| GuestBook 4 Mid to late 2003 The first email here is the last to be posted meaning that to read these posts as they appeared you would need to start at the bottom. This reverse process is how Geocities does their guestbooks. Back to Main Page Go To Guestbook No 3 Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : im not sure what point you are trying to get to with the below statement Comment (second 35 words) : then cut out the wanted organs: all this based on next of kin agreeing to it - and nothing more. Is this an accurate possibility? Comment (third 35 words) : what do you mean by ..is this an accurate possibility?? what is the alternative you see?? Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : i may not agree with the manner in which you descibe what happens, but the essence is true. The pt is not declared brain dead as there are pronounced dead from every system in the body so brain dead has no relevance here Comment (second 35 words) : once the hospital MD has declared death the recovery team THEN come in and recover the organ....i hear distain in your email which i find hard to understand Comment (third 35 words) : as it is like a coroner perfoming a P.M...All of the familys opinions are listened to in every donor situation and recovery can only be perfomed when they give conset Name (optional) : Norm Address (optional) : Adelaide Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : Sam, do you have the exact URLs for the Yusuke Kubota and Yong Cho studies, or abstracts, or print publisher details? Comment (second 35 words) : I would like to check the parameters of their studies and analyse the results. Comment (third 35 words) : Name (optional) : Norm Address (optional) : Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : To summarise, Sam, with NHBOD.s: A patient may not have signed an organ donor card. This patient has not been declared brain dead and still has a beating heart. Comment (second 35 words) : He or she may then be wheeled into a harvest theatre,where medical support such as a breathing machine is turned off; doctors wait a few minutes for brain destruction; Comment (third 35 words) : then cut out the wanted organs: all this based on next of kin agreeing to it - and nothing more. Is this an accurate possibility? Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : Graft funtion question... Yong Cho and UCLA has an extensive study on NHBD graft funtion with the conclusion NHBD of kidneys yield similar graft survival rates to cadaveric kidneys Comment (second 35 words) : and i believe Yusuke Kubota also preformed a study with NHBD with similar result, being they have an excellent graft survival rate Comment (third 35 words) : Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : the law covering the decision to donate is covered by the uniform anatomical gift act. i foget the specific section, and each hospial is Comment (second 35 words) : covered to withdraw care by policies referencing to the laws covering this...i forget the legislation for this, but they are both covered by law Comment (third 35 words) : hope this answers your questions so far. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : the question of donation is offered to all families regardless of a donor card as it is the familys right to be offered this. equally it is their Comment (second 35 words) : right to refuse if this is not something they wish to not pursue. Many families do not discuss end of life issues with their loved ones so in this case the decision is Comment (third 35 words) : left to the family. As it is the legal next of kin consenting towithdrawl/ donation that covers foe these procedures to take place. Name (optional) : Norm Address (optional) : Adelaide Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : Thanks for your replies, Sam. There is one question they prompted: would the NHBOD candidate already have signed a donor card prior to the family being asked, Comment (second 35 words) : or, could non heart beating organ donation happen, with family approval, if he/she hasnt signed one. Comment (third 35 words) : Legally, the answer might be yes, but I am wondering what it would be in practice. Oh, and using what state legilsation and protocols are you basing your answers? Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : CONT.....have decided to withdraw and the pt is deemed a potential NHBD the family are offered this option... they can either say yes or no Comment (second 35 words) : regardless of the answer withdrawl looks the same. It is managed by the hospital staff. After the pt is declared dead by the hospital MD Comment (third 35 words) : the pt is taken to the OR and recovery commenced. It is the same as an autopsy as the pt is dead.. expect the organs are sent to recipients Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : Many people now have advanced directive saying if they are in a coma they would want support stopped. So ethically it is not Murder. Comment (second 35 words) : Norm ..there is NO organ maintenance AT ALL..the patient dies naturally due to the withdrawl and NO resucitation happens AT ALL Comment (third 35 words) : scenario....pt has profound anoxia d/t cardiac arrest..has minimal brain function and the family decide to withdraw care AT THIS point after they Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : some pts are taken to the OR where withdrawl happend in the OR, Usually the withdrawl is attended to by the MD taking care of the hospital. NON of the recovery MD are involved in this AT ALL Comment (second 35 words) : I have experienced MANY families who withdraw care on pts for many reasons. im unaware of the legality in Australia, and maybe using a PSV was a bad example to use Comment (third 35 words) : the care is withdrawn not to create a NHBD, because donation is not discussed with a family UNTIL AFTER the have decided to withdraw support anyway Name (optional) : Norm Address (optional) : Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : Sam, when you say, - ... Once the pt has been declared dead it is then the perfusion fluid is given to reduce ischemic time - does this mean no organ maintenance Comment (second 35 words) : drugs or coolants are used when the NHBOD is still alive? If any are ever used what are they? Can we consider the following scenario? The heart has stopped and Comment (third 35 words) : the patient, now a NHBOD, is dead. After waiting a few minutes to allow for brain death, is the heart ever re-started by CPR or current to preserve organs. Name (optional) : Norm Address (optional) : Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : Sam, would there be any instances when the patient was alive, prior to withdrawal of medical support, when wheeled into the harvest theatre? Comment (second 35 words) : I can understand the logic when relatives withdraw medical support to avoid PVS (vegetative state), but this brings up an interesting legal point. Comment (third 35 words) : Isnt it murder to kill a PVS patient? If so, then isnt killing the patient by withdrawing medical support to create a NHBOD, and avoid a PVS, somewhat legally nebulous. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : with regards to the illness the patient was suffering from it can be anything causng a family to think of withdrawl of care the obvious being PVS Comment (second 35 words) : there are times when a pt has had MASSIVE trauma and EVERY effort to resucitate has not worked and the family decided to withdraw for the dignity of their loved 1 Comment (third 35 words) : obviously a terminal pt with ca or AIDS would NOT be an organ donor candidate.., there are many reasone why care is withdrawn. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : when an organ recovery is performed on a NHBD they are DEAD. Withdrawl can happen in the ICU, OR or room close to the OR depending on the familys needs Comment (second 35 words) : so to answer the question about them being dead when they are taken to the OR...it depends if withdrawl has already happened or not. Comment (third 35 words) : in a NHBD situation they are ALWAYS declared DEAD prior to the recovery commencing. Once the pt has been declared dead it is then the perfusion fluid is given to reduce ischemic time Name (optional) : Norm Address (optional) : Email (optional) : Comment (holds up to 35 words) : With your extensive clinical experience can you describe the basics of a liver harvest from a Non heart-beating organ donor (NHBOD). Wouldnt lack of ventilation and heartbeat mean quick deterioration of the liver. Comment (second 35 words) : It is the graft and patient survival rates that I am really after - and the papers you originally mentioned. Can you supply their titles on this guestbook? Comment (third 35 words) : Name (optional) : Norm Address (optional) : Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : From your experience, Sam, are NHBODs alive or dead when they are wheeled into the theatre for harvesting? And what illness were they suffering prior to withdrawal of medical support? Comment (second 35 words) : The point I made about an expanded definition of death for transplant purposes is based on the NHBOD being neither brain dead or cardiac dead when harvest preparation begins. Comment (third 35 words) : This being when medical support is removed and the patient dies. With CPR the dead patients heart could be revived so harvesting can happen on a beating heart body. The proposed changes for NHBODs may include this. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : another point is they are not resuscitated after asystole ....what so ever! if you are familiar with advanced life support...the treatment for asystole is Comment (second 35 words) : CPR...logically how can chest compressions be perfomed if they are trying to perform surgery.. and even with this there is a vast V/Q mismatch. Comment (third 35 words) : the last point is you mentioned about neurological testing the pt...but when the heart has stopped they are DEAD. regardless of the initial illness. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : i am going to read the article you have been referencing to on the first page of your web site as the quotations you are making are disturbing Comment (second 35 words) : as in a real NHBD you say they are ventilated with O2 and i know this to be an untrue practice in the US. So, for me to be to comment i want to sit and read the Comment (third 35 words) : article to be subjective. Unless the practice is so different from country to country. I can only really speak for the US and from some knowledge in the UK Name (optional) : Norm Address (optional) : Email (optional) : Comment (holds up to 35 words) : In regard to, ...cannulas can be put in pre OR..., sam, what sort of stuff would be inserted into the still alive NHBOD? Coolant and blood thinner? Comment (second 35 words) : Comment (third 35 words) : Name (optional) : Norm Address (optional) : Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : Sam, I became interested in the re-emergence of NHBODs as it may be connected to the broadening of the definition of death for transplant purposes. Comment (second 35 words) : Would you be interested in supplying a longer description of the organ maintenance procedures for NHBODs and the withdrawal of medical support to bring on death? You could send it via email to me. Comment (third 35 words) : Could the NHBOD possibly be conscious while being wheeled into the theatre prior to withdrawal of medical maintenance? Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : in 2001 in the US 167 donors were NHBD. in this year the number of OPOs recovering NHBD were 33. 1n 2001 6 OPOs revovered more than 10 NHBD Comment (second 35 words) : 2 OPOs procured 6-10 and 25 OPOs procured 1-5. for the most active OPO NHBD represented 10%of total donors. Comment (third 35 words) : so as you can see this is a relative active programme. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : so organs recovered are full organs not just nodes as i think you are referencing to. (as i said i need to read the article, just have been a little busy!!) Comment (second 35 words) : i wish i had more space to describe donor maintenence and withdrawl, but this guestbook doesnt give much room. Comment (third 35 words) : so are there NHBD in Australia? What made you decide to dedicate a your web site to this subject?? Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : Many OPO in the states are pursuing NHBD/DCD many for liver and kidneys, but also some center for lungs as i mentioned before Comment (second 35 words) : i have printed the article you are referring to, and have to make time to read it. Comment (third 35 words) : donor maintenance is minimal if at all as the focus in a NHBD is different. cannulas can be put in pre OR but family can say NO to this, and be out in post asystole Name (optional) : Norm Address (optional) : Adelaide Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : Where did you obtain this understanding? Where in the USA is NHBOD happening and for what organs? Comment (second 35 words) : There was a reference in Dr DD Bells article about kidney and liver nodes being removed from NHBODs but I am not aware where it is actually happening. Comment (third 35 words) : Also, is there any donor organ maintenance done while the patient is still alive: eg blood thinner, coolant instilled into aortic artery, etc? Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : Norm....with a NHBD there is nothing given to speed up the process of their death as i explained before...but death reliability index Comment (second 35 words) : gives a good guideline of how long they will take to become asystolic. As the window stands at 1-2 hours from withdrawl to asystole in which organs can be recovered Comment (third 35 words) : if people take over that time....its simple...the organs cant be recovered!!!!!! but NOTHING is given to quicken the process these patient die just from the withdrawl of treatment. Name (optional) : Norm Address (optional) : Email (optional) : Comment (holds up to 35 words) : I am looking forward to seeing statistics showing that graft function is similar between NHBODs and brain dead donors. Comment (second 35 words) : Also, the precise plan for making prospective NHBOD donor patients die quickly: as a slow death would damage the organs. Comment (third 35 words) : People have a habit of dying slowly even when medical intervention is withdrawn. Name (optional) : Rdorigo Address (optional) : Email (optional) : GhettoMexican@aol.com Comment (holds up to 35 words) : good site Comment (second 35 words) : Comment (third 35 words) : Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : norm..yes NHBD and NHBC are the same just different terms...they are also referred to as donation after cardiac death too...which i belive Comment (second 35 words) : is a better explination...as it is what is says...donation after the heart has stopped... Comment (third 35 words) : Name (optional) : Norm Address (optional) : Adelaide Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : Sam, I got the following from A Positions Paper by the Ethics Committee of the American College of Critical Care Medicine. Comment (second 35 words) : …although the use of cadaver organs rose in the late 1960s and early 1970s, the practice of procuring organs from NHBC [Non heart beating cadavers] declined and all but disappeared… Comment (third 35 words) : Would, in your estimation, Sam, NHBCs be identical to Non Heart-Beating Organ Donors. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : no NHBD in the USA is not new. The frequency of which they were perfomed i suppose declined for many reasons, but it is Comment (second 35 words) : is a practice pursued for many years. I cant remember specific reasearch off the top of my head about graft function from NHBD, but Comment (third 35 words) : articles i heave read have showed little difference from brain dead donor and NHBD. I have research articles somewhere i just have to fiind them (i will forward titles for your reference) Name (optional) : mugu Address (optional) : 14 re sdop Email (optional) : mugu@mugu.com Comment (holds up to 35 words) : keep off Comment (second 35 words) : Comment (third 35 words) : Name (optional) : Norm Barber Address (optional) : Adelaide Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : I hadnt realized livers were taken from NHBODs. Do you know which OPOs are getting them? Also, with both NHBOD kidneys and livers: are there any graft survival statistics yet? Comment (second 35 words) : The Japan Organ Transplant Network told me three years ago they were getting, from NHBODs, 84% kidney graft survival at one year and 72% at five years. I think, recently, USA was getting 50% Comment (third 35 words) : But it is new in USA,(apart from 1960s removal of kidneys from donors whose hearts had stopped.) Correct me if I am wrong. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : by aggressive centers i mean these are centers which accept organs that believe the function of the organ will improve. ie it may be a lung that is from an Comment (second 35 words) : older donor which a different center may not wish to accept for the recipients they have listed at that particular time as the recipient and sugeons have to Comment (third 35 words) : consider the risk of transplanting this organ vs the risk of not. of which , of course the recipient has the ulimate say if he wants that organ or not Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : at present with NHB donors many OPOs are just pursuing kidneys and liver but aggressive centers now have found with research lungs may also be possible Comment (second 35 words) : i know that to be true in the USA, but dont know about the UK or anywhere else. Comment (third 35 words) : even though we may have differing opinions i would like to share my appreciation with you for being able to discuss this in a diplomatic manner Name (optional) : Norm Address (optional) : Email (optional) : Comment (holds up to 35 words) : Sam, are vital organs such as kidney, liver, heart, lungs and pancreas harvested from cardiac dead donors currently? I thought only kidneys in Japan and lungs in Sweden were the go. Comment (second 35 words) : By cardiac dead I mean the heart has stopped permananently and not re-started via massage or shock. And that the patient has not been delcared brain dead as a Comment (third 35 words) : precursor to removing heart or breathing support. Name (optional) : Norm Address (optional) : PO box 64, Kensington Park SA 5068 Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : But the proposals are to expand the definition of death thus increasing organ harvesting. We are not talking about current conceptions and protocols. Comment (second 35 words) : Volume 29 of The Journal of Medical Ethics is devoted to discussing the moral dilemnas of both current organ harvesting and expanded definitions of death. Comment (third 35 words) : Might be worth a read. Written by experts in the field. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : so norm you are right in saying organs will not tolerate extensive ischemia time, but in cases were it is thought the pt would not become cardiac dead Comment (second 35 words) : in the 1-2 hour window, donation is not offered to these families. Comment (third 35 words) : i was just wondering...(just to be nosey, i hope you dont mind) what do you do for a living?? Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : the death reliability index looks at the dependancy the patient has on all the interventions its receiving IE. % of oxygen and amount of pressors (BP meds) are on Comment (second 35 words) : so when a family decided to withdraw care without the topic of donation being in this scenario. with withdrawl what will happen is the pt will be extubated and pressors removed thus will be Comment (third 35 words) : cardiac dead in X amount of time. As you see the same protocol is used for witdrawl of care regardless of donation or not. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : Norm.. when assessing a pt for a NHBD there is a tool called a death reliabilty index which some OPOs use which can give a guideline of the time a patient Comment (second 35 words) : will take to become cardiac death. If the patient does not expire NATURALLY within a 1-2 hour window donation can not occur due to ischemic time Comment (third 35 words) : but the is NOTHING that is given to expedite the process. The care the pt receives is the same as in a normal withdrawl of care. Name (optional) : Norm Address (optional) : Email (optional) : Comment (holds up to 35 words) : I understand, Sam, what you said below, however, Most organs do not tolerate the deterioration in cardiorespiratory performance that precedes all but sudden death, or the warm ischaemia that follows Comment (second 35 words) : classical cardiorespiratory death..., according to Dr Bell. This means death would have to be short and sharp to obtain good organs. Comment (third 35 words) : One might wonder how this sudden death is going to be obtained particularly if the patient is not dependent on ventilation - as NHBODs wont necessarily be brain injured. Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : so when a fmily decided to withdraw care at that point,regardless of donation or not the patients meds are witdrawn and ventilation removed Comment (second 35 words) : the only difference in a NHBD is after their heart has stopped organs are recovered where as normally the body would go to the morgue? Comment (third 35 words) : So no treatment is different, nor withdrawl of treatment is different. even the location can be the same I.E in the ICU if the family wish to be there at time of cardiac death Name (optional) : sam Address (optional) : Email (optional) : Comment (holds up to 35 words) : Norm ...i have to disagree with the statement you made (below) Comment (second 35 words) : The difference between the new Non-heart beating organ donor proposal is that death will be speeded up by withdrawing basic treatment Comment (third 35 words) : donation after cardiac death does not speed anything up as it is offered to family AFTER they have already DECIDED to withdraw care on their family member. so time wise makes no difference Name (optional) : Norm Address (optional) : Australia Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : Legislation differs. In many jurisdictions when a patient has signed a donor card then asking permission of relatives is merely a hospital protocol - a politeness. Comment (second 35 words) : The actual legislation does not require asking permission. In most places surgeons may even harvest organs from a heart-beating donor if the person has not signed a donor card if they Comment (third 35 words) : believe the patient had never expressed any objections to being a donor. There is a radical difference between what organ donation agencies say and the legislation indicates. Name (optional) : Norm Address (optional) : PO Box 64, Kensington Park, SA 5068 Email (optional) : gumflat88@hotmail.com Comment (holds up to 35 words) : The first few heart transplants, starting in 1967, were done using hearts from patients whose hearts had naturally stopped during the dying process. This natural process tended to damage the heart. Comment (second 35 words) : From 1968 organ harvesting began while hearts were still beating - this process produced better quality organs for transplant. If the heart had stopped naturally organs were not used. Comment (third 35 words) : The difference between the new Non-heart beating organ donor proposal is that death will be speeded up by withdrawing basic treatment - this differing from the 1967 method where death was allowed to happen naturally. Name (optional) : Howard Gestetner (alias) Address (optional) : Email (optional) : would I be so stupid Comment (holds up to 35 words) : Are organs removed currently from bodies with hearts stopped already? That quote made it appear as something new. Comment (second 35 words) : Comment (third 35 words) : Name (optional) : Address (optional) : Email (optional) : Comment (holds up to 35 words) : To Howard Comment (second 35 words) : Donation after someones heart has stopped......is NOT a new procedure it had been happening for 50 years....it was how one of the the first hearts was recovered for transplant Comment (third 35 words) : so when you say..They will not be so stupid as to antagonize the public by trying this grotesque stunt. Mark by word....IT IS ALREADY BEING PERFORMED !!!!! Name (optional) : Address (optional) : Email (optional) : Comment (holds up to 35 words) : this page gives the impression that organ recovery happenens regarless of the families wishes, cleary many people do not understand the process of donation Comment (second 35 words) : i can only speak of in the USA, UK from a first hand ...YOU HAVE TO HAVE CONSENT from the legal next of kin ....otherwise they would be prosecuted. Comment (third 35 words) : the people envolved in donation are firstly humans....do you really think a nurse or any member of the recovery team would go along with an organ recovery if they thought they were killing a pt??? if not just because they couldnt sleep at night, but the f Name (optional) : Howard Gestetner (alias) Address (optional) : Email (optional) : would I be so stupid? Comment (holds up to 35 words) : Do not be fooled by proposals to remove organs from people whose hearts have stopped. Comment (second 35 words) : It is a new trick to avoid doing a brain death diagnosis. It widens the scope of excisable organs by killing even more alive patients than before. Comment (third 35 words) : They will not be so stupid as to antagonize the public by trying this grotesque stunt. Mark by word. Name (optional) : webmaster Address (optional) : Email (optional) : Comment (holds up to 35 words) : The guestbook was full and has been arhcived as GuestBook No 3 and can be accessed from the top right corner of the index or main page of www.oocities.org/organdonate Comment (second 35 words) : Comment (third 35 words) : |