For the week starting 28 April 2003 United Kingdom Transplant Audit Warns Against overoptimistic reports about Organ Transplanting "Intrathoracic organ transplantation in the United Kingdom 1995-99: results from the UK cardiothoracic transplant audit. "...Within six months of listing, 52.5% of patients on the heart transplant list had been transplanted and 11.0% had died, compared with 31.3% and 15.2% for lung, and 23.4% and 20.4% for heart-lung. The median time to transplant in days (95% confidence interval) was 133 (115 to 149) for heart, 386 (328 to 496) for lung, and 471 (377 to 577) for heart-lung. After three years, the waiting list mortality was 16.9% (6.1% to 46.8%) for heart, 33.1% (9.0% to 100%) for lung, and 36.5% (10.5% to 100%) for heart-lung. The three year graft survival after transplantation was 74.2% (71.2% to 77.0%) for heart, 53.8% (48.2% to 59.2%) for lung, and 57.2% (49.0% to 64.6%) for heart-lung. CONCLUSIONS: This validated database defines the current state of thoracic transplantation in the United Kingdom and is a useful source of data for workers involved in the field. Thoracic transplantation is still limited by donor scarcity and high mortality. Overoptimistic reports may reflect publication bias and are not supported by data from this national cohort. Read the whole abstract report http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11997419&dopt=Abstract For the week starting 21 April 2003 The Legal and Medical Fiction Wendy Carlisle: So is brain death the death of the person, in your opinion? Alan Shewmon: I used to think that it was. But in fact, during the 1980s and early 90s I read a number of articles and gave lectures supporting that idea, and since then I have had to change my opinion about it due to an accumulation of evidence to the contrary.... ....Wendy Carlisle: I think you’ve actually called somewhere the notion of brain death a medical fiction. Alan Shewmon: A legal fiction. Wendy Carlisle: A legal fiction. What does that mean, then, in your opinion for the whole donor debate? Alan Shewmon: I guess it’s also a medical fiction. You’re right. Alan Shewmon Professor of Neurology and Pediatrics, University of California (Los Angeles) School of Medicine from "All In the Mind", Radio National Australian Broadcasting Corporation http://www.abc.net.au/rn/science/mind/s746719.htm Or go to http://www.abc.net.au/ then click on ABC RAdio, then Radio National and finally click on "All In The Mind" For the week starting 14 April 2003 Indians Paid less than $US1000 for a kidney "The `donors' were not even given proper postoperative care, and in some cases were threatened with imprisonment for the illegal act [of selling an organ] and thrown out of hospital a week after the transplant," he said. " He confirmed the deaths of six labourers as a result, although the numbers could be much higher, he added. Sanjay Kumar, New Delhi Go To Whole Story in British Medical Journal For the week starting 7 April 2003 Police uncover large scale organ trafficking in Punjab Sanjay Kumar, New Delhi The police in Amritsar city in Punjab state, northern India, have unearthed what they call "the mother of all scandals in human organ trafficking in India." The police have arrested several doctors, middlemen, and donors, including the alleged main player, transplant surgeon Dr Parveen Kumar Sareen, who works for Kakkar Hospital, which is run by a private charitable trust. Also arrested was Dr O P Mahajan, principal of the Government Medical College and chairman of the authorisation committee that certifies that no commercial transaction has taken place. Go To Whole Story In British Medical Journal For the week starting 31 March, 2003 Where Would the Palestinians Fit Into An Israeli Organ Buying Program? Jewish religious law is liberal in approving nearly any procedure that saves lives. Dr Mordechai Halperin, head of medical ethics at the ministry, and a rabbi, says that religious law does not prohibit giving or receiving compensation for an organ, as long as certain conditions are met. It is acceptable "if the would be donor fully understands the medical consequences, gives his written consent, and is not doing so as a result of desperate financial distress, which can create a situation of coercion," he said. Judy Siegel-Itzkovich, Jerusalem Go To The Full Article In The British Medical Journal For the week starting 24 March 2003 Israel considers paying people for donating a kidney "The severe shortage of kidneys for transplantation has induced Israel's health ministry to make a 180 degree turn in its policy and prepare a bill allowing compensation to be paid to people who donate a kidney for transplantation. "Averse to the idea of organ "selling," the ministry's legal experts stipulated that the compensation whose amount has not yet been set would be considered reimbursement to donors for their time, inconvenience, discomfort, and recovery. "If the bill is passed by the 16th Knesset (parliament), due to be elected on 28 January, it would be the first of its kind in the world, said ministry legal adviser Mira Huebner." Judy Siegel-Itzkovich, Jerusalem Go To Full Article in British Medical Journal For the Week Starting 17 March 2003 Sober, Precise Lanuage from Dr David Wainwright Evans The paper titled "Role of short latency potentials in the diagnosis of brain death" by Facco E, Munari M, Gallo F, Volpin SM, Behr AU, Baratto F & Giron GP, and published in Clinical Neurophysiology (2002) 113; 1855-66, offers irrefutable, genuinely scientific, evidence in support of the contention that the tests of brain stem function in general use for the diagnosis of "brain stem death" (or that element of "brain death") lack the power to exclude remaining function in the brain stem. The authors stress the necessity of certainty in the diagnosis of 'BD' (as a basis for the diagnosis and certification of human death) and report that 3 patients diagnosed 'BD' on the current Italian criteria - meeting "all EEG and clinical criteria of whole brain death" - still had detectable brain stem activity when more rigorously tested. As they say, "they were not yet dead". Since the tests of brain stem function listed as required in satisfaction of the Italian criteria (including the now-admittedly dangerous apnoea test) appear to be the same as those prescribed in the UK Code of Practice for the diagnosis of "brain stem death" (or "death for transplant purposes"), it can no longer be maintained that those simple bedside tests suffice for the certain diagnosis of death of the brain stem. That being so, arguments about the role of the brain stem in the generation of consciousness are seen as irrelevant. Dr David W Evans For the week starting 10 March 2003 Do Potential Organ Donors Get Inferior Hospital Treatment? Like Marino, Bargholt wasn't looking for a fight. She'd always been a vocal advocate of transplantation, and she had given much more than lip service to the movement. Fifteen years earlier her three-year-old had died of a brain hemorrhage linked to a congenital defect. She donated his organs and became one of the first mothers to go public with her story. The deeper Bargholt got into the document, the more uneasy she felt. The protocol was designed for patients who had just suffered catastrophic head injuries and required ventilator support but were not yet certifiably brain-dead. It recommended infusing such patients with two drugs, Regitine and heparin. Bargholt, a one-time nursing student, wondered why they'd be giving such large doses of a blood thinner like heparin to comatose patients with cranial bleeding. Something else bothered her: The protocol told doctors to make decisions about the presence or absence of a heartbeat by feeling for a pulse at the carotid artery. She thought, My God, you're at the Cleveland Clinic. Why go groping around somebody's neck? Hook him up to a heart monitor! The Heart-Stopping Truth About Organ Donation by Steve Salerno Read the whole article For the week starting 3 March 2003 Would You Donate Your Child for Organ Removal? Then there is the procedure itself, which can look like anything but an operation on a dead body. For example, in Charleston, South Carolina a 16-year-old girl was shot in the head. At the time of hospital admission she was showing signs of life - she was moving and breathing. Though a CAT scan showed the bullet lodged in her skull, it had skirted major blood vessels, and the brain itself appeared remarkably intact. That didn't stop attending physicians from declaring her dead two hours later. She was rushed to an operation room where surgeons opened her abdomen and cut assorted arteries in order to remove both kidneys and her spleen. When the ventilator was shut off, she failed to breathe - no bid shock, since the transplant team also bisected her diaphragm. Even after this full-scale assault on her body, 14 minutes passed before the girl's heart gave out. Finally, mercifully, she was dead. Steve Salerno, The Brain-Stopping Truth About Organ Donation Read the whole article For the week starting 25 February 2003 Who Killed Mr Burns? It Could Be A Scene From The Simpsons Does anyone remember a Simpsons episode where the Simpsons' baby shot Mr Burns. An ambulance took Mr Burns to an underclass hospital where doctors pronounced him dead. Then another ambulance took him to a rich folks' hospital and he was treated as alive and recovered. Reality may be somewhat similar as Carmen Marino states: "You go without a pulse for two minutes in some hospitals, you're dead. They take your organs. In other places, at two minutes, they're still trying to revive you." Carmen Marino, a former prosecutor for Ohio's Cuyahoga County from "The Heart-Stopping Truth About Organ Donation Read the whole article For the week starting 18 February 2003 Organ Harvesters Save Killer From Murder Charge After He Shoots Woman In Head “The hospital declared her brain-dead. Surgeons did the harvest. But just before they made the decision to cut, a neurosurgeon had examined the woman. When he found out later about the harvest, he was furious. He says, “This woman might have been blind in one eye or had other problems, but I think we could have salvaged her!” So when the man is charged with murder, the defense had the neurosurgeon and other experts testify that what actually caused the woman’s death was not the gunshot but the harvest. Now they got the guy on felonious assault, but they didn’t get him for murder.” Carmen Marino, a former prosecutor for Ohio's Cuyahoga County from "The Heart-Stopping Truth About Organ Donation Read the whole article For the week starting 11 February 2003 "Dead, but not dead-dead" A transplant surgeon will tell the family of a patient, “Your brother is brain-dead, but we’re keeping him alive on a respirator.” A trauma nurse will tell her replacement during a shift change that a patient is “dead, but not dead-dead.” Steve Salerno, The Heart-Stopping Truth About Organ Donation Read the whole article For the week starting 3 February 2003 Back Room Talk "I think you could do a lot to encourage live donation from relatives. I think it is wrong to be talking about buying organs from the third world when they have relatives who they could go to, all of whom have not offered a kidney. How can that be right? As long as it is done with proper informated consent, it [payment] is a thing to think about. Sir Peter Bell, Professor of Surgery at the University of Leicester, "Plan to offer cash to organ donors" , Guardian Weekly,London, United Kingdom. October 24-30, 2002 For the week starting 27 January 2003 By contrast, a review of the literature shows that some of even the most severely head-injured patients (GCS of 3 or 4, with pupils fixed to light) who are not subjected to apnoea may recover to normal life. Early labelling of these patients as dead (for transplant purposes) during the past 3 decades has diverted medical researchers away from developing novel therapeutic resources that could already have saved many thousands of human lives throughout the world. "Primum non nocere" must be reinstated as the governing principle in the care of the defenceless comatose and early apnoeic/hypercarbic insults avoided. http://bmj.com/cgi/eletters/325/7368/836#26574 BMJ 2002;325:836 ( 12 October ) Cicero G Coimbra Associate Professor Department of Neurology and Neurosurgery, Federal University of São Paulo For the week starting 20 January 2003 A recent Australian opinion is that, rather than redefining those who are brain dead as dead, it may be more honest to acknowledge that such individuals are not dead and that removing their organs is in fact killing them and, and that the long term viability of the transplantation programmes is likely to be better served by telling the truth than by trading in fiction. This must be a better approach than writing that we should not disturb the current pragmatic consensus that lets the brain dead be dead. Honesty is still the best policy. David J Hill, retired anaesthetist. The Old Post House, Eltisley, Huntingdon, Cambridgeshire PE19 6TG http://bmj.com/cgi/eletters/325/7368/836#26574 BMJ 2002;325:836 ( 12 October ) For the week starting 13 January 2003 As repeatedly proposed and never scientifically refuted during the past 2 years, the apnoea test (performed twice) may exacerbate the brain damage. Apnoea may induce severe hypotension in up to 39%, hypoxia (PaO2<70mmHg) in 13%, and further increase of intracranial pressure (ICP) in an unknown number of those so tested, despite the implementation of current oxygenation measures. Cicero G Coimbra Associate Professor Department of Neurology and Neurosurgery, Federal University of São Paulo BMJ 2002;325:836 ( 12 October ) http://bmj.com/cgi/eletters/325/7368/836#26574 For the twelve days starting 2 January, 2003 Carry an Organ Retainer or Organ Keeper Card as a relative or bureaucrat may be able to order your harvesting despite your not having signed an organ donation card. "If you are the legal next of kin and your family member has not made their wishes known, you will be required to make the decision on their behalf." Karen Herbertt Manager - South Australian Organ Donation Agency 10 Pulteney Street, Adelaide SA 5000 Editor: Notice the use of the word "required". Though not legally sustainable these organ managers want to make next of kin believe they don't have any choice. New Go To The Chilling Steve Salerno Article about transplanting in the USA For the week starting 24 December 2002 The Search for Reliable Statistics (who can be trusted?) Below are three views for two Australian states, New South Wales and South Australia, both of whom follow similar organ harvest and transplant protocols and from the National Office of Australians Donate, on the rate of refusal by "families of potential donors" to allow harvesting of their dying relatives. New South Wales Kerridge, Saul, Lowe, McPhee and Williams report in their paper in the Journal of Medical Ethics 2002; 28: 89-94, a "refusal rate" (by families of potential donors) of 82% in 1999 in the Australian State of New South Wales - up from 56% in 1995. South Australia "...there has been 1 case this year and 1 case last year." Karen Herbertt, Manager of the South Australian Organ Donation Agency Nationally (Australia) Next of kin refusal rate of "...nearly 50%" Bruce Lindsay in an Australians Donate promotional letter For the week starting 17 December 2002 Lazarus Phenomenon in the so-called Brain Dead "Eelco F. M. Wijdicks' recent book "Brain Death" again attributes the complex and seemingly purposive movements sometimes seen in those diagnosed "brain dead" to purely spinal reflexes - although they are clearly highly coordinated and may include opening of the eyes as the allegedly dead person attempts to sit up. To the rigorously scientific mind those observations should suggest the possibility that the tests used to diagnose brain death lack the power to exclude the ability to respond to ultimate stress stimuli of the intracerebral pathways involved." Name and Home Address Supplied "Brain Death by Eelco F.M. Wijdicks. Lippincott Williams & Wilkins Publishers; ISBN: 0781730201; (April 15, 2001) For the week starting 10 December 2002 "Dr. Michael Friedlander, chief nephrologist at Hadassah Hospital in Jerusalem, tired of reports about commercialization of kidneys in Israel, decided, like Dr. Diflo, to speak out, and he says that among his recovering international transplant patients are several Israelis who have recently returned this year and last from the United States with kidneys purchased here from living donors." "In March of 2001, I interviewed in Israel two men, one a young student and the other a retired civil servant, who had both returned to Jerusalem from transplant units in Baltimore and NewYork City, each with a brand new purchased kidney." STATEMENT OF Professor NANCY SCHEPER-HUGHES, PROJECT DIRECTOR, ORGANS WATCH from THE COMMITTEE ON INTERNATIONAL RELATIONS,HOUSE OF REPRESENTATIVES, United States Congress U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 73452PS2001 ORGANS FOR SALE: CHINA'S GROWING TRADE AND ULTIMATE VIOLATION OF PRISONERS' RIGHTS HEARING BEFORE THE SUBCOMMITTEE ON INTERNATIONAL OPERATIONS AND HUMAN RIGHTS OF THE COMMITTEE ON INTERNATIONAL RELATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED SEVENTH CONGRESS FIRST SESSION JUNE 27, 2001 Serial No. 10729 For the week starting 3 December 2002 The Nature of Transplant Medicine - Will the worldly rich and powerful always do this to the other humans? "... in the late 1990s, Shapira [Dr Zaki Shapira of Israel] simply moved his illicit practice overseas toTurkey and to countries in Eastern Europe where the considerable economic chaos of the past decade has created parallel markets in bodies for sex and bodies for kidneys." STATEMENT OF Professor NANCY SCHEPER-HUGHES, PROJECT DIRECTOR, ORGANS WATCH from THE COMMITTEE ON INTERNATIONAL RELATIONS,HOUSE OF REPRESENTATIVES, United States Congress U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 73452PS2001 ORGANS FOR SALE: CHINA'S GROWING TRADE AND ULTIMATE VIOLATION OF PRISONERS' RIGHTS HEARING BEFORE THE SUBCOMMITTEE ON INTERNATIONAL OPERATIONS AND HUMAN RIGHTS OF THE COMMITTEE ON INTERNATIONAL RELATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED SEVENTH CONGRESS FIRST SESSION JUNE 27, 2001 Serial No. 10729 For the week starting 26 November 2002 "Advantage is taken of exemplary people who are asked to perform acts of mercy and altruism at a time of profound grief, like Linda Johnson-Schuringa, from Orange, California who put her late husband's body into the care of the Orange County Eye and Tissue Bank, believing that his tissues and bone would alleviate the suffering of another person, only to discover later that the gift of her husband's bones had been shipped to Germany and ``processed'' into a dental product and sold internationally." STATEMENT OF Professor NANCY SCHEPER-HUGHES, PROJECT DIRECTOR, ORGANS WATCH from THE COMMITTEE ON INTERNATIONAL RELATIONS,HOUSE OF REPRESENTATIVES, United States Congress U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 73452PS2001 ORGANS FOR SALE: CHINA'S GROWING TRADE AND ULTIMATE VIOLATION OF PRISONERS' RIGHTS HEARING BEFORE THE SUBCOMMITTEE ON INTERNATIONAL OPERATIONS AND HUMAN RIGHTS OF THE COMMITTEE ON INTERNATIONAL RELATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED SEVENTH CONGRESS FIRST SESSION JUNE 27, 2001 Serial No. 10729 For the week starting 19 November 2002 "Dr. Zaki Shapira, head of transplant services at Bellinson Medical Center near Tel Aviv ... has been operating as a transplant outlaw since the early 1990s when he first used intermediaries and Arab brokers to locate kidney sellers amongst [cash]-strapped Palestinian workers in Gaza and the West Bank ... Meanwhile, human rights groups in the West Bank complained to me of tissue and organs stealing of slain Palestinains by Israeli pathologists at the national Israeli legal medical institute in Tel Aviv." STATEMENT OF Professor NANCY SCHEPER-HUGHES, PROJECT DIRECTOR, ORGANS WATCH THE COMMITTEE ON INTERNATIONAL RELATIONS, HOUSE OF REPRESENTATIVES, United States Congress U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 73452PS2001 ORGANS FOR SALE: CHINA'S GROWING TRADE AND ULTIMATE VIOLATION OF PRISONERS' RIGHTS HEARING BEFORE THE SUBCOMMITTEE ON INTERNATIONAL OPERATIONS AND HUMAN RIGHTS OF THE COMMITTEE ON INTERNATIONAL RELATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED SEVENTH CONGRESS FIRST SESSION JUNE 27, 2001 Serial No. 10729 For the week starting 12 November 2002 Beware of Hospital Staff Claiming the Patient is Finished "A doctor who recovered from a coma after a car crash is suing a hospital trust for £100,000 for allegedly advising her family to consider switching off her life support machine. Relatives of Fiona Smith say a consultant told them she was in a persistent vegetative state - although she appeared to respond to sound on several occasions - and that they should prepare themselves for a "difficult decision". When her family ignored the advice and moved her to another hospital, her condition improved. She woke from the coma after three weeks and finally made a full recovery from the accident,..." Go To Full Story In The Daily Telepgraph Thanks to Stella Masters of "The Lantern" www.housewives.freeuk.com For the week starting 5 November 2002 What A Senior Medical Expert Thinks "I have just received, with my Electoral Registration form, a letter from our Mayor asking me to register as an organ donor by signing the standard NHS Organ Donor Register form enclosed. That form has gone straight into the waste bin, ... But I am concerned that the wording on the Donor Register form - “I request that after my death any part of my body (or as specified) may be used for the treatment of others” - may mislead some generous-minded citizens without specialised knowledge into thinking that they will be really dead before their organs are removed. ... It might, indeed, be argued that the wording on the form constitutes active deception." Dr David W Evans, Cardiologist and Fellow Commoner, Queens College, Cambridge, United Kingdom From the Organ Transplants article in the October 2002 issue of "The Lantern", 17 Osborne Road, Palmers Green, London N13 5PT, UK www.housewives.freeuk.com Read the Whole Article For the week starting 29 October 2002 Why Organ Donors with Beating Hearts Are Not Given Anaesthetic "…There is, of course, a very sound POLITICAL argument against anaesthetising organ donors. By giving an anaesthetic, we are conceding the point that the patient may be – in some sense – still alive. We are therefore withholding anaesthetics from organ donors to make a political point. Our point; their lives”. From 'Today's Anaesthetist', Vol 16, No. 1, Spring 2001, pp.13 - 16. Published by www.mediapublishingcompany.com Media Publishing Company Media House 41 Crayford Way Crayford Kent, DA1 4JY Reprinted in The Lantern. www.housewives.freeuk.com Thanks to Stella Masters For The Week Starting 22 October 2002 MostTransplanted Hearts Go Into People Who Won't Live Longer Than If They Missed Out "Patients with a predicted low or medium risk have no reduction in mortality risk associated with transplantation; they should be managed with organ saving approaches rather than transplantation." Dr Mario Deng, Columbia University, New York http://bmj.com/cgi/content/full/321/7260/540 For the week starting 15 October 2002 Transplant Hearts Put Into The Wrong People "More than 80% of hearts in Germany are not allocated to those who can be expected to have a survival benefit from cardiac transplantation." Dr Mario Deng, Columbia University, New York http://news.bbc.co.uk/1/hi/health/904627.stm For the week starting 8 October 2002 Are SA Transplant/Harvest Co'ordinators Overstepping Their Legislation? Next of kin in South Australia can legally stop harvesting of dying relatives by simply saying one word, "no". But harvest co'ordinators don't respect this legal requirement and may force relatives to cry or shout. “If the family was adamant and extremely stressed by this we would respect that...” Karen Herbertt, Manager of the South Australian Organ Donation Agency from Messenger Press, 18 September, 2002, Journalist Chris Pippos "If a family says no, we need to know why. In the past we haven’t pursued that avenue. We’ve said that’s their right and leave it at that. What we’re doing now is still respecting that decision, but wanting to know why." Professor Geoffrey Dahlenburg of the South Australian Organ Donation Agency quoted in an article in The Weekend Australian newspaper of 9 August, 1997, where he said transplant coordinators would no longer be accepting a "soft no" from relatives who would not agree to harvesting of their dying relative. For the week starting 1 October 2002 Two new letters is the British Medical Journal "Brain Death" is a recent invention says the Editor of the British Medical Journal Dr David Evans adds that the "brain death" test has no therapeutic value and may even damage or kill the patient yet it is still used in the United Kingdom and other countries to determine if a patient is "brain dead". Fear has basis in Reason Michael Potts, Head of the Philosophy and Religion Department at Methodist College, Fayetteville, NC, USA says a deep seated fear of being declared dead while still alive and then being harvested is a fear with a basis in reason. Go To Both Letters in the British Medical Journal in One Click For the week starting 17 September 2002 The pressure to prematurely declare patients brain dead isn’t limited to United States and Australia. Dr Yoshio Watanabe, a cardiologist at the Chiba Tokushu-kai Hospital in Funabashi, Japan reports that, "…a middle-aged female with a subarachnoid (and perhaps cerebral) haemorrhage. When she was brought to Kochi Red Cross Hospital, the physicians failed to give certain important life-saving measures, including administration of drugs to lower her extremely high blood pressure. Instead, they immediately told her family that she was in the state of ""impending brain death"" and did not explain the possibility of surgical removal of intracranial hematoma. A clinical diagnosis of brain death was made 60 hours after admission, disregarding the fact that repeated Phenobarbital administration could have made an accurate evaluation of brain function difficult. Preparations for organ transplantation were expedited…" From Beyond Brain Death or Aggressive Hospital Transplant Teams For the Week starting 10 September 2002 from the London Times 27 August Sir, The legislation that Mr Moris Vandenberg calls for (letter, August 20) to forbid organ removal except under full anaesthesia exists – but not for him. The Animals (Scientific Procedures) Act 1986, 1 (4) states that an animal shall be regarded as continuing to live until the permanent cessation of circulation or destruction of its brain and under the Protection of Animals (Anaesthetics) Act 1954, 1 (1), an operation performed on any animal without the use of an anaesthetic…shall be deemed to be performed without due care and humanity. Animals, as so often, seem to get the better deal. Yours faithfully, David Hill The Old Post House Eltisley, Huntington PE19 6TG For the Week starting 3 September 2002 From the London Times of August 20 Sir, Odd that Irwin Stelzer thinks it is from "corpses" that donor organs are extracted. ("There is a solution to the organ donor shortage." Comment, [London Times], August 16). A liver or heart taken from a dead body would of course be no use to anyone. Donor organs are cut from live bodies on life support systems, which die only when the system is switched off upon completion of surgery. When there is a law in place that forbids organ removal except under full anaesthetic, as called for by Anaesthesia, the journal of the Royal College of Anaesthetists in August, 2000, well-informed individuals like myself might conceivably permit the "harvesting" of our organs. Before that – over our dead bodies. Yours failthfully, Moritz Vandendberg PO Box 19717 Putney, SW15 6WA For the Week Beginning 27 August 2002 "With patients closer to brain death, the struggle was even more agonizing. The transplant team would be present in full panoply. The coordinator would object to my policy of two flat EEGs separated by 24 hours. I repeat his demand as I recorded it in a newspaper article: "Dr Nilges, you don’t need another electroencephalogram tomorrow. Today’s is flat. Declare death today". Of course, I did not declare death that day." Dr Richard Nilges, Emeritus Neurosurgion of Swedish Covenant Hospital, Chicago, USA from Beyond Brain Death, Potts, Michael; Byrne, Paul A. and Nilges, Richard, editors. Kluwer Academic Publications, London, United Kingdom For the Week Starting 20 August 2002 Critical Care Nurses recognise that preparing the donors’ organs may hasten death " Medical interventions before death including the use of heparin and phentolamine, that deal with preparation of the donor rather than care of the patient (the administration of certain medications could questionably hasten death." From the article Ethical Considerations in Organ Donation for Critical Care Nurses by Kathryn Schroeter and Gloria Taylor that appeared in April, 1999 issue of Critical Care Nurse magazine. Vol. 19, No 2 Thanks to the person who posted this in the quest book For the Week Starting 13 August 2002 Aggressive Transplant Teams “…the transplant team was called to our community hospital without my knowledge and before I was ready to declare brain death on an unconscious patient who had a severe head injury in a motorbike accident. He had reflex extension of his arms and legs on painful stimulation. He was, therefore, not unresponsive even though his movements were no longer under the control of his will. His pupils reacted sluggishly to light. He had none of the criteria of brain death (except unresponsiveness). I rather too abruptly dismissed the transplant coordinator and his "team". I continued to treat this young man’s brain swelling. He walked out of the hospital and returned to college" Dr Richard Nilges, Emeritus Neurosurgion of Swedish Covenant Hospital, Chicago, USA from Aggressive Hospital Transplant Teams Potts, Michael; Byrne, Paul A. and Nilges, Richard, editors. Beyond Brain Death. Kluwer Academic Publications, London, United Kingdom. 2000 p 256 For the Week Starting 6 August 2002 "Actively killing the "brain dead" or anyone else by removing vital organs promotes treating living persons as means to an end, in the most extreme way, by taking their lives. It is a violation of the fundamental end of medicine to "do no harm" to the patient. It weakens the psychological barrier against viewing other, less disabled, lives as no longer being "worthy" to live. Society, and the practice of medicine itself, is held together, to a large extent, by respect for human life. Claiming that the line between life and death is only a "semantic question" or supporting killing some patients, no matter how disabled, for their organs diminishes respect for human life." Michael Potts British Medical Journal 14 May 2002 http://bmj.com/cgi/eletters/324/7345/1099#22026 For the Week Starting 30 July 2002 Even Some Doctors Think "Brain Dead" Donors are Still Alive “Most impressive, to the medical reader, are the candid views of those involved in the care of the so-called brain dead, and in the removal of their organs, which Margaret Lock obtained by personal interview. Physicians, specialists in intensive care, and surgeons admit to their difficulties in regarding these patients as dead. Some say explicitly that real death occurs when the heart stops. Hence the title of this remarkable book.” From David W. Evans ‘Lancet’ review of Margaret Lock’s new book “Rethinking Our Criteria for Death” Twice Dead: Organ Transplants and the Reinvention of Death, Berkeley: University of California Press, 2002. Pp 429. $24.95. ISBN 0 520 22814 6. Dr Evans ‘Lancet’ review is on page 179 of the 13/7/02 edition (Volume 360, Number 9327) For the Week 23 July 2002 "I grew weary of being at loggerheads with the demands of the transplanters when their demands were contrary to the interests of my patients. To preserve a suitable kidney for transplantation, transplant technicians would demand that I order what I would judge to be an intravenous fluid overload. I would refuse patiently and sometimes impatiently, explaining that too much fluid would cause more swelling of the already injured brain and might cause my patient’s brain to die sooner. My commitment was to my patient, not to a faceless "society," to the next unknown (to me) patient on a waiting list. Dr Richard Nilges, Emeritus Neurosurgion of Swedish Covenant Hospital, Chicago, USA Potts, Michael; Byrne, Paul A. and Nilges, Richard, editors. Beyond Brain Death. Kluwer Academic Publications, London, United Kingdom From aggressive hospital transplant teams For the Week 16 July 2002 The Swedish medical writer, Nora Machado, quotes one expert as saying, "…Even surgeons are sometimes heard to say that the patient "suffered brain death" one day and "died" the following day." Machado, Nora, Using The Bodies of the Dead ,Dartmouth Publishers, England, 1997. Dr Machado is quoting from Veatch:1993:18. Veatch, R. The Impending Collapse of the Whole Brain Definition of Death. Hastings Centre Report 1993a p 18-24 For the Week 9 July 2002 Kerridge, Saul, Lowe, McPhee and Williams report in their paper in the Journal of Medical Ethics 2002; 28: 89-94, a "refusal rate" (by families of potential donors) of 82% in 1999 in the Australian State of New South Wales - up from 56% in 1995. For the week starting 1 July, 2002 From the Issues Paper "Death, dying and donation : organ transplantation and the diagnosis of death" by Kerridge, Saul, Lowe, McPhee and Williams (J med Ethics 2002;28: 89-94), published by the Australian Institute of health, Law and Ethics the authors say: (1) We believe that the term "death" should be reserved for people who meet circulatory criteria (identification of irreversible cessation of circulation of blood) (2) Rather than redefining those who are "brain dead" as "dead" it may be more honest to acknowledge that such individuals are not dead and that removing their organs is in fact killing them. (3) The long term viability of transplantation programmes is likely to be better served by telling the truth than trading in fictions. For the week 25 June, 2002 "A measure of life is the continuing hypothalamic function which controls body temperature. If the patient is warm then that part of the brain is functioning." Dr David Hill, Emeritus Consultant Anaesthetist at Addenbrooke Hospital, Cambridge, United Kingdom from The Donors May Need Anaesthetic For the week 18 June, 2002 "The reason why the heart goes on beating in patients pronounced "brain dead" is, usually, that their brain stems are not really and truly dead but still providing the "sympathetic tone" necessary for the support of the blood pressure. In other words, the state of "shock" (profound hypotension) that characterises the destruction of the brain stem, has not occurred in those patients." Dr David W Evans, Emeritus Consultant Cardiologist at Papworth Hospital, UK and Fellow Commoner at Queen’s College, Cambridge, UK from The Donors May Need Anaesthetic. For the week 11 June, 2002 "…a 40-year old crime victim with a head injury was brought to the emergency room of Osaka University Hospital in August 1990, the team of physicians apparently looked at him as a potential kidney donor from the outset. Thus, as early as three days before the first diagnostic tests for brain death were made, they had started a set of new regiments (a combination of anti-diuretic hormone that reduces the urine volume, drugs that elevate blood pressure, and a drip infusion of a large amount of fluid) developed by this group, which is considered very effective in keeping transplantable organs fresh and viable. It would, however aggravate brain oedema, increase intracranial pressure, and accelerate the process of brain death. Without telling this fact to the victim’s wife and by using words of threat, they persuaded her (in a manner far from an informed consent to donate his kidneys. Dr Yoshio Watanabe, a cardiologist at the Chiba Tokushu-kai Hospital in Funabashi, Japan quoted from the book Beyond Brain Death and Aggressive Hospital Transplant Teams For the week 4 June, 2002 Give Organ Donors Anaesthetic and Don’t Bother Declaring Them Dead? Tom Woodcock’s Bombshell The only reason we need to label as dead those patients without brain stem function is to make beating-heart organ harvesting from them legal and because attempts to extend the label to patients with what we now call persistent vegetative state were not generally accepted. The main premise on which the colleges have argued the propriety of accepting brain stem death as death of the person has always been the claimed inevitability that when brain stem function ceases "the heart will stop beating shortly thereafter." There is no physiological reason why this should happen, and review of the published evidence shows that it is not true. An important danger of persisting with this false premise is that more perceptive observers and critics of medical practice have already noticed the discrepancy and have concluded (inappropriately) that misdiagnoses are being made. I suggest that it is time to revise the law, perhaps by a new Human Organ Transplant Act, to allow families to give informed consent to beating-heart organ donation under anaesthesia for patients certified to have irreversible loss of brain stem function. The unanswerable semantic question of whether the donor is dead would then disappear. Tom E Woodcock, critical care consultant. Critical Care Directorate, Southampton University Hospitals, U.K. British Medical Journal, 4 May 2002 http://bmj.com For the week starting 28 May, 2002 Immediately after the organs are removed, the various doctors whisk them away in coolers, never giving a thought to the person who just died or the grieving family. They have no idea of even the person's name. So one by one, these ghouls leave the operating room till all that is left is the body, laying WIDE open, quiet, & cold, and the nurses. from The Nurse's Tale For the week starting 21 May, 2002 Apnea (Brain-death) testing may cause rather than diagnose “brain-death” Associate Professor Cicero Galli Coimbra, Head of the Neurology and Neurosurgery Department at the Federal University of Sao Paulo, Brazil is author of the study, "Implications of ischemic penumbra for the diagnosis of brain death. Apnoea testing may induce rather than diagnose brain death". Coimbra CG (1999) Implications of ischaemic penumbra for the diagnosis of brain death. Brazilian J Med Biol Res; 32:1538-1545 www.unifesp.br/dneuro/brdeath.html#intro For the week starting 14 May, 2002 No more “Soft No” "If a family says no, we need to know why. In the past we haven’t pursued that avenue. We’ve said that’s their right and leave it at that. What we’re doing now is still respecting that decision, but wanting to know why." Professor Geoffrey Dahlenburg of the South Australian Organ Donation Agency explaining that transplant coordinators would no longer be accepting a “soft no” from families who wouldn’t agree to harvesting of their “brain dead” next of kin. The Weekend Australian newspaper. Gentle Persuader by Roy Eccleston. 9 August, 1997 For The Week starting 7 May, 2002 Reaction of "brain-dead" donors to being harvested. "Almost everyone will say they have felt uneasy about it. Nurses get really, really upset. You stick the knife in and the pulse and blood pressure shoot up. If you don't give anything at all, the patient will start moving and wriggling around and it's impossible to do the operation. The surgeon always asked us to paralyse the patient." Dr Keep adds, "I don't carry a donor card at the moment because I know what happens," Dr Phillip Keep, a consultant anaesthetist at the Norfolk and Norwich Hospital, United Kingdom Guardian Newspaper, United Kingdom. Sarah Boseley, Health Correspondent. 19 August 2000 www.guardianunlimited.co.uk/ For the Week starting April 30, 2002 "King's College Hospital in London runs Europe's largest liver transplant programme and has recently celebrated its 2000th liver transplant. The unit is pleased to announce that the heaviest liver removed weighed 10 Kg, the most blood lost during a transplant was 160 litres..." British Medical Journal (vol 324, p.926) for 13 April 2002 |
| The Older Quote of the Week Archive (April 30, 2002 to 28 April 2003) |