re: Dad pulls gun to stop son from being removed from life support, saves son's life

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For anyone reading who's horrified, take it firsthand from a guy who works in the field rather than a guy who "knows a guy." This doesn't happen.

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I don't believe you.

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generally irreverent way that the people treat the beautiful gift is what prevents me, personally, from wanting to be a donor.

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This is code for docs alerting transplant units "we've got one on the vent, fading fast" and big cheers and parties after matching, and a doc on the floor rationalizing the facilitation of death by stating the person has left the body, then it's "call Mrs. X and tell her she's got a new heart, put a new blade on the saw, get the cooler and liquid nitrogen and tell the chopper crew to start it up".

Any cursory review of survival analysis and transplant studies tells you prospective recipients must be 'healthy' enough to go through the ordeal, and lasting long enough to get a new organ almost guarantees manifestation of survivor treatment bias, with longer time to death than if the transplant was not done.
The money brought in from the transplant procedure is huge because it involves so much and so many, and also the longer survival of the recipient who will need regular exams and potent immunosuppression to prevent rejection means more money over the duration of a patient's remaining years.

Don't forget as well that large hospitals generally are associated with these procedures, and are also generally affiliated with universities, which means research is taking place and that can't be done without data. A transplant surgeon wanting publication in the field has zero incentive to keep potential donors alive, and though he or she is unlikely to be involved in their care, that person will influence the course of events.

Translation: once your health is in a grave condition, there's an overwhelming balance of forces pushing you 6 feet under compared to those trying to get you standing on 2 feet. Hence, no way am I listing myself as an organ donor.

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most actions deemed as irreverent are mature coping mechanisms because we're talking about people who deal with some fairly screwed up situations, and joking about it is much easier than accepting how terrible some people's luck is.

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This is just weakness here. Transplant teams are not made up of the nurses and care givers of those dying. They are not seen as people or patients, they are MHC's and matching variables etc in the eyes of these transplant teams.

They may visit the family and put some spin on things, like done in this post, while trying to coax them into signing paperwork and such, but that's about it.

Mentioning coping mechanisms as some excuse here is simply an indicator of failures in professionalism and failures in ethics.

Furthermore, and most importantly, there's a recognition of the 'irreverence' and a shockingly high number of transplant staff not listed as potential donors, while calling it a beautiful gift - yet there's no action taken to address those things. So what we have here, in reality, is a systemic failure.

This seems to be an updated report.

LINK

#wipestearaway

Stone cold badass. Faith restored!

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So what we have here, in reality, is a systemic failure.

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What you've actually got is a well-thought out argument to a vast number of false premises.

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This is code for docs alerting transplant units...

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This shows an entire lack of understanding of the process and is very far from the point I was attempting to make. If a patient is on a vent and fading, they'll almost definitely never be an organ donor. Organ donation requires a strong body which has become brain dead, basically. They need to have a machine breathe for them with a strong heartbeat. They'll often require other medications to help their body stay alive. Usually they don't "fade" at all. Not infrequently, there will even be consent given, matches made, and OR times set prior to the body just giving out and there being no organ donation because they passed on the vent.

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Any cursory review of survival analysis and transplant studies...

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Sure. The recipients must be in good enough condition for receive a new organ. But a survivor treatment bias? I think not. For a patient to be eligible for organ donation in the state I'm in, two different doctors, totally uninvolved with transplant and with absolutely no knowledge of any recipient must declare a patient brain dead. Despite the comments about how rudimentary the exam is, a physician's physical exam and failed apnea test do indicate a patient without any brain activity. Further, the patient absolutely does not begin breathing again after the test is over and the machine turned back on. The machine is forcefully pumping air in and out of lungs, which work fine, because the brain does not tell them to breathe and the patient, without the help of the ventilator, would expire within a few minutes. But back to your point of treating recipients over the critically ill. Once two, separate doctors who haven't talked to each other and have absolutely nothing to do with transplants deem a patient to be without neurological activity at any level, then the organ team has a representative speak to the family about donation. Only once the family has said yes there is a transplant surgeon even involved. Those two doctors from before? Their loyalty is to the patient. They don't give a damn about transplant. They want to keep the patient alive. That's their goal. The transplant surgeon has no interaction until the primary doctor has given up, thinks the patient is brain dead, invited a second Doctor to think the patient is brain dead, and the family has agreed to donation, and the donor is suitable for donation. Once that has occurred, you are right. The transplant surgeon's goal is to treat recipients. There is absolutely no interest in the critically ill patient. But if you follow the story, he had nothing to do with the patient getting to that point.

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The money brought in from...

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Don't confuse the cost and the money brought in. The long-term immunosuppression has absolutely nothing to do with the cost of the procedure nor the reimbursement to the hospital. Nor does the follow up care really have much to do with the moneys initially brought in. There is a large up-front cost. Tons of labs, critical care for the donor and recipients, a skilled team of technicians and nurses who must be paid round the clock regardless of whether cases are coming in or not, an OR team, airplane charters...those are the up-front costs, and the hospital is involved in them. The cost for follow up is absolutely high- that's why only the insured are typically given new organs. But many of the things you mention have nothing to do with the hospital's incentive to have donors.

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Don't forget as well that large hospitals..

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Your extrapolation is an overreach on multiple levels. You're still right- the transplant surgeon has no reason to keep that patient alive or not pursue donation. But that was never their job in the first place. For it to be their job would cost a research institution, many, many of which are not associated with universities, probably all of their research dollars and likely their status as an organ transplant center. It's a major breach of ethics if the transplant surgeon is involved in the care prior to the family's consent because the patient has already been deemed neurologically dead. Of course, if your statement was intentionally meant to say that the transplant surgeon has no reason to keep the patient alive, then you've set up about the easiest straw man ever, and there's still no ethical dilemma.

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Translation: once your health is in a grave...

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Once your health is in grave condition and the doctor who was taking care of you thinks your dead and calls a different Doctor to confirm, the two choices are cardiac death by withdrawal of care or cardiac death by transplant surgery. Again, the surgeon doesn't have a single thing to do until the patient is deemed unable to be saved.

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Hence, no way am I listing myself as an organ donor.

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In many states, including mine, all this registry does is allows the person approaching for organ or tissue donation to say "we do have record of him being in our registry by (name, DOB, drivers license number, and address). We believe his wishes were organ donation, but the final decision is always left to the family (legal next of kin)." Speaking of the decision being left to the NOK, if you do or don't want to be a donor, the absolute most important thing for you to do is speak to your family. Way more important than choosing to register or not.

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They may visit the family ...

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May I ask what you're basing this off of? We stay in contact with families after the fact. And everyone who's either the donor or the recipient of a transplant is invited, at least annually, to a memorial service in honor of those who gave.
I realize I used the word "joke" instead of "make light of the situation" which was inappropriate on my part. During the first organ donation case I was in the OR for, I watched two surgeons prep, as for any other surgery. They carried on a conversation about sailing. When the heart surgeon was done, the one doing the liver and kidneys bid him farewell and invited him to get out on the water sometime. Neither mentioned the gravity of the situation at hand- that a patient with no neurological activity's family willingly gave his insides so that, in this case, 4 other people would receive solid organs and an additional who knows how many would get skin grafts, bone grafts, tendons for ortho surgeries, and possibly even restoration of lost sight. There's nothing unethical or unprofessional about not making a scene in the OR about each patient, reading their biography before the case starts. It's literally a mature coping mechanism. If you'll familiarize yourself with the term and realize I'm speaking of mature mechanisms (detachment being one, removing one's self from the situation mentally, humor is another form of mature coping. I'm not suggesting that inappropriate jokes or comments are made. Just that the whole situation seems cold an callous at times) vs immature mechanisms (splitting everything into all good vs all bad, going home and cutting oneself, turning to drugs, alcohol to let out feelings about their job). Mature coping mechanisms are absolutely used. Coping mechanisms of some sort must be used. Nothing about it is unprofessional or unethical. And yes- during the course of the operation, people make jokes. They're not about the patient in any instance I've been part of.

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a shockingly high number of transplant staff not listed as potential donors,

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Based on...? I'm registered, btw.

Way too many people are kept on "life support," for way, way too long. Costs millions of dollars, for literally zero gain in quality of life or societal contribution. Just a vegetable garden. People don't understand that.

Physician here, albeit rheumatologist.

I was involved in several organ donation cases while in my residency working in the ICU. Mostly isolated head injuries in young, otherwise healthy individuals (ideal donors, btw). The ones I remember were two gunshot wounds to the head.

I agree with Hopeful Doc and appreciate his perspective. I suspect those against the process have never had a loved one waiting on the transplant list (neither have I, actually).

Nonetheless, I am a registered donor and encourage my friends and family to be as well. I have no reservations about the end-of-life care I will receive as a potential donor.

Great discussion, and absolutely wild story. Merry Christmas fellas.