Samantha Berg

In order to get more organs, the Organ Procurement and Transplantation Network (OPTN) is CHANGING a longstanding rule that protects potential donors. Historically, there has been a strict separation between those caring for the patient’s health, and those others whose primary interest is in that patient’s organs. Doctors caring for patients have been prohibited from discussing organ donation, and people from the organ procurement system have been prohibited from approaching family until AFTER the difficult decision to withdraw support has been made. But the OPTN, which runs the nation's organ system, is relaxing that rule. Under their new guidelines, organ procurement teams will now be authorized to talk with families earlier — while they are still considering whether or not to let go. University of Rochester bioethicist Dr. Lainie Ross strongly opposes the new rule, which is set to take effect next month: “I think it's actually a really serious and really bad move. I'm horrified to think that families will feel pressured. They'll feel manipulated. They'll feel distrustful - that the docs are looking out for some person who needs an organ and not for their loved one in the bed.” Dr. Ross is correct. Now, not only will families and caregivers be pressured to discontinue care more quickly, but people will have no way of knowing whether doctors are working to protect and preserve their loved ones’ life, or if they are just trying to obtain their valuable, viable organs.

Researchers at Columbia have developed a new EEG - computer interface — revealing that about ONE THIRD of comatose patients with an acute brain injury have hidden consciousness. “…many patients with acute brain injury who appear to be in a coma actually have some level of preserved consciousness, even though they are unable to speak or move their hands or eyes to communicate.” - Jan Claassen, MD, professor of neurology at Columbia University Vagelos College of Physicians and Surgeons. Claassen’s team attached EEG wires to the heads of patients and trained the patients to control a beeping tone by using their thoughts. With EEG electrodes in place, a beeping tone was played through headphones and a recorded voice asked the patient to adjust the frequency of the beeps by trying to open and close their hands. As the patient tried to perform the task, electrical impulses from the brain were relayed to a bedside computer, which analyzed the signals in real time. The voice encouraged patients when they change the beep frequency and congratulated them when they met the target. Though these patients did not respond to commands from their physicians—to blink, make a fist, or wriggle their toes—analysis of the EEG recordings showed that the patients TRIED to comply but were unable to move their muscles. Previous studies have shown that fMRI (a functional MRI scanner) can be used to obtain answers to simple yes or no questions from unresponsive patients, but fMRI is not practical for routine use. “That's why our system is a major advancement,” Claassen says. “EEG is used in clinical practice every day in the ICU. The only sophisticated part is the computer program we wrote, which analyzes the data in real time and modulates the feedback to the patient.” This tool has tremendous potential to identify hidden consciousness in brain-injured people — leading to increased efforts to help them, instead of writing them off as hopeless and shunting them towards organ donation. Thanks to @JirasolPNW for alerting me to this research!

Do you prefer to base your end-of-life decisions on fact or fiction? The off-Broadway play “The Heart“ uses a heart-wrenching story and a pulsing score to drive people into making an emotional decision about organ donation. This is another example of the complete a LACK of informed consent given to people who are registering in good faith to become organ donors. Here are the facts about brain death, donation after circulatory death, and normothermic regional perfusion organ donation: 1.      Whereas the Uniform Determination of Death Act (UDDA) law requires that there be an irreversible cessation of ALL functions of the entire brain, including the brain stem, for a diagnosis of brain death, the American Academy of Neurology brain death guideline explicitly allows brain death to be declared in the presence of ONGOING brain function. 👉People should be made aware that the way doctors diagnose brain death does not comply with the law under the UDDA. 2.      Donation after Circulatory Death (DCD) organ procurement begins after just 2-5 minutes of pulselessness. But everybody knows that people are routinely resuscitated within this short timeframe. Dr. Ari Joffe published a list of patients who auto-resuscitated up to 10 minutes after cardiac arrest, with some making a full recovery. A case report from Illinois of a young DCD donor whose heart began beating again and who began gasping for breath DURING the removal of her kidneys also shows that people cannot be known to be dead within this short timeframe. (The county coroner determined her death to be a HOMICIDE.) 👉DCD donors are not known to be dead at the time that their organs are removed, and the public deserves to be informed of this. 3.      Normothermic Regional Perfusion (NRP) organ retrieval begins by declaring death according to the UDDA’s circulatory-respiratory standard: the irreversible cessation of circulatory and respiratory functions. But then surgery begins with CLAMPING OFF the circulation to the brain, following which a full resuscitation of the remaining organs takes place, such that the heart starts beating again in the patient’s own chest. Of course, this shows that the UDDA’s legal definition of death under the circulatory-respiratory standard WAS NEVER MET because the patient’s circulatory-respiratory function had obviously not irreversibly ceased. But, because doctors are planning to restart the patient’s heart, they take steps to make the patient BRAIN DEAD ON PURPOSE so that now the patient’s death becomes defined by the UDDA’s brain death clause. This technique plays fast and loose with the legal definitions of death under the UDDA as well as with the dead donor rule. The American College of Physicians (ACP) called for a pause in the practice of NRP in 2021, as "the burden of proof regarding the ethical and legal propriety of this practice has not been met," but this concern has been ignored. 👉People should be informed about the particulars of the NRP donation process, and that the largest medical specialty organization in the world (ACP) has called for a pause in NRP because of concerns regarding its ethical and legal propriety. In Summary Each of these points listed above is of sufficient magnitude to deserve immediate remedial action, and in aggregate constitute a severe breach of public trust by the current organ transplantation system. The public has a right to know in what ways their deaths are being determined prior to registering as an organ donor.