this - do you want to withdraw life sustaining therapies, or do you want to donate your loved one's organs first and then withdraw life sustaining therapies? Organ donors have no chance of recovery if left alone. 4) trust me, we want things to go as quickly as possible once the donation process gets rolling. The general timeframe is 1-3 days to get the organs matched, book the OR, make travel arrangements and accommodate the family's wishes.
 
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I'm also in the transplant field. Much good info has been added already.

But a couple of things to add also: people don't get transplants through favors or status either. Even Dick Cheney got his heart after waiting an extremely long time with an assist device.

The typical image of transplants coming from car accidents is partially incorrect. This is both due to safer cars with lower risk of head injuries (and a higher likelihood that if you die in a car accident, it is not from head trauma) and the nature of what is required to become an organ donor. A majority of donors are victims of strokes and brain aneurysms, both of which are particularly likely to result in brain death with an otherwise healthy body.


For 1: it is pretty rare for the average doctor to see a donor at all. If you are at a major center, in either intensive care or trauma care, you are more likely.

If anything, the most aggressive lifesaving efforts are more likely to produce a situation where a person could be eligible to donate. There are only a small fraction of deaths that are eligible for donation (though we should do what we can to expand on this.) In general, you have to die in a hospital on a ventilator. Brain death is even more particular, in that you have to have no brain activity whatsoever, while at the same time, have the rest of your body functioning. If you come in dying from an aortic dissection or something, the way you are most likely to become an organ donor is if you are immediately taken to the OR, transfused as fast as you bleed, and after the surgical staff heroically patches your aorta, they close, your heart is beating, and it seems to be a successful surgery. Except you never wake up, since your brain had been without oxygen too long. You are then eligible to donate your organs, and the organ procurement organization would approach your next of kin.

If you arrest in surgery, and the surgeons conclude there's nothing they can do, it's over. While it would be possible to immediately cool and recover organs at this point, it is not permitted under the current rules.

If you are on a ventilator, in the hospital, but there is any brain function, you may still be able to do a donation after cardiac death, where life support is withdrawn normally, and as soon as your heart stops on its own, after a certain "hands off" period, kidneys (primarily) and livers can be recovered. However, this is not always successful for various reasons.

The only actions that your particular physician has with regards to organ donation are a "notification of imminent death" to the organ procurement organization, and to give medical history to the OPO.



With China, they schedule heart transplants ahead of time, with usually under 2 week wait times. A heart can go for 4-6 hours on ice, maybe a little longer with perfusion. Make what you will of that.
 
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If you arrest in surgery, and the surgeons conclude there's nothing they can do, it's over. While it would be possible to immediately cool and recover organs at this point, it is not permitted under the current rules.
What if you know it's a risky surgery and do all the paperwork/arrange it with the surgeon prior to the operation beginning? I'd hate for my organs to go to waste when I was already open on the table when I died. My family can deal with it...my decision on the matter should trump theirs, period.

Actually, on that note, do they always ask next of kin? What if I don't want them to have a say...I know what I want done with me and their opinion is irrelevant? If I have an incredibly clear advanced directive, do they have to listen to my emotionally distraught relatives (cuz yeah, sure...they're thinking clearly right then)?
 
What if you know it's a risky surgery and do all the paperwork/arrange it with the surgeon prior to the operation beginning? I'd hate for my organs to go to waste when I was already open on the table when I died. My family can deal with it...my decision on the matter should trump theirs, period.

That's an interesting question, and I feel the same on it. I'll have to ask some folks about that. Theoretically, you could do what's known as an "uncontrolled donation after cardiac death," (uncontrolled DCD) but it would require consent procedures to be in order, potentially from a driver's license. In many states, drivers license registration is full consent, whatever the family says. The same thing with a living will.

The difficult part is that in general, the OPO has to handle the recovery, not your surgeon. However, with consent, your surgeon could probably provide stabilizing care to preserve for organ recovery. So either leaving someone on a heart/lung machine, or immediately cooling the body and perfusing kidneys with cold saline (or similar) via a balloon catheter. Properly cooled kidneys can be transplanted up to about 48 hours after recovery.

One of the issues is time: you need to do tissue typing and find a recipient, and it's best to do that when the organs aren't on ice already. I guess you could probably get your doctor to call in an imminent death and get the OPO moving before the surgery. Then they could proceed with what is essentially a normal DCD protocol, so the recovery team is waiting in the next room while the surgery happens. If the surgery is successful, you're alive, yay. If it is unsuccessful, they could come in and do a recovery.

A lot of trauma deaths could be eligible under these procedures, but they often aren't pursued since there is the separation between doctor and organ recovery. You'd really need to have a recovery team waiting in the hospital, and handle consent for everyone beforehand.

With the family, in general the only regret people have is that they didn't donate. If you register as a donor, or state it in your living will, in general it makes the decision much easier for the family as well: they don't need to make one, they know what you wanted already.

Depending on the OPO, they actually have really great grief counseling services they provide to everyone, regardless of if they donate.

Here's some interesting articles related to this as well:

http://www.theatlantic.com/health/archive/2015/05/the-right-way-to-ask-for-human-organs/393311/

http://host.madison.com/news/local/...cle_6c5d178a-48bc-5eee-9ba6-6c5c72fce62d.html
 
That's an interesting question, and I feel the same on it. I'll have to ask some folks about that. Theoretically, you could do what's known as an "uncontrolled donation after cardiac death," (uncontrolled DCD) but it would require consent procedures to be in order, potentially from a driver's license. In many states, drivers license registration is full consent, whatever the family says. The same thing with a living will.

The difficult part is that in general, the OPO has to handle the recovery, not your surgeon. However, with consent, your surgeon could probably provide stabilizing care to preserve for organ recovery. So either leaving someone on a heart/lung machine, or immediately cooling the body and perfusing kidneys with cold saline (or similar) via a balloon catheter. Properly cooled kidneys can be transplanted up to about 48 hours after recovery.

One of the issues is time: you need to do tissue typing and find a recipient, and it's best to do that when the organs aren't on ice already. I guess you could probably get your doctor to call in an imminent death and get the OPO moving before the surgery. Then they could proceed with what is essentially a normal DCD protocol, so the recovery team is waiting in the next room while the surgery happens. If the surgery is successful, you're alive, yay. If it is unsuccessful, they could come in and do a recovery.

A lot of trauma deaths could be eligible under these procedures, but they often aren't pursued since there is the separation between doctor and organ recovery. You'd really need to have a recovery team waiting in the hospital, and handle consent for everyone beforehand.

With the family, in general the only regret people have is that they didn't donate. If you register as a donor, or state it in your living will, in general it makes the decision much easier for the family as well: they don't need to make one, they know what you wanted already.

Depending on the OPO, they actually have really great grief counseling services they provide to everyone, regardless of if they donate.

Here's some interesting articles related to this as well:

http://www.theatlantic.com/health/archive/2015/05/the-right-way-to-ask-for-human-organs/393311/

http://host.madison.com/news/local/...cle_6c5d178a-48bc-5eee-9ba6-6c5c72fce62d.html
Thanks!
I'm a huge proponent of donation in general. I try to make it to the blood bank every 2mo - I'd do the platelet donation which is more frequent, but I'm CMV+ (who the hell isn't?) and the local bank won't let you do any sort of apheresis if you are - I'm a listed organ donor, on the bone marrow list, and I'd do an anonymous kidney donation only I haven't decided whether to do the military for a stint after med school and they don't like it when people are missing body parts before deployment. :laugh: It would just suck to be passed up despite the need being high, me being extremely willing, and it being very much possible, just over protocols.
 
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So I had a rather frustrating conversation with my dad about organ transplantation and being an organ donor (I am, he is not). I generally consider him to be pretty reasonable, so I was surprised that he was vehemently opposed to organ donation.

His points:
1. It twists the doctors incentives so that they have an incentive to harvest your organs rather than to save you.
2. You are giving the organs for free, and the hospital system makes a lot of money off of them. He wants to see a cut of it.
3. Scared of potential for pain during organ transplantation, scared that he will be harvested while still alive.
4. An inane point about how he thought that bodies were kept in some secret room indefinitely, circulated with blood and plasma, and he thought that this could happen over the course of months.

SDN, respond! I had counterpoints of course, but I was curious as to how you would address these concerns.


Wow. Yea I don't put anything past Hitler types that do exist; but fortunately right now, as far as know, this is NOT the case in the US. LOL
I worked heart/lung transplant in peds hospital. What's the point in wasting one's organs when they could help others? What's the point in letting them rot or burning them up and the ashes of which are left in an urn? It's a difficult and challenging predicament all the way around; but when you see those on the need end of organs--what they go through--it will definitely change your perspective. And often it's no picnic for them after they receive the transplanted organ. My hope is further genetic research will help with this.

I agree with the person that says some education from organ procurement orgs would be helpful. Also, becoming aware of people that are in dire need of organs and what they and their families go through is beneficial to understanding the need.

A secret room? People can only stay on some kind of bypass circuit for so long, for a great number of reasons--and this is not usually how organs are procured. Sigh.
 
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Um, regardless, you will want to have your family aware and register formally, b/c legal issues can still arise.

[If I register as a donor will my wishes be carried out?
Even if you are a registered donor, it is essential that your family know your wishes. Your family may be asked to sign a consent form in order for your donation to occur. If you wish to learn how organ donation preferences are documented and honored where you live, contact your local organ procurement organization (OPO). The OPO can advise you of specific local procedures, such as joining donor registries that are available to residents in your area.]

http://www.organdonor.gov/faqs.html
 
Yeah, I figure I'll be dead anyways, so might as well have the organs go to some use. Evidently people have other opinions.
 
What if you know it's a risky surgery and do all the paperwork/arrange it with the surgeon prior to the operation beginning? I'd hate for my organs to go to waste when I was already open on the table when I died. My family can deal with it...my decision on the matter should trump theirs, period.

Actually, on that note, do they always ask next of kin? What if I don't want them to have a say...I know what I want done with me and their opinion is irrelevant? If I have an incredibly clear advanced directive, do they have to listen to my emotionally distraught relatives (cuz yeah, sure...they're thinking clearly right then)?

Maxwell makes some really good points. The other major issue that not just any surgeon can recover organs, and I can't imagine a transplant surgeon hanging out outside an OR of a "healthy" patient in the event that something might go wrong. Also, by the time all measures are done to try to save the patient, the loss of perfusion to the organs would likely be too long for the organs to be viable.
 
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Maxwell makes some really good points. The other major issue that not just any surgeon can recover organs, and I can't imagine a transplant surgeon hanging out outside an OR of a "healthy" patient in the event that something might go wrong. Also, by the time all measures are done to try to save the patient, the loss of perfusion to the organs would likely be too long for the organs to be viable.

Every organ has a certain amount of time that they can go without perfusion. I don't recall the exact numbers for the important organs like liver, kidney, heart and lungs but maybe one of the surgeons here can help specify. That's why the clock starts once they clamp the aorta during a harvest and these guys get to travel on planes once they have the organ.
 
Maxwell makes some really good points. The other major issue that not just any surgeon can recover organs, and I can't imagine a transplant surgeon hanging out outside an OR of a "healthy" patient in the event that something might go wrong. Also, by the time all measures are done to try to save the patient, the loss of perfusion to the organs would likely be too long for the organs to be viable.

Every organ has a certain amount of time that they can go without perfusion. I don't recall the exact numbers for the important organs like liver, kidney, heart and lungs but maybe one of the surgeons here can help specify. That's why the clock starts once they clamp the aorta during a harvest and these guys get to travel on planes once they have the organ.
I mean, how the heck long are they trying to resuscitate me for? Screw the organ donation as a concern, there's a limit to how much pointless effort I'm OK with them putting in anyway!
If I'm going into something risky enough that I'd talk over my organ donation options and try to solidify them at the beginning of the op, there's no bashing of the surgeon's head against the wall...the op either goes smoothly and I live, or it doesn't and a bunch of people get a new holiday to celebrate - the day their transplants came through. 'All measures' is something else that would have to be discussed ahead of time.

Now, the availability of a transplant surgeon is a different issue.
 
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Every organ has a certain amount of time that they can go without perfusion. I don't recall the exact numbers for the important organs like liver, kidney, heart and lungs but maybe one of the surgeons here can help specify. That's why the clock starts once they clamp the aorta during a harvest and these guys get to travel on planes once they have the organ.

In general, the kidneys are the most tolerant, for several reasons. First, they are fairly durable to start with. But secondly, we have a viable replacement for them (dialysis) and the transplant surgery is fairly minor (compared to say a liver, heart, or lung) and leaves the deficient, natural kidneys in place, so taking a risk that the organ won't function is totally acceptable, and provides better outcomes (and far better quality of life) than staying on dialysis. The outcome of a failed kidney graft is not catastrophic, while a heart, lung, or liver is.

Kidneys are tolerant of about 30 minutes of warm ischemia, and 24 hours of cold ischemia before risks start going up. In general, they are transplantable to about 48 hours, though I've seen records for 90+ hours. The usage of "kidney in a box" perfusion can push the time a lot, and they have it for other organs as well. The heart ones are extremely cool: they actually have a heart beating, being perfused with oxygenated blood. http://www.dailymail.co.uk/health/a...ce-keeps-donor-organs-alive-OUTSIDE-body.html

With the kidneys, it's actually kind of funny how simple the usual transportation is: if it's going out of the area, such as to go to someone that's a perfect HLA match, it's bagged, wrapped in ice, put in a styrofoam cooler, and is taken on commercial planes. So essentially, it flies coach.

The more time critical organs, if they are to be shipped, usually go via charter jet and/or helicopter.
 
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This is untrue. Modern China's healthcare is remarkably state-regulated for its population and cases of abduction/forced organ donation only happen in the rarest of the rarest backwoods cases. Once arrested, offenders are immediately put to death via firing squad as well. Organ trafficking and offering money for donations is also illegal, and once again punished by death via direct warden rule w/o a trial or jury.

The death penalty is a fair punishment in my opinion (via firing squad, I'd be terrified of lethal injection, electric chair, the guillotine, etc.)

Some crimes are unforgivable and it's about time we recognize that.

The following crimes should result in the death penalty, in my opinion: Rape, Crimes against Children, Stealing organs (or trafficking)!, some murders (ex: Walking in on your spouse and some man and killing that man should result in jail time not death... obviously that was the heat of the moment gone too far not an actual psychopath out to harm society), generally speaking "heinous crimes." I'd also legalize some drugs (while going after gangs/cartels hard.... on a side note.

Thanks!
I'm a huge proponent of donation in general. I try to make it to the blood bank every 2mo - I'd do the platelet donation which is more frequent, but I'm CMV+ (who the hell isn't?) and the local bank won't let you do any sort of apheresis if you are - I'm a listed organ donor, on the bone marrow list, and I'd do an anonymous kidney donation only I haven't decided whether to do the military for a stint after med school and they don't like it when people are missing body parts before deployment. :laugh: It would just suck to be passed up despite the need being high, me being extremely willing, and it being very much possible, just over protocols.

After the U of M paved the way it would seem kidney donors do A-OK in life w/ no side effects whatsoever.... W/ that said I've met patients who've come to regret it (entered high stress situations bodies couldn't cope.... aka they stopped being so healthy and the less healthy them needed BOTH kidneys..). Probably, not relevant here but I'd wait till post-Med School to do so. Thanks for donating platelets though! As for CMV that sucks. I'd donate myself....... but apparently I've been out of the country too many times, like a month every single year.

Maxwell makes some really good points. The other major issue that not just any surgeon can recover organs, and I can't imagine a transplant surgeon hanging out outside an OR of a "healthy" patient in the event that something might go wrong. Also, by the time all measures are done to try to save the patient, the loss of perfusion to the organs would likely be too long for the organs to be viable.

I'm aware many organs are simply discarded since it's been too long..... or the patient wasn't healthy enough.
I'm also aware that many people die on the list w/out coming close to receiving an organ.

I don't know what the cutoffs are and how reasonable it is.... but couldn't some people who are outright rejected for a transplant or so low on the list odds are they will die very soon....... receive some of these subpar organs? Or are they so subpar that they're essentially useless or would increase the patients life by such a short span as to be rendered insignificant?
 
The death penalty is a fair punishment in my opinion (via firing squad, I'd be terrified of lethal injection, electric chair, the guillotine, etc.)

Some crimes are unforgivable and it's about time we recognize that.
I think once they've decided to kill you, whether you're terrified of the method used is kind of a moot point...

After the U of M paved the way it would seem kidney donors do A-OK in life w/ no side effects whatsoever.... W/ that said I've met patients who've come to regret it (entered high stress situations bodies couldn't cope.... aka they stopped being so healthy and the less healthy them needed BOTH kidneys..). Probably, not relevant here but I'd wait till post-Med School to do so. Thanks for donating platelets though! As for CMV that sucks. I'd donate myself....... but apparently I've been out of the country too many times, like a month every single year.
Nah, I just donate whole blood...it's things like platelets, DRBC, plasma, etc that I can't do (and only at this one center).
The studies I've read seem to indicate that there's not a notably higher incidence of kidney disease among donors, though that may be because kidney donors are a population selected for health of that organ. At any rate, if that's true (and obviously I would look into it further if I were contemplating it seriously) it kind of seems like a win/win, because it's not going to make you more likely to get kidney disease, but if you do, and you previously donated, you get some amount of priority on the transplant list. AND people who 100% need a kidney, get one.


I'm aware many organs are simply discarded since it's been too long..... or the patient wasn't healthy enough.
I'm also aware that many people die on the list w/out coming close to receiving an organ.

I don't know what the cutoffs are and how reasonable it is.... but couldn't some people who are outright rejected for a transplant or so low on the list odds are they will die very soon....... receive some of these subpar organs? Or are they so subpar that they're essentially useless or would increase the patients life by such a short span as to be rendered insignificant?
Some programs are starting to include "Expanded Criteria Donor" programs...basically they inform the donor of the risks of getting a suboptimal organ, then let them decide between 'right NOW but less than ideal' and 'maybe eventually, but long wait and still no guarantees on anything because transplant'
http://www.ucdmc.ucdavis.edu/transplant/nonlivingdonors/nonliving_exp_criteria.html
 
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After the U of M paved the way it would seem kidney donors do A-OK in life w/ no side effects whatsoever.... W/ that said I've met patients who've come to regret it (entered high stress situations bodies couldn't cope.... aka they stopped being so healthy and the less healthy them needed BOTH kidneys..). Probably, not relevant here but I'd wait till post-Med School to do so. Thanks for donating platelets though! As for CMV that sucks. I'd donate myself....... but apparently I've been out of the country too many times, like a month every single year.


I'm aware many organs are simply discarded since it's been too long..... or the patient wasn't healthy enough.
I'm also aware that many people die on the list w/out coming close to receiving an organ.

I don't know what the cutoffs are and how reasonable it is.... but couldn't some people who are outright rejected for a transplant or so low on the list odds are they will die very soon....... receive some of these subpar organs? Or are they so subpar that they're essentially useless or would increase the patients life by such a short span as to be rendered insignificant?

With living donation, the long term risks are not unmanageable, but they are real. On average, living donors fare better than the general population, but that is just selection bias. Risk of death is on par with pregnancy/childbirth, (~1 in 3000), and some data seems to suggest a 3-5 fold risk increase in kidney failure long term. However, that risk is still below the general population.

There are lots of discards; it's a major issue. There are several problems, primarily being that surgeons are afraid that the risk adjustment for their center evaluations don't adequately address the outcomes of the higher risk organs. However, some centers successfully get very good outcomes from marginal organs, and at the same time, some of the best centers rarely, if ever, accept a high risk organ.

In general, if you are outright rejected for a transplant, they won't do anything, even a living donor. It's a matter of the center not feeling you are capable of complying with treatment requirements, or being medically unsuitable.

With regard to being far down on the list, they can get transplanted quicker if they are willing to accept donor organs which are higher risk of failure from diabetes, blood pressure, obesity, non-heart beating donor, etc or at a higher risk of infection (IVDU, Hx of Prison, MSM, History of Cancer, etc). The new allocation system this year also tries to match younger, healthier donors with younger, healthier recipients, in order to match life expectancy with graft life expectancy.

Personally, I'd be willing to take a HCV positive organ in a snap: Start a course of Harvoni the second I got the call that an organ was available.
 
With living donation, the long term risks are not unmanageable, but they are real. On average, living donors fare better than the general population, but that is just selection bias. Risk of death is on par with pregnancy/childbirth, (~1 in 3000), and some data seems to suggest a 3-5 fold risk increase in kidney failure long term. However, that risk is still below the general population.

There are lots of discards; it's a major issue. There are several problems, primarily being that surgeons are afraid that the risk adjustment for their center evaluations don't adequately address the outcomes of the higher risk organs. However, some centers successfully get very good outcomes from marginal organs, and at the same time, some of the best centers rarely, if ever, accept a high risk organ.

In general, if you are outright rejected for a transplant, they won't do anything, even a living donor. It's a matter of the center not feeling you are capable of complying with treatment requirements, or being medically unsuitable.

With regard to being far down on the list, they can get transplanted quicker if they are willing to accept donor organs which are higher risk of failure from diabetes, blood pressure, obesity, non-heart beating donor, etc or at a higher risk of infection (IVDU, Hx of Prison, MSM, History of Cancer, etc). The new allocation system this year also tries to match younger, healthier donors with younger, healthier recipients, in order to match life expectancy with graft life expectancy.

Personally, I'd be willing to take a HCV positive organ in a snap: Start a course of Harvoni the second I got the call that an organ was available.
Or one with history of MSM because f*** that policy bull****, this is frakking two-zero-FIFTEEN.
 
Or one with history of MSM because f*** that policy bull****, this is frakking two-zero-FIFTEEN.

Well, the risk of HIV and HCV is still a lot higher for MSM donor's. Same reason they screen for prison history or IVDU. HIV is transmissible prior to seroconversion for 3-8 weeks, and in the case of organ donors, Hemodilution due to massive transfusions render the tests less sensitive.

Having a history of MSM does not exclude one from donating organs, but it does flag as elevated risk. Candidates for transplant and their surgeons indicate whether they will be willing to accept an organ with elevated risk.

A positive HIV test excludes a person from donating an organ outside of a research trial at the moment. (The HOPE act allows for transplants from HIV+ donors to HIV+ Recipients under IRB approval).

This is for a living donor, but tested negative prior to transplant. Evidently became infected prior to organ recovery. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6010a1.htm

The rate really is much higher: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a2.htm
 
Well, the risk of HIV and HCV is still a lot higher for MSM donor's. Same reason they screen for prison history or IVDU. HIV is transmissible prior to seroconversion for 3-8 weeks, and in the case of organ donors, Hemodilution due to massive transfusions render the tests less sensitive.

Having a history of MSM does not exclude one from donating organs, but it does flag as elevated risk. Candidates for transplant and their surgeons indicate whether they will be willing to accept an organ with elevated risk.

A positive HIV test excludes a person from donating an organ outside of a research trial at the moment. (The HOPE act allows for transplants from HIV+ donors to HIV+ Recipients under IRB approval).

This is for a living donor, but tested negative prior to transplant. Evidently became infected prior to organ recovery. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6010a1.htm

The rate really is much higher: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a2.htm
I just don't think that blanket-banning the entire population, without a similar accounting for actions, is the appropriate measure.

Mr. SleazyPUA who refuses to use protection with his continuous string of random hookups can bone 30 strangers in 30 days, each of whom themselved boned 30 people (unprotected) in the days leading up to their encounter with him, and then on the 31st day he can go donate blood.
Mr. MSM who is in a monogamous, consensual, long-term relationship, got married ages ago, and (hell, just for the extreme of it since the new FDA suggestions aren't in play yet) hasn't had sex since he and his partner adopted 5yrs ago...he's banned for life.

Obviously those are extremes, but come on...we can do better than we are.
Also, I thought half of this thread was pointing out how most organ donors aren't massive-transfusion type scenarios, but more 'brain death/stroke' situations.
 
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I just don't think that blanket-banning the entire population, without a similar accounting for actions, is the appropriate measure.

Mr. SleazyPUA who refuses to use protection with his continuous string of random hookups can bone 30 strangers in 30 days, each of whom themselved boned 30 people (unprotected) in the days leading up to their encounter with him, and then on the 31st day he can go donate blood.
Mr. MSM who is in a monogamous, consensual, long-term relationship, got married ages ago, and (hell, just for the extreme of it since the new FDA suggestions aren't in play yet) hasn't had sex since he and his partner adopted 5yrs ago...he's banned for life.

Obviously those are extremes, but come on...we can do better than we are.
Also, I thought half of this thread was pointing out how most organ donors aren't massive-transfusion type scenarios, but more 'brain death/stroke' situations.

These guys get flagged on the high risk category too. It's different between blood and organs too.
 
These guys get flagged on the high risk category too. It's different between blood and organs too.
They sure don't for blood...which is what I referenced in my post. My point is that there are far more relevant questions that could be asked rather than a blanket ban.
 
They sure don't for blood...which is what I referenced in my post. My point is that there are far more relevant questions that could be asked rather than a blanket ban.

There would be some value to more questions. Though the epidemiology behind the ban is solid, and it limits the number of invasive questions that would have to be asked of everyone (which could disturb potential donors). The prevalence is just so much higher as a population on a whole.

The blood supply has to have a much higher level of safety than organ transplants. False positives are relatively harmless (while a finite resource, blood donation is pretty common, and can be bolstered especially in an emergency), false negatives are catastrophic. It's why I couldn't donate blood after being in a malaria endemic country, even though I took prophylaxis and presented nearly zero risk.

The FDA shifted to a 1 year deferral from a lifetime deferral; this would provide adequate time for any infections to seroconvert.
 
1. It twists the doctors incentives so that they have an incentive to harvest your organs rather than to save you.
2. You are giving the organs for free, and the hospital system makes a lot of money off of them. He wants to see a cut of it.
3. Scared of potential for pain during organ transplantation, scared that he will be harvested while still alive.
4. An inane point about how he thought that bodies were kept in some secret room indefinitely, circulated with blood and plasma, and he thought that this could happen over the course of months.

I work in organ donation, directly and indirectly with my states OPO.

1) The doctors that are working to save you generally have zero clue if you are a donor or not. Also, they have no incentive to take your organs as a normal doctor does not see a cent of it. If anything, they want to keep you alive if their goal is financial gain.

2) If you're dead, how would you "get a cut". I guess he means his family but buying and selling human tissue/organs is illegal.

3) "Extensive" study is done to ensure you are indeed brain dead. If you are not brain dead, you are in a coma and they have to proceed through DCD (basically removing life support and allowing your body to die). If you do not die within a certain time frame after removal, you cannot donate certain organs.

4) Ridiculous. Organ donation generally occurs within a day of your pronouncement as Brain Dead or there is consensus that you are beyond recovery.

Inform your dad that you can save up to 9 lives through organ donation and improve up to 50+ with tissue donation.
 
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There would be some value to more questions. Though the epidemiology behind the ban is solid, and it limits the number of invasive questions that would have to be asked of everyone (which could disturb potential donors). The prevalence is just so much higher as a population on a whole.

The blood supply has to have a much higher level of safety than organ transplants. False positives are relatively harmless (while a finite resource, blood donation is pretty common, and can be bolstered especially in an emergency), false negatives are catastrophic. It's why I couldn't donate blood after being in a malaria endemic country, even though I took prophylaxis and presented nearly zero risk.

The FDA shifted to a 1 year deferral from a lifetime deferral; this would provide adequate time for any infections to seroconvert.
I think we're just gonna have to agree to disagree on this one. I think it's unreasonable to expect anyone to be celibate for a year in order to donate, regardless of their orientation. I see no reason why it could not be one of those questions that triggers followup Qs for certain answers - just as travel, piercings, etc do - which would still limit the number of invasive questions asked of everyone (though seriously, how is "do you use a condom" more invasive than "have you ever hired a hooker"?)
 
I think we're just gonna have to agree to disagree on this one. I think it's unreasonable to expect anyone to be celibate for a year in order to donate, regardless of their orientation. I see no reason why it could not be one of those questions that triggers followup Qs for certain answers - just as travel, piercings, etc do - which would still limit the number of invasive questions asked of everyone (though seriously, how is "do you use a condom" more invasive than "have you ever hired a hooker"?)

That is true. Definitely a tricky issue, because the risk of transmission per act varies so widely too.

You're right on follow-up questions: they really could stratify the risk. Could even include "when was your last HIV test?" which in itself would probably do a pretty good job at filtering for those most at risk.

The funny thing with sexual questions is that people are usually more comfortable with them than they are with questions about their income.
 
That is true. Definitely a tricky issue, because the risk of transmission per act varies so widely too.

You're right on follow-up questions: they really could stratify the risk. Could even include "when was your last HIV test?" which in itself would probably do a pretty good job at filtering for those most at risk.

The funny thing with sexual questions is that people are usually more comfortable with them than they are with questions about their income.
I've given up predicting people's comfort levels...heck, I'm more comfortable with questions about income, sexual history, medical history, and mental health than I am about my music preferences, yet everyone seems to think that is a great icebreaker :laugh:
 
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Already did. is it metal?
Now, you and I both know that I'm not going to answer questions on it :p That was kinda the point I was making. Feel free to ask me non-music things though (or we could just stop derailing the thread, sorry guys).
 
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