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132 Myth about Organ Donors Not Receiving Good Medical Care




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This article is from the Organ Transplant FAQ, by mike_holloway@hotmail.com (Michael Holloway) with numerous contributions by others.

132 Myth about Organ Donors Not Receiving Good Medical Care


People have told us that they would not carry donor cards because they
thought that, if they were in critical condition, they would not receive
the best care available. They believe that harvesting their organs might be
more important to physicians than keeping them alive.

This is another very unfortunate myth, and is one that is difficult to
convince people is false. In practice, the physician must always look out
for what is best for his or her patient and treat them accordingly. Perhaps
it will help to give a technical explanation of what goes on under these
circumstances:

The situation that produces brain death is one of too much pressure inside
the skull. The skull is hard and cannot expand. When the brain is injured
by a blow, it swells just the way an injured ankle swells. Except the skull
prevents the brain from expanding and therefore causes the pressure inside
it to rise. If the pressure gets so high that blood can no longer get into
the skull and reach the brain -- then brain death is the result. Brain
death can also happen when bleeding occurs inside the brain (a ruptured
aneurysm is a common reason) and the blood has no place to go. Again, since
the skull cannot expand, too much pressure builds up.

The care of patients under these conditions is very standardized. Sometimes
the swelling stops short of the critical point and the patient recovers.
Sometimes the swelling reaches the critical point and the patient dies.
Fortunately for transplant patients, the heart and the other organs may be
fine even though the patient "dies" when the brain is no longer being
perfused. Many times, however, the other organs are injured by attempts to
keep the swelling down in the brain. It is understood by everyone in the
transplant business that some organs may not be useful to us because they
were, in essence, sacrificed in the attempt to save the patient's life.
This is as it should be. In reality, a patient's survival chances are not
affected by their being a potentially useful organ donor. This is the issue
that the people voicing his myth do not understand.

If techniques changed from our current method of treating brain injuries,
there could potentially be a conflict of interest. This is extremely
unlikely from a scientific point of view, however, because we already know
of one possible way to prevent the swelling of the brain from resulting in
a loss of blood flow to the brain: remove the skull. This hideous sounding
treatment has been shown to make no difference at all in the long run:
people that have sustained brain injuries that are going to cause brain
death eventually go on to die, while the people that were going to survive
with conventional management survive as they would have anyway.

If anything, it is more common that heroic, extraordinary means are used to
keep the patient's heart beating, so that they can potentially donate
organs when patient's life is clearly not salvageable. Brain dead is dead.
In reality, you must be "more dead" to be brain dead than is necessary to
be declared dead. As weird as this sounds, you are officially dead when a
licensed physician declares you dead -- you are brain dead when a complex
set of conditions are satisfied that vary from state to state and from
hospital to hospital. Commonly, this involves radiological testing to
determine lack of blood flow to the brain, and clinical conditions that
include normal body temperature, normal blood pressure, lack of barbiturate
sedatives in the blood, and more. In many situations, a patient cannot meet
the criteria for brain death -- even though they are in fact dead. In these
cases, the patient is declared dead and that is it. My point is that there
are enough safeguards in the system to prevent any bias from entering into
the care of the patient before they are declared brain dead. In addition,
the teams involved with organ procurement have no role in the care of the
patient until after they are declared dead.

Unfortunately, I have still heard this myth expressed quite often. We need
to work on finding ways of easing the public's concern about the issue.

Jeff Punch
Transplantation Surgery
University of Michigan
jeff.punch@umich.edu

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