It "meet[s] the legal definition of death because there is no intention of reviving them"

March 17, 2007 9:18 PM

"The person is not dead yet," said Jerry A. Menikoff, an associate professor of law, ethics and medicine at the University of Kansas. "They are going to be dead, but we should be honest and say that we're starting to remove the organs a few minutes before they meet the legal definition of death."
. . . .
In addition to giving DCD donors morphine, valium and other drugs to make sure they do not suffer as life support is withdrawn, doctors often insert a large tube into an artery and inject drugs such as the blood thinner heparin to help preserve the organs. Some say those measures may hasten death.

posted by orthogonality (90 comments total)

Talk about a slippery slope. In no time, they'll be at your doorstep looking for your liver while you're still using it.
posted by davelog at 9:29 PM on March 17, 2007 [4 favorites has favorites]

... Supporters, however, argue that hospitals have stringent safeguards are in place. Each case is reviewed by an independent panel, and the decision to withdraw care is separated from the decision to become a donor. ...

I'm ok with this, as long as the doctors and hospitals are being scrupulous. I think ethics committees need to be beefed up and given real power to intervene if needed--or to have court orders issued immediately to stop abuse. As the boomers age, this will grow as a problem, i'm sure.

Isn't there some state now where they're reducing prisoner's sentences if they donate an organ? That's much worse, and totally reduces --and commoditizes --people into pure organ banks.
posted by amberglow at 9:31 PM on March 17, 2007

And there has to be clear, unequivocal proof that the person really is a donor, or wanted to be.
posted by amberglow at 9:34 PM on March 17, 2007

here it is:
S.C. may cut jail time for organ donors
posted by amberglow at 9:35 PM on March 17, 2007

The prisoner sentence story is a damned Brazil nightmare. FFS, there isn't a week that goes by that I'm not simply stunned by the things that go on in the USA.

I've been in IU with IV drip (skull fracture). The cold ice drip of foreign fluids into my blood vessels was the single horrifying as hell component of the entire experience. All aspects of the experience were awful, but the burning ice in my veins is the only thing that really stands out for me now.

So me, I think it'd be better to wait until the person is quite dead. I know it's going to suck for a bunch of other people, but there's something a little sick about giving a person a hell experience as they're heading to oblivion. It is an unfair sacrifice.
posted by five fresh fish at 9:39 PM on March 17, 2007 [1 favorite has favorites]

I think that's a pot-stirring article. Single line quotes from concerned professionals lack proper context. I would be happy to see this as part of tv documentary so that we have the question and the whole answers. But I think it's a bit of a stretch to think that a whole raft of professional people conspiratorially engage in unethical behaviour to harvest more organs. They're just more efficient at it.
posted by peacay at 9:48 PM on March 17, 2007

In no time, they'll be at your doorstep looking for your liver while you're still using it.

I'm using my liver right now...
posted by TheOnlyCoolTim at 9:54 PM on March 17, 2007

I don't see a problem with this. No one is placing any of these incidents into a larger context - clearly, if the hospital teams are ready to harvest organs, this person is not going to be waking up any time soon. Yes, it would be ethically rosier to wait for them to die on their own (especially so the families involved don't have second thoughts), but the fact of the matter is, no matter what activity is happening on any monitors, they're not going to recover.

It should be up to the family to continue with a DCD, as per the donor's wishes, or to wait for brain death. If the family understands the donor's wishes and is fine with that, then I don't see where the problem lies.

(Other than the problem with making blanket statements about end of life care and organ donation procedure, when these things would all be better handled on a case by case basis, as so many episodes of E.R. and even Law & Order have taught us.)
posted by grapefruitmoon at 9:56 PM on March 17, 2007

life imitates "art"
posted by Kwantsar at 9:56 PM on March 17, 2007

davelog: They already can use your liver while you're still alive.

Watch out! Don't trust anyone with a scalpel!
posted by grapefruitmoon at 9:57 PM on March 17, 2007

S.C. may cut jail time for organ donors

Does anyone feel like we're in an episode of Max Headroom?
posted by Blazecock Pileon at 10:02 PM on March 17, 2007 [1 favorite has favorites]

I think that's a pot-stirring article.

Agreed. Seems that the relevant parties are aware of the issues surrounding the matter, and are currently in that transition period where the finer points regarding ethics and legalities are still being worked out.
I am confident that the right people are working on it, and everything will be all right in the end.
posted by kisch mokusch at 10:07 PM on March 17, 2007

They say hasten death like its a bad thing in these cases. Yes, it could be abused but if someone's terminal and they want to help as many people with their organs as they can then I'm not so sure I see a big problem with this.

Of course, if doctors are withholding treatment because the patient is poor and has a really nice cloaca he's promised to the rich guy who just "donated" a new wing to the hospital then that's a problem.

But its not like there aren't totally unethical doctors practicing today already. There are (or should be) systems to keep them in check or to punish them when they misbehave.
posted by fenriq at 10:22 PM on March 17, 2007

If I'm terminally ill and/or damaged and on my way out I'd prefer they hastened my death even if nobody but me benefitted by it.
posted by davy at 10:27 PM on March 17, 2007

So what rich Mefite wants dibs on my cloaca?
posted by davy at 10:28 PM on March 17, 2007

davy, good point. I'd want to be hastened if each minute I was being kept alive (assuming there was zero chance of recovery, of course) was costing my family thousands of dollars.

Woops, its only certain congenital disorders that make people be born with a cloaca. Maybe I meant coccyx?
posted by fenriq at 10:34 PM on March 17, 2007

kisch mokusch writes "I am confident that the right people are working on it, and everything will be all right in the end."

Mr. President?? Mr. President, you said that about Plamegate and Katrina too. Shouldn't you be working fixing Walter Reed and the US Attorney firing scandal and the Iraq quagmire, instead of posting on MetaFilter?
posted by orthogonality at 10:39 PM on March 17, 2007 [4 favorites has favorites]

(I'm not admitting I wasn't born with a cloaca either.)
posted by davy at 10:44 PM on March 17, 2007

In no time, they'll be at your doorstep looking for your liver while you're still using it.

This concept makes me want to use my liver even more.

there isn't a week that goes by that I'm not simply stunned by the things that go on in the USA.

Well, enjoy your confirmation bias.
posted by oaf at 11:09 PM on March 17, 2007

Wasn't there a Monty Python skit in The Meaning of Life very much to this effect but funnier?

Orthogonality and lazaruslong, yeah, I can see how it might be liberating to know. Maybe it wouldn't be so liberating without the inevitable tag? I.e. you can still die by stupidity, suicide or stunt-gone-wrong (Hey Earl, watch this!). But I guess that sort of defeats the purpose. Hmmm.
posted by fenriq at 11:25 PM on March 17, 2007

five fresh fish, what are you talking about? That must be some strange drip. Burning ice? I think the point with most drips is that you're not supposed to feel it after the needle prick.
posted by Firas at 12:11 AM on March 18, 2007

Wait. If they can organ harvest before death, why can't I have myself cryogenicly (bullshit, I admit) preserved before death?
posted by sourwookie at 12:31 AM on March 18, 2007

Little known True Fact:

I use your liver all the time while you're sleeping. I just sneak in, borrow it for a lot of a bit of drinking, a little Tylenol abuse, some research chemicals, a bit of needle-sharing with ex-convicts and such, and then I sneak back before you wake and then just sew it right back in, nearly good as new!

Why are you acting all surprised about it? It's not like you're actually using it much. I'd use mine but I'm saving it for later so I can get on with some serious drinking.

fenriq, by the way, you should probably go to a doctor. Last time round your place I left a wee bit sponge under your spleen - just a tidbit, really, a mere squee hair larger than a breadfruit, or perhaps a football - and that cirrhosis is getting a bit out of control. Look, if God didn't want me to drink turpentine he shouldn't have made it taste so damn good.
posted by loquacious at 3:09 AM on March 18, 2007 [3 favorites has favorites]

Mr. President?? Mr. President, you said that about Plamegate and Katrina too. Shouldn't you be working fixing Walter Reed and the US Attorney firing scandal and the Iraq quagmire, instead of posting on MetaFilter?

Heh. Just re-read my post, and it does come across as your typical dumbass, generalised, political-style comment. But we can't get over-excited by everything. This isn't a catastophe here, nor is it even really a political issue. The medical profession is always re-assessing it's policies, both from medical and ethical standpoints. Concern is raised over a given treatment, either from within or without the medical community, and that treatment is re-examined. None of this is unusual.

Now, the news article that amberglow linked to on the other hand, is extremely political, and far more disturbing. Actually, disgusting would be a more appropriate term.
posted by kisch mokusch at 3:20 AM on March 18, 2007

SOME SAY
posted by quonsar at 6:07 AM on March 18, 2007

Hello. Can we 'ave your liver?
posted by Drexen at 6:23 AM on March 18, 2007

I don't see a problem with this. No one is placing any of these incidents into a larger context - clearly, if the hospital teams are ready to harvest organs, this person is not going to be waking up any time soon.

Clearly, if they harvest the organs, this person is not going to be waking up any time soon. And equally clearly, the pressing need for organs provides a motive to declare people goners more readily than might otherwise be the case. I appreciate the need to help people who need organs, but I'm not sure some of you appreciate the ease with which boundaries get pushed once there is a motive to do so.

The Dead Body That Claims It Isn't: I'm not dead.
The Dead Collector: What?
Large Man with Dead Body: Nothing. There's your ninepence.
The Dead Body That Claims It Isn't: I'm not dead.
The Dead Collector: 'Ere, he says he's not dead.
Large Man with Dead Body: Yes he is.
The Dead Body That Claims It Isn't: I'm not.
The Dead Collector: He isn't.
Large Man with Dead Body: Well, he will be soon, he's very ill.
The Dead Body That Claims It Isn't: I'm getting better.
Large Man with Dead Body: No you're not, you'll be stone dead in a moment.
The Dead Collector: Well, I can't take him like that. It's against regulations.
The Dead Body That Claims It Isn't: I don't want to go on the cart.
Large Man with Dead Body: Oh, don't be such a baby.
The Dead Collector: I can't take him.
The Dead Body That Claims It Isn't: I feel fine.
Large Man with Dead Body: Oh, do me a favor.
The Dead Collector: I can't.
Large Man with Dead Body: Well, can you hang around for a couple of minutes? He won't be long.
The Dead Collector: I promised I'd be at the Robinsons'. They've lost nine today.
Large Man with Dead Body: Well, when's your next round?
The Dead Collector: Thursday.
The Dead Body That Claims It Isn't: I think I'll go for a walk.
Large Man with Dead Body: You're not fooling anyone, you know. Isn't there anything you could do?
The Dead Body That Claims It Isn't: I feel happy. I feel happy.
[the Dead Collector glances up and down the street furtively, then silences the Body with his a whack of his club]
Large Man with Dead Body: Ah, thank you very much.
The Dead Collector: Not at all. See you on Thursday.
posted by languagehat at 6:26 AM on March 18, 2007 [1 favorite has favorites]

Paging Mr. Niven, Mr. Niven, White Courtesy Phone.
posted by eriko at 6:27 AM on March 18, 2007 [1 favorite has favorites]

I'd want to be hastened if each minute I was being kept alive (assuming there was zero chance of recovery, of course) was costing my family thousands of dollars.

Now that's some curious kind of generosity , a kind that some of my phd in biz admin colleagues would "appreciate", these psycopatic assholes.....because if you off yourself to save your family money, somebody will call the casket guys and tell them they can ask an extra thousand . The insurance guys will be dancing on your grave, maybe will offer your family a discount on the car insurace , the doctors will have more time to golf , the organ harvesters will have more meat for their business, the only one honestly thanking you will be the receiver.

Who will die someday anyway, it's not like you saved the world or something.

So thank you fenriq, we all hope you drop dead soon :D !

---

As for the ethical commette, the scientific paralegal supernatural superconducting evaluation teams...let' say I know somebody in the direction of the hospital biz.

I place a lil call or two..mention a business cycle or two..name names...my friend SO MUCH needs a new liver..you know, drinking....yes yes I know he's a lil dirty rascal isn't he ehehehehe..yeeeaahhh don't worry about the next batch of douchebags, It's like you have it a 50% discount. AHAHAH what Frontapage with tits ? that's nice !

Now listen..mmhhh...see my friend needs a liver..I know there's a patient down there..poor thing..yeah he's 99,9% dead...would you keep an eye on him ? No really poor pal, there is no hope..my friend on the contrary has an half assed chance.
posted by elpapacito at 6:43 AM on March 18, 2007

Firas writes "That must be some strange drip. Burning ice? I think the point with most drips is that you're not supposed to feel it after the needle prick."

Not all drips deliver numbing painkillers, even those that do are often delivered with a saline drip that is started prior to the drug being injected.
posted by Mitheral at 8:11 AM on March 18, 2007

I'm not dead yet... I'm getting better
posted by mike3k at 8:52 AM on March 18, 2007 [2 favorites has favorites]

This is why we really need to get on that whole growing-organs-in-the-lab thing, people! Organ donation, even when administered as well as possible, is a clusterfuck; it freaks out potential donors who feel transformed into saleable organs (and that possibility is always there), many of the potential beneficiaries die waiting anyway, except for many wealthy/famous ones who mysteriously always seem to get their kidneys/whatever, and every advance in medicine cuts down on the available supply.

I mean, how fucked up is it to be waiting for an organ and hoping that someone's 21 year old honor student who never took drugs/drank will die in a horrible accident so you will get a really good one?
posted by emjaybee at 8:56 AM on March 18, 2007

The medical profession is always re-assessing it's policies, both from medical and ethical standpoints. Concern is raised over a given treatment, either from within or without the medical community, and that treatment is re-examined. None of this is unusual.
I was given to understand, however, that these kinds of policy decisions are generally made by managers rather than doctors. Which I find a little bit scary.
posted by nowonmai at 9:13 AM on March 18, 2007

Well, enjoy your confirmation bias.

You keep telling yourself that. Meanwhile, I'm sure it's going to be a shitload of fun to be in lockup in Ohio.
posted by five fresh fish at 10:13 AM on March 18, 2007

elpapacito, actually, I won't be dropping dead, I'll be floating dead because I'm headed straight to heaven. And no, you cannot have my eyes or my glorious sphincter with its superclenching capabilities. Haha!

My point is that intensive care in hospitals is ridiculously expensive, if that burden is going to be passed on to my family and I have no chance of recovery then why prolong the inevitable and the consequent massive debt burden on my family?

And there's also the aspect of taking back some measure of control in the final decision of one's life.

But yeah, the whole thing is one big, stinking racket.
posted by fenriq at 10:15 AM on March 18, 2007

I place a lil call or two..mention a business cycle or two..name names...my friend SO MUCH needs a new liver..you know, drinking....yes yes I know he's a lil dirty rascal isn't he ehehehehe..yeeeaahhh don't worry about the next batch of douchebags, It's like you have it a 50% discount. AHAHAH what Frontapage with tits ? that's nice !

Now listen..mmhhh...see my friend needs a liver..I know there's a patient down there..poor thing..yeah he's 99,9% dead...would you keep an eye on him ? No really poor pal, there is no hope..my friend on the contrary has an half assed chance.

Hopefully that's just Frist's hospitals, and not all.

nowonmai--that's a good point--are insurance companies/HMOs vinvolved at all in organ donation at death? or is it purely costs paid for by the donation orgs/lists?
posted by amberglow at 10:16 AM on March 18, 2007

In Singapore, all patients are presumed to be donors unless they have specifically opted out. In a recent case, the hospital apparently decided to remove life support before the family was ready to see that happen, because the organs would be in better condition.
posted by dilettante at 10:30 AM on March 18, 2007

Oaf, as your country slouches toward wholesale surveillance of citizens, a one-in-fifteen jail rate, use of prisoners for slave labour and organ harvesting, and so on and so forth...

...well, have fun with your rose-coloured tint of confirmation bias.
posted by five fresh fish at 10:35 AM on March 18, 2007 [2 favorites has favorites]

The "slippery slope" has been so abused as an excuse for keeping non-issues alive that I've actually become prejudiced against those who use it. It's great as an attention-getting technique, but if it's the strongest argument you've got, you have no argument.

In other words, what languagehat said...
posted by Mr. Gunn at 10:56 AM on March 18, 2007

Er, the only thing languagehat said were lines from a Monty Python movie.

If you choose to be prejudiced against the facts I have stated, that's your perogative.

It certainly won't be of any help to your country should you make that choice.
posted by five fresh fish at 11:13 AM on March 18, 2007

Hopefully that's just Frist's hospitals, and not all.

Hell I hope that too, but you know..being from Italy I know a thing or two about how pervasive and invisible corruption can be and how lethal the combination of short sightedness, greed and "market invisible fist" can be.

Not saying that we are in a nightmare and there is no hope and all is lost, that'd just be useless depression ; in fenriq's words

But yeah, the whole thing is one big, stinking racket.

suggesting that we shouldn't underestimate the less visible profit factors as component of a phenomenon.

Let's not focus on the "scoundrel psycopath manager with some power" boogeyman , but let's focus on the fact people may start accepting behavior as a given, ordinary event , that they will start justifying with razionalization such as "well he didn't need the organ anyway" or "he's 99.0 death let's ...ehmmm..help him suffer less" ...the push will be immense, either for silly things such a new LCD tv or from a mortgage that needs to be paid asap.
posted by elpapacito at 11:17 AM on March 18, 2007

I wonder what the implications are for these folks.
posted by owhydididoit at 11:41 AM on March 18, 2007

elpapa, that's why many of us (and more each time a medical story like this comes out) have living wills and healthcare proxies now. We're aware of the profit thing (especially those 50 million of us without healthcare at all) and how it hurts us.

Here's NY State's healthcare proxy forms--i think all states have them online now to download.

I know at least that public hospital systems and religious ones won't be the first to do this sort of thing, i don't think. That's something, at least.
posted by amberglow at 11:47 AM on March 18, 2007

1. If this is happening, it is against the Hippocratic Oath, which doesn't say "Do no harm unless another patient can be saved." But then, idealistic codes like that never work when put up against the real world's hyper-commercial nature. (Note: Prior sentence was 10058;SARCASM10058;.)
2. If donating organs lessens the cost of a hospital stay, remember that the people who would be giving the discount are also the ones charging the exorbitant hospital fees to begin with, and the discount is likely to be less for reasons of appreciation than that they'll make that profit back on the organ.
3. Ultimately, what this will do is severely lessen the number of people willing to check that little organ donor box on the driver's license. I myself only checked it because I figured it wouldn't result in, like, greater pain at the end of my life.
posted by JHarris at 12:28 PM on March 18, 2007

Gah, unicode works in the preview box but not in the message.
posted by JHarris at 12:29 PM on March 18, 2007

Mitheral, yeah, saline drips is what I was thinking about. Maybe I have a bad memory but (usually) you're not really supposed to feel it coursing through your veins?
posted by Firas at 12:32 PM on March 18, 2007

Regardless, it felt like about ten inches of ice running up the vein.

I guess if I was going to kick the bucket during that misadventure, it wasn't likely have been any one of the moments I was conscious/self-aware enough to really notice how horrible the IV felt. In fact, feeling it was probably a sign I wasn't going to die.

Still, it really is overly morbid to have a flock of people actively desiring your hastened death because you're more valuable to them dead than alive. Very unhealthy for society, in fact: it removes respect for the individual.
posted by five fresh fish at 1:17 PM on March 18, 2007

we can't get over-excited by everything

THE HELL WE CAN'T!!!

*Hits Post, instantly forgets what I was worked up over, clicks over to the next tab: "'Facing Life With a Lethal Gene'?!? GRAHHHH!!!"*
posted by Alvy Ampersand at 2:49 PM on March 18, 2007 [1 favorite has favorites]

Saline doesn't hurt. An IV can hurt post-insertion, but that just means that the flow rate is too high, and a nurse can usually adjust that without compromising the dosage.

This is why patients should mention when it hurts - they can't manage your pain if they don't know it's there.
posted by spaceman_spiff at 3:02 PM on March 18, 2007

The article is rather misleading, particularly in the implication that brain dead patients are "more dead" than cardiac patients in some kind of practical or moral way simply because they are legally dead. In the case of brain death, the patient's body dies on the operating table during the organ removal procedure. There is no doubt that the person's body would have died soon anyway, but the person's body is kept alive until the surgery in order to give the organs the best chance for successful transplantation. The heart stops as a result of the organ removal process.

The article seems to imply that brain death surgeries (which happen after legal death but before a complete physical death) are significantly different from cardiac surgeries, and that cardiac surgeries are "worse" because the decision to donate organs is made before the person is declared dead. However, the pre-declaration-of-death-decision is also common in brain death; when a patient is almost certainly brain dead but not officially so, organ procurement specialists begin talking to the family about donation. It's hard to imagine any other way of procuring organs, since they begin to deteriorate as soon as the heart stops.

There have been some studies on organ donation, how it works, how it affects families and recipients, and the ethical and legal questions it raises. While organ donation is something I find deeply problematic, personally, I think articles like the one linked don't provide very useful information for understanding the medical, social, ethical, legal, or practical quandaries that organ donation raises.

Lesley Sharp talks a lot about how the people associated with organ donation (doctors, family member, organ procurement organization workers) deal with the "double" death of organ donors (basically brain death and body death) in Strange Harvest, which is a very interesting and sensitive account of the givers and receivers of organs in America.

Margaret Lock explores the legal/medical history of the classification of "brain death" in Twice Dead.
posted by carmen at 3:11 PM on March 18, 2007

...well, have fun with your rose-coloured tint of confirmation bias.

When I demonstrate through my comments that I have such, then feel free to accuse me of it.

This isn't as bad as not being able to sue people who testify falsely against you and wrongly get you incarcerated and your child taken away from you.
posted by oaf at 3:55 PM on March 18, 2007

This is why patients should mention when it hurts - they can't manage your pain if they don't know it's there.

It wasn't pain. It was ice-cold this-ain't-right. Very wrong, not what veins are for, something that alarms one's body. A visceral reaction.
posted by five fresh fish at 5:53 PM on March 18, 2007

My father gets the frozen arm feeling when getting an IV. He describes it as an ice cream brain freeze in his arm. I've assumed the feeling is because the saline is at room temperature and his body is much warmer.
posted by Mitheral at 7:12 PM on March 18, 2007

Agree that the FPP and the linked articles are misleading or in error.

There are two ways to be declared dead. One is brain death, which requires a pair of careful neurological exams many hours apart, documenting the absence of all brain function, blood tests to rule out the presence of brain-death-mimicking drugs, and finally a confirmatory test such as a flatlined EEG or a cerebral perfusion scan showing no perfusion. While you're spending hours procuring these things, the organs are turning to mush.

The other way is cardiopulmonary arrest. If a doctor certifies that you have cardiopulmonary arrest, you're legally dead.

Now can you see why one of those ways is preferable for declaring death?
posted by ikkyu2 at 8:05 PM on March 18, 2007

I'll take brain death for five hundred, Alex.

I'm sorry it's viewed as selfish, but I think asking to turn my last living moments into hell is a little selfish in itself.
posted by five fresh fish at 8:50 PM on March 18, 2007

five fresh fish, I'm unclear on why you "take" brain death over cardiac arrest. Brain dead patients are anaesthetized and given various drugs before their organ transplant surgeries as well, and total death does not occur for brain dead patients until the arteries around the heart are clamped off for the heart's removal. The patients are, of course, legally dead first.

Death can best be viewed as a process, and organ donation necessitates that legal death (and organ removal) occur before that process is complete (but after it is started). The problem that the article is concerned with (I think, it's not very well written) is whether in the case of cardiac deaths the organ-donation preparation process begins (or is susceptible to beginning) *before* the process of death does.

There is, of course, some very questionable stuff happening with organ transfer, as well as some outright outrageous/illegal/dispicable stuff (Nancy Schepper Hughes does a fair amount of research on the illegal organ trade). But it's not clear that allowing patients to donate who die from cardiac arrest after being removed from life support automatically counts as one of these things.
posted by carmen at 9:32 PM on March 18, 2007

Okay let's back up a parsec here.

Let's pretend I'm almost dead. Not already dead, but I'm as good as dead and the doctors already know even if they could keep me alive, I'll be lucky if I can watch Jerry Springer reruns and comprehend them.

If I'm already as good as dead, and I can't feel anything anyway, and there's no chance I can get better, what's the harm in letting doctors see my body as a buffet table? "That kidney there could save that middle aged man in Portugal. Maybe this spleen could help that kid in Milwaukee. Those lungs are too bad to salvage, but maybe these corneas could do some good somewhere.." Morbid? Darn tootin.'

If they actually want anything in me that's gonna stop working in five minutes anyway, go ahead and take it. What am I gonna need it for? A lotta good it'll do ya, cuz I didn't take care of any of it when I lived. But once I'm on life support systems cuz either my brain or my lungs or my heart have stopped working, if you want the other two go right ahead cuz I'm already not here anymore anyway.

Then whatever's left after that could be sent to medical school as a cadaver to help doctors learn on already dead people. If the student makes a mistake studying for surgical skills, it won't matter cuz I'm already dead. After I'm dissected like a frog, burn the rest of me, or donate me to speculative fiction.

Why should I care? I'm not there.

This clinging to life after the quality of life has gone? That's bullshit. Where'd Kevorkian go? He was on the right track. If you're facing death and it's terminal, and all fighting is gonna do is hurt and annoy you and make what's left of your life no fun at all, what's wrong with deciding to end it on your own terms, and letting doctors take whatever's left of you that doesn't completely suck and use it to help people who actually can be saved?

So what if this means the rich will be able to buy organs on the black market that used to be in poor people? You think that's not already happening? You're either way too naive and idealistic or I'm too pessimistic, but it's happening anyway. We might as well just own up to it and make it legal. Then maybe families could start selling the organs of their parting family members to pay for the wake.

Hell, I'm facing forty and Logan's Run is starting to look like a good idea. When the palm flower starts blinking, everything from there on out is just a downhill slope anyway. I don't wanna break a hip and hear myself say those words. I'd rather already be dead. Besides that way they'd have two moderately okay hips they could put on someone else.

Of course, life is wasted on the living.

I also think those of you who insist on reserving ground to be buried in are selfish bastards wasting perfectly good property that could be used to make golf courses. You should be ashamed of yourselves.
posted by ZachsMind at 10:22 PM on March 18, 2007 [1 favorite has favorites]

99.9% likely brain-death = death in my eyes, but then again, I just threw away my organ donor card in selfish terror.
posted by tehloki at 10:44 PM on March 18, 2007

If I'm already as good as dead, and I can't feel anything anyway, and there's no chance I can get better, what's the harm in letting doctors see my body as a buffet table?

You're missing the point. Yeah, if the world were a perfect and beautiful place where only people "as good as dead" would ever get harvested, you'd be right. But we live in a world where the least glimmer of possible profit makes people run around feasting on each other like cannibal wolverines, and it's a cast-iron cinch that if you make it acceptable to take organs from people certified "as good as dead" by some passing doctor, you're going to get the equivalent of the Monty Python bit I quoted above. Unless you have a caring and determined family member or spouse around to fight for you tirelessly—and many, many people don't—you're going to be viewed as a large wad of cash lying on a gurney, and the temptation to declare you "as good as dead" is going to be well nigh irresistible, even though if it were the doctor's mother on the gurney he might say "Listen, I've seen people come out of this condition—let's wait a couple of days and see what happens."
posted by languagehat at 5:25 AM on March 19, 2007

"It just so happens that your friend here is only MOSTLY dead. There's a big difference between mostly dead and all dead. Mostly dead is slightly alive. With all dead, well, with all dead there's usually only one thing you can do."

I'd like to be all dead before you start going through my organs.
posted by five fresh fish at 8:41 AM on March 19, 2007

All dead means something to us than it does legally tho--that's the problem. That difference is also the difference between others getting a chance at surviving or not, thanks to organs you won't be using ever again.

We need some kind of health education in schools about all this (maybe under social studies/civics).
posted by amberglow at 1:57 PM on March 19, 2007

oop--means something different to us than it does legally
posted by amberglow at 1:58 PM on March 19, 2007

the temptation to declare you "as good as dead" is going to be well nigh irresistible, even though if it were the doctor's mother on the gurney he might say "Listen, I've seen people come out of this condition—let's wait a couple of days and see what happens."

Uh, the physician who's caring for you won't get a dime from it if you get harvested -- they don't, AFAIK, get a bounty or kickback. It might make the transplant surgeons richer, or keep the organ procurement agency in skittles and beer, but AFAIK neither of them can declare you harvestable.

And I imagine that the physician caring for you knows that giving less than the established standard of care is like hanging out a big "SUE ME SUE ME SUE ME" sign.

So unless you're worried that the physician caring for you has some great desire to risk his livelihood (and maybe imprisonment) in order to make some jackass surgeon even richer and more full of himself, I wouldn't fret too much.
posted by ROU_Xenophobe at 2:15 PM on March 19, 2007 [1 favorite has favorites]

What I'm afraid of is that the doctors, eager to do the best they can do, will make assumptions about my state that lead me to have a rather unpleasant dying experience.

I'm really sorry that someone waiting for my organs might be disadvantaged by the practice, but I am not giving them up just willy-nilly. I do not feel I should suffer an awful death just so you might live.
posted by five fresh fish at 3:37 PM on March 19, 2007

Yet, when it comes time for you to die, the needs of the many will trump the interests of the few. Cruel, but I suppose that's the natural order.
posted by tehloki at 5:32 AM on March 20, 2007

the needs of the many will trump the interests of the few. Cruel, but I suppose that's the natural order.

No, that's the fascist order. Ask not what your country can do for you, ask what you can do for your country. Be a good citizen and if someone needs your money/property/organs more than you do, give them up with a smile, citizen!

No thanks. You'll pry my organs from my cold, dead body.
posted by languagehat at 6:19 AM on March 20, 2007

If you won't give up your last few hours of wasting away, pseudo-life, when your consciousness is already dissolving into nothingness, what -will- you give up?
posted by tehloki at 6:52 AM on March 21, 2007

that's why people need living wills and healthcare proxies--if you have a "do not put on life support" or something like that on the papers, etc, you'll never be in this position, i don't think. They're not taking organs from 90-year-olds. They need young and healthy and seldom-used organs. Corneas, kidneys, livers, hearts, etc, all degrade enormously with time and use.

I don't think the same people in this thread who are against taking organs before brain death is declared would want to be alive if it mean Schiavo or worse conditions. I hope they've filled out proxies, and living wills, and have people to speak for them before it gets to the point of an accident or horrific thing where this organ thing would actually come into play. It's essential--if you want control over your body.
posted by amberglow at 5:28 PM on March 21, 2007

Fersure. If I pull a Schiavo, I hope someone presses a pillow across my face.

Once I stop kicking, y'all can rip my guts out for whatever purposes please you.
posted by five fresh fish at 5:37 PM on March 21, 2007

FFF, you just need more and stronger drugs. Then you'll feel happy and not care about going on the cart.

languagehat - I don't think there's a profit motive in it for anybody, the way it's set up now, but if there was, I'd agree with you.
posted by Mr. Gunn at 8:47 PM on March 21, 2007

Fersure. If I pull a Schiavo, I hope someone presses a pillow across my face.

Once I stop kicking, y'all can rip my guts out for whatever purposes please you.
Even if you haven't had "brain death" yet?

It's so situational--i don't think you can just simpy condemn wanting to get fresh organs by not waiting for "brain death" officially. (it's weird--i've been reading these short stories by Niven, and in the future he writes about, all criminals go to organ banks to be killed for their organs, and every single infraction is a crime that sends you to those organ banks--even things like jaywalking or not paying a parking ticket and stuff)
posted by amberglow at 8:53 PM on March 21, 2007

Then you'll feel happy and not care about going on the cart.

Shoot me up on heroin. Let me OD on bliss.

i think i mean heroin.

Hoi! I've got the solution! Guillotine the patient! I'm pretty damn sure it's a painless, if startling, death. Quick, too.
posted by five fresh fish at 10:28 PM on March 21, 2007

I love your use of "startling" there :) Yes, the same way being set afire may be distracting.
posted by Firas at 11:50 PM on March 21, 2007

Startling, as in the "Whoa, hey, I'm dead!" moment between the head parting ways with the body, and the brain dying from lack of oxygen. There would be a period of several seconds, as the brain tries to comprehend what happened to its body, that one's eyes would see the tumbling ceiling, floor, faces of witnesses and then, about the same time it is pulled from the basket, it would snuff it, still quite surprised that death really is going to be terminal.

Which all sounds horrid, but it's better than having one's lungs removed while one's still using them.
posted by five fresh fish at 12:09 AM on March 22, 2007

I don't think there's a profit motive in it for anybody

Yeah, I expressed myself sloppily—I was vaguely thinking of the illegal trade in organs, but obviously in normal cases it's not a matter of literal profit, so "pile of cash" was a silly way to put it. Reword to "pile of organs," where said organs are so desperately sought-after they're even more attractive than a pile of actual cash. The point is the same: there's a huge incentive to declare somebody "on the point of death" or "as good as dead," when if your focus were on saving the person instead of their organs you might well decide they had a fighting chance.
posted by languagehat at 5:10 AM on March 22, 2007

How is there not a profit motive? Cutting you up to place into five other patients = five times the billing.
posted by five fresh fish at 6:42 PM on March 22, 2007

Contrary to popular* belief, doctors tend are not lecherous money-grubbing psychopaths.
posted by tehloki at 7:41 PM on March 22, 2007

I think I've figured out how to protect myself: I'm going to abuse drugs. Then those nasty doctors won't want my organs anyway!
posted by five fresh fish at 8:10 PM on March 22, 2007 [1 favorite has favorites]

Bingo! Everybody wins.
posted by tehloki at 1:31 AM on March 23, 2007

Well, except those people who desperately need organs. Ah well, at least you can show them how to party.
posted by tehloki at 1:32 AM on March 23, 2007

fff, you don't even have to take drugs--regular wear-and-tear degrades all of us anyway in the normal course of life. There aren't many senior citizens who naturally have the healthy organs of a 18-year-old (esp for us men)--i've read that it's tissues (like skin for burn victims) that are most frequently taken from older people--i'll find a link on stats.

Here's Deceased Donors Recovered in the U.S. by Donor Age from the OPTN--they radically drop off after 64 years old, and i believe more old people die each day than young, no? (it's also probably societal--younger drivers are more likely to be donors, and older people might have more taboos against it, or just not be as aware of the possibilities, or simply be more decrepit, etc)

Tons of other stats there too--hearts, for instance, are almost entirely taken from 18-34 year-olds.
posted by amberglow at 2:00 AM on March 23, 2007

It's eyeballs that worry me. What if they take my eyeballs?
posted by five fresh fish at 1:19 PM on March 23, 2007

I'll buy you a pair of googly ones on springs if they take yours, ok?
posted by amberglow at 2:00 PM on March 23, 2007

I wonder if stem cells will eventually make organ donation moot?
posted by amberglow at 3:18 PM on March 23, 2007

Hopefully, we'll be growing desperately needed organs in huge quantites within the next 50 years. Realistically, probably not.
posted by tehloki at 9:17 PM on March 23, 2007

well, they have done that pig thing, where they grow ears and stuff on them for transplant. (it's so gross, but if it works)

and this: ... the highly controversial field of xenotransplantation, in which organs and cells are transplanted between different species, including humans. ...
posted by amberglow at 10:16 PM on March 23, 2007

A pig's liver will never function as well as a liver grown from human cells to fit your specific genetic profile, though.
posted by tehloki at 2:34 AM on March 24, 2007

That's ok, i guess--it really bothers me that we're trying to use them like this (but it shouldn't--we eat animals and wear their skin and have been using them for all sorts of purposes for eons--maybe it's the insertion of human genes thing that gets to me and seems monstrous)
posted by amberglow at 12:43 PM on March 24, 2007

I guess that all I can say is: if we ever do find a source of undifferentiated stem cells which doesn't touch on the whole abortion issue, everything in the medical field will get a whole lot better.
posted by tehloki at 10:32 PM on March 24, 2007

Nah--a lot of the GOP wants more stem cells available too--everyone who has any disease in their families.

Now scientists create a sheep that's 15% human
posted by amberglow at 10:02 AM on March 26, 2007