The Big Business of Organ Donation and Hospital Termination (And What You Need to Know)
Part I
A child lays in a hospital as her parents are told she is brain dead. The hospital personnel come to parents of the child and ask them if they can do something good for some other people in need, and donate her organs. The parents, putting aside their own grief, sign the organ donation papers. Literally moments before the girl is about to be rolled in to have her organs harvested, she squeezes her mother’s hand. Turns out, that she isn’t brain dead at all, but in a coma, a state that she can recover from. She is presently progressing towards recovery.
This was the scene that played out earlier this week. The girl is was one of the victims of the Uber shooting rampage. She was also almost a victim of a rush to harvest organs, something that goes on everyday.
George Pickering III was declared to be in a permanent coma after suffering a massive stroke in January of 2015. His father had to hold up the hospital staff at gunpoint, after his son squeezed his hand. George Pickering II wasn’t listed on the healthcare proxy, only his mother and brother were. At the hospital’s insistence to George’s mother and brother that he would never come out of the coma, his mom and brother decided to do a “Terminal Wean”, which means withdrawing all food and any other life support. "They were saying he was brain dead, he was a vegetable," said Pickering II, according to KRPC. "They were moving too fast. The hospital, the nurses, the doctors.”
Indeed they were. Shortly after the stand off in the hospital, Pickering awoke and made a full recovery.
These are but two of the cautionary tales of being uninformed when it comes to our own healthcare and that happens because the average individual doesn't understand medical terms. They are also afraid to ask questions of medical personnel. Most don't even have a health care proxy. These are things that are essential to know.
The first thing to understand is the difference between “brain dead” and “coma” In brain death, the brain is literally dead. There is no electrical activity going on. Coma, on the other hand, there is brain activity. There is a coma scale to determine how deep the coma is. Coma is the way the brain heals itself and people come out of comas frequently. Despite knowledge of this, there are reasons why someone in a coma may seem brain dead, and hospitals are supposed to follow guidelines to insure that someone in coma isn’t accidentally diagnosed as brain dead, yet most hospitals are not following these guidelines and hence the rush to call people "brain dead".
"This is truly one of those matters of life and death, and we want to make sure this is done right every single time," says David Greer, a neurologist at the Yale University School of Medicine who led the study.
Greer helped write a detailed set of guidelines in 2010 that the American Academy of Neurology recommended every hospital follow when declaring patients brain-dead.
Greer and his colleagues then analyzed actual policies at 492 hospitals and health care systems across the country. While most have adopted the guidelines, the researchers report to JAMA Neurology that there are significant differences in how the key parts of the guidelines have been put into practice.
More than 20 percent of hospital policies don't require doctors to check that patients' temperatures are high enough to make the assessment, as the guidelines call for. "If somebody has a low temperature then their brain function can actually be suppressed based on that," Greer says.
Almost half of policies don't require doctors to ensure patients' blood pressure is adequate for assessment of brain function. And some hospitals say doctors can skip tests that the guidelines recommend.
In addition, most of the hospital policies don't require that a neurologist, neurosurgeon or even a fully trained doctor make the call. "In some hospitals they actually allowed for a nurse practitioner or a physician assistant to do it," Greer says.
Based on the findings, Greer says compliance needs to improve. "There are very few things in medicine that should be black and white, but this is certainly one of them," he says. "There really are no excuses at this point for hospitals not to be able to do this 100 percent of the time.”
Neurologist James Bernat, a leading authority on brain death, says, "It's disturbing that despite all of the educational intervention to try to bring doctors up to the national standards that there remains such great variability."
Leslie Whetstine, a bioethicist at Walsh University in Ohio. put it well. "If one hospital is using a testing method that's different from another hospital, people might wonder: 'Are they really dead?’"
And as these most recent cases have come to light, people should.
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You need to protect yourself from the medical community and become informed consumers.
HEY!! You can't vote if you're dead, LOL!
That's pretty horrifying.
Yes it is Big C!
It is very important to get informed, and even more so, to make sure whoever your health care proxy is (you really should have 3)that they understand what they have to do to protect your interests. I will be going over that in Part 2
This is why I am not an organ donor. I don't trust their motivation.
Based on the findings, Greer says compliance needs to improve. "There are very few things in medicine that should be black and white, but this is certainly one of them," he says. "There really are no excuses at this point for hospitals not to be able to do this 100 percent of the time.”
Many, many rural hospitals will never, ever be able to staff appropriately. PA's and NP's make up a large part of the backbone of ER's in a ton of rural hospitals.
Larry,
I realize that, and they should and can be trained to do some of the more basic tests. Now obviously a neurologist has to read for brain death, but making sure that a person is warm and is getting enough food to stop the bodies preservation mode can be done. An PA or NP can do a babinski test. This is elementary medical knowledge.
The basic medical assessments mentioned to determine death are done (at least the one's I've observed). It is the call for a neurologists to be the one to determine brain death that will never happen. It's simply impossible. There are not even a thousandth of the number of neurologists that would be needed to meet this standard. Especially in a rural setting.
Is Planned Parenthood involved ? Let's see what Carly Fiorinna thinks. This issue might revive her campaign.
Otherwise, good article Perrie, and food for thought if and when any of us find ourselves with an incapacitated and comatose loved one.
No planned parenthood involved.
But people need to educate themselves so that a loved one (or yourself) doesn't find themselves trapped in a coma while someone is taking your organs out. It is a nightmare situation.
The entire problem is that the medical definition of death has changed . It is now much more abstract than the old : "His heart is no longer beating ."
Petey,
It is now much more abstract than the old : "His heart is no longer beating ."
Actually not.
Organs can only be taken from people whose hearts are beating. The problem is two fold. One is that hospital personnel are not making the right calls on brain death. The other comes from organ donation vs tissue donation. More about that in Part 2.
Organs can only be taken from people whose hearts are beating.
Odd ... what is the thinking on that ?
When the body dies, it goes through a process of breakdown. This makes organs unviable in most cases. There is very little time to harvest. In the 1970's they would take organs when the heart stopped beating but the organs are not as viable and also little time to make a match with a transplant recipient.
Your extinct Barney, no need to worry.
Excellent article Perrie.
It touches on a very important subject which is the intimidation that people have with medical professionals. So much so that they won't ask questions, blindly accepting what they're told. My father was in the hospital a couple years ago. After a week in the hospital my mother was frantic because he was getting worse under their care. She called my sister and I and asked us to come. When we arrived we spoke with the doctor and didn't like his answers so we called John Hopkins and had my father transferred that night. Initially my father was embarrassed and didn't want us to interfere with the doctor but within a day after his transfer his vitals had improved and he was released after a week. He doesn't question us anymore when he has to go in for treatments. In fact he warns the doctors now.
Great article Perrie!
I'm an organ donor and it's on my license. Plus my family knows my wishes. I'm still trying to decide what should be done with what's left. I'm thinking cremation, but my wife doesn't want to be cremated and we want to be buried next to each other. I suppose they could just bury my ashes.
While many hospitals use lack of reflex, EEG, or an apnea test, probably the most definitive is a nuclear brain scan. Able to sleep at night knowing all these were performed on our daughter before our final consent was given.
Many states have changed the laws, if "donor" is selected on your driver's license families no longer have the final word. Almost 18 years ago, husband and I had the final word and able to choose what was to be harvested. A process not unlike what people witnessed on the Planned Parenthood video - horrid doesn't begin to describe the "selection" menu.
Unless you're willing to give carte' blanche to the hospital, have a medical proxy and allow someone with a voice to speak for you.