When are we dead?

[VentMedic]

Here's a deep subject for some of you to think about.

http://www.washingtonpost.com/wp-dyn/content/article/2008/10/03/AR2008100301974.html

The Doctors Who Are Redefining Life and Death

By William Saletan
Sunday, October 5, 2008; Page B02

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.

http://www.washingtonpost.com/wp-dyn/content/article/2008/10/03/AR2008100301974.html

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.

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Here's another article that can be related to the above but not necessarily her situation for organ donation:

http://www.cbs8.com/story.php?id=138964

Triathlete Dies After Bike Crash In Santa Barbara
Last Updated:
08-29-08 at 6:29AM

Warren crashed her bike on a downhill road about halfway through the 34-mile cycling section of the race on Saturday, race director Joe Coito said.

Warren was paralyzed from the neck down and was breathing with the aid of the ventilator. Drake said her sister told the family by blinking and nodding that she wanted to die.

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This next article may not apply to the woman in the above article but could have been possible.

The Definition of Death and the Ethics of Organ Procurement from the Deceased
http://www.bioethics.gov/background/rubenstein.html

Along similar lines, the 1999 IOM report specifies that "in most cases, the patient who becomes a non-heart-beating donor has suffered devastating neurological damage, most often from trauma or stroke. In rare cases, a conscious, paralyzed, ventilator-dependent person has requested non-heart-beating donation." (IOM 2000, p. 42)

Organ Donation after Cardiac Death

http://content.nejm.org/cgi/content/full/357/3/209

Volume 357:209-213 July 19, 2007 Number 3

Since 1968, when an ad hoc committee at Harvard Medical School proposed a brain-based definition of death that became widely accepted, organs for transplantation have been removed primarily from hospitalized patients who have been pronounced dead on the basis of neurologic criteria, when they are on ventilators and their hearts continue to function. The continued circulation of blood helps to prevent the organs from deteriorating.

Obtaining organs from donors after cardiac death — when the heart is no longer beating — is the approach that was generally followed in the 1960s and earlier. Today, such donations typically involve patients who are on a ventilator as the result of devastating and irreversible brain injuries, such as those caused by trauma or intracranial bleeding. Potential donors might also have high spinal cord injuries or end-stage musculoskeletal disease. Although such patients may be so near death that further treatment is futile, they are not dead.

The United Network for Organ Sharing, a private nonprofit group based in Richmond, Virginia, operates the Organ Procurement and Transplantation Network under contract with the federal government and is committed to increasing the number of donors. OPTN/UNOS, as the networks are collectively known, has developed rules for donation after cardiac death. According to these rules, finalized in March 2007, the process begins with the selection of a suitable candidate and the consent of the legal next of kin to the withdrawal of care and retrieval of organs. Subsequently, life-sustaining measures are withdrawn under controlled circumstances in the intensive care unit (ICU) or the operating room; donation after an unexpected fatal cardiac arrest is rare.

 

[Meursault]

I'll get back to you when my Biomedical Ethics course gets around it it. For now, I'm a fan of death at apparently irreversible loss of all brain function, although I'm also somewhat interested in the concept of death at loss of all "higher" brain function. My like for the second probably comes more from emotion than reason, though.

 

[Sasha]

I dont know, ask some of the doctors over on the SIDS thread!

 

[VentMedic]

I dont know, ask some of the doctors over on the SIDS thread!

It was actually babies and children that initiated some of the legislation for the new rulings that pertain to organ procurement.

http://content.nejm.org/cgi/content/full/359/7/749

[FONT=Arial, Helvetica, sans-serif]Cardiac Transplantation in Infants[/FONT]
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Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D. Volume 359:749-750

August 14, 2008

Number 7

 

[BossyCow]

We can't agree on when life begins so how can we know when its over? I think this definition is a very personal one, made based on your own beliefs. Not sure I want a scientific definition or court ruling making that for me. But then I've had an advance directive since I was in my 40's.