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post #1 of 27 (permalink) Old 10-05-2008, 05:19 PM Thread Starter
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Redefining death?

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Think being the next president would be a brutal job? Imagine being a transplant surgeon. You can't tell the parents of a dying kid when to pull the plug, but you have to be there, ready, the minute he expires. You have to wait until he's dead, but not so long that his organs become useless. You can give him drugs to keep his organs healthy, but you mustn't technically revive him. And you can't remove and restart his heart until it's been declared kaput.

Pick up a recent issue of the New England Journal of Medicine, and you'll see the far edge of this tortured world. In the journal, doctors at Children's Hospital in Denver describe how they removed hearts from infants 75 seconds after they stopped. The infants were declared dead of heart failure, even as their hearts, in new bodies, resumed ticking.

Is this wrong? We like to think that moral lines are fixed and clear: My heart is mine, not yours, and you can't have it till I'm dead. But in medicine, lines move. "Dead" means irreversibly stopped, and stoppages are increasingly reversible. And when life support ends, says one bioethicist, "not using viable organs wastes precious life-saving resources" and "costs the lives of other babies." Failure to take body parts looks like lethal negligence.

How can we get more organs? By redefining death. First we coined "brain death," which let us take organs from people on ventilators. Then we proposed organ retrieval even if non-conscious brain functions persisted. Now we have "donation after cardiac death," the rule applied in Denver, which permits harvesting based on heart, rather than brain, stoppage.

But stoppage is complicated. There's no "moment" of death. Some transplant surgeons wait five minutes after the last heartbeat; others wait two. The Denver team waited 75 seconds, reasoning that no heart is known to have self-restarted after 60 seconds. Why push the envelope? Because every second counts. Mark Boucek, the doctor who led the Denver team, says that waiting even 75 seconds makes organs less useful.

So how can death be declared based on irreversible heart stoppage when the plan is to restart that heart in a new body? Boucek offers two answers. First, even if the heart resumes pumping in a new body, it couldn't have done so in the old one. (That used to be true, but today, hearts can be restarted by external stimulation well after two or even five minutes.) Second, Boucek says the heart is dead because the baby's parents have decided not to permit resuscitation. In other words, each family decides when its loved one is dead. In a commentary attached to the Denver report, another ethicist proposes extending this idea -- letting each family decide not just whether to resuscitate but also at what point organs can be harvested. Brain death? Cardiac death? Persistent vegetative state? Death is whatever you say it is.

Robert Truog, an ethicist who supports the Denver protocol, says this redefinition of death has gone too far. Let's accept that we're taking organs from living people and causing death in the process, he argues. This is ethical as long as the patient has "devastating neurologic injury" and has provided, through advance directive or a surrogate, informed consent to be terminated this way. We already let surrogates authorize removal of life support, he notes. Why not treat donations similarly? Traditional safeguards, such as the separation of the transplant team from the patient's medical team, will prevent abuse. And the public will accept the new policy since surveys suggest we're not hung up on whether the donor is dead.

But down that road lies even greater uncertainty. How devastating does the injury have to be? If death is vulnerable to redefinition, isn't "devastating" even more so? The same can be asked of "futility," the standard used by the Denver team to select donors. Is it safe to base lethal decisions on the ebb and flow of public opinion, particularly when the same surveys show confusion about death standards? And can termination decisions really be insulated from pressure to donate? Even if each family makes its own choice, aren't we loosening standards for termination precisely to get more organs?

Modern medicine has brought us tremendous power. Boundaries such as death, heart stoppage and ownership of organs have guided our moral thinking because they seemed fixed in nature. Now we've unmoored them. I'm a registered donor because I believe in the gift of life and think that the job of providing organs falls to each of us. So does the job of deciding when we can rightly take them.
http://www.washingtonpost.com/wp-dyn...100301974.html
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post #2 of 27 (permalink) Old 10-05-2008, 05:33 PM
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and that my friends is why i took my name off the organ donors list. WHen i die, so do my organs, idont want some doctor to not try as hard as he can to save my life, just so my organs can be donated to someone else.

????
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post #3 of 27 (permalink) Old 10-05-2008, 05:37 PM
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Interesting article, MLS. I personally believe that death occurs when the soul leaves the body and can no longer return. In a metaphysical sense, when the Silver Cord is severed, death is final.

As it relates to organ transplants, I have come across interesting reading with regard to certain organ transplants actually causing new and foreign memories of the donor to occur within the recipient. I have read a few articles such as the following one now, enough to convince me that there may be something to this. However I am not sure what this knowledge, if true, reveals about our existence. Here is a link to an article on cellular memory as it relates to organ transplants. There are many similar articles.

http://www.med.unc.edu/wellness/main...r%20memory.htm
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post #4 of 27 (permalink) Old 10-05-2008, 06:01 PM
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when i die i dont whan anyone to touch my eyeball i am sorry but that's just me
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post #5 of 27 (permalink) Old 10-05-2008, 06:06 PM
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When I die, I hope all of my organs can go to someone else, and if I'm brain dead or cardiac death, I'd like them transplanted then too. I may come out of it, but it's not a worthwhile chance.


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post #6 of 27 (permalink) Old 10-05-2008, 07:30 PM
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Quote:
Originally Posted by Redrum View Post
As it relates to organ transplants, I have come across interesting reading with regard to certain organ transplants actually causing new and foreign memories of the donor to occur within the recipient. I have read a few articles such as the following one now, enough to convince me that there may be something to this. However I am not sure what this knowledge, if true, reveals about our existence. Here is a link to an article on cellular memory as it relates to organ transplants. There are many similar articles.

http://www.med.unc.edu/wellness/main...r%20memory.htm
Don't be Religulous!
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post #7 of 27 (permalink) Old 10-05-2008, 08:25 PM
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Originally Posted by RushFan View Post
Don't be Religulous!
What a unique and thoughtful insight, Bill Mahr. Tell me, Bill, what is the difference in your mind between a person worhsipping a deity and a person worshipping the democrat party? Better yet, why don't you elaborate on the contents of the article contained in the link you quoted and explain what you think it suggests as it relates to the subject of "religulous."
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post #8 of 27 (permalink) Old 10-05-2008, 08:36 PM
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If the person is an organ donor and didn't leave any instruction as to when their organs can be harvested then I think it's the parents or guardians right to decide when the person is dead and when they can be harvested.
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post #9 of 27 (permalink) Old 10-05-2008, 08:54 PM
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tough issues

I am a nurse, and I am currently beginning the process and education to become a CNTC, certified nurse transplant coordinator. It will actually be my job to work with the families of both donor and recipient. Transplantation as always been a very gray area, both emotionally and ethically. I do not allow my personal feelings to reflect upon other peoples wishes in my work atmosphere. If you don't want to donate that is fine. I personally have seen the quality of live for some individuals not only after brain death but other not so severe injuries. I don't always believe that death is the worse thing that can happen to someone. As long as they, the individual, not the family per say are ready. I am personally a donor, but I have also set up a very extensive living will with the guidelines of my wishes. There is no easy answer to transplantation. But the thing to do is have a living will with your wishes outlined. As for children, you have to allow the parents to make their decision and fully support them. They need more support at that time in their life then ever before. They have to live with the choice everyday, always wondering what if. Yet many parents find peace in the fact that another child is able to live to see another day. Everyone has their opinion on the fact. There are thousands of articles and stories out there regarding the issues. But there are no easy answers.

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post #10 of 27 (permalink) Old 10-06-2008, 03:35 AM
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Hmmm, I think I'll allow my organs to be doctor-napped, but the recipient will have to change his name, style of dress, haircut etc to mine.
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