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(CBC)   Doctors debate one of the thorniest issues in medical science: Dead or just Canadian?   (cbc.ca) divider line 14
    More: Interesting, Canadians, logical implications, Dalhousie University, clinically dead, University of Alberta  
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1744 clicks; posted to Geek » on 21 Mar 2014 at 9:35 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



14 Comments   (+0 »)
   
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2014-03-21 08:39:24 AM  
cdn.arstechnica.net

/loved that show
 
2014-03-21 10:03:27 AM  
www.learningradiology.com

That looks pretty dead to me. Your brain is not coming back from no blood flow above the level of C2, dude.
 
2014-03-21 10:09:47 AM  
Why not both?
 
vpb [TotalFark]
2014-03-21 10:31:11 AM  
wp.patheos.com.s3.amazonaws.com
 
2014-03-21 10:42:37 AM  
We're not dead, we're hibernating.
 
2014-03-21 10:43:56 AM  

hardinparamedic: [www.learningradiology.com image 383x390]

That looks pretty dead to me. Your brain is not coming back from no blood flow above the level of C2, dude.


True, but the article wasn't about that. I would quibble that the article was about donation after cardiac death, not after brain death, which is what I'm guessing you're showing.

I believe the article was a bit misleading, though. They talk about wait times without a heart beat of 75 seconds to 10 minutes, then state that people have come back after 5 minutes without a heartbeat with CPR. The problem I have is that I think that the people who have responded to CPR after 5 minutes typically had very lowered temperature (e.g. fished out of a frozen lake) and no other severe injuries.

The people who are considered for DCD are fundamentally different from the type of person who is brought back after 5 minutes. These potential donors have suffered Catastrophic brain injury or other illness such as endstage musculoskeletal disease, pulmonary disease or high spinal cord injury. While wait-times and other standard may vary from hospital to hospital, they're limiting the choice to people the treating physician (not the transplant team) have decided have "no expectation of meaningful survival".
 
2014-03-21 10:44:55 AM  

draypresct: Catastrophic brain injury or other illness such as endstage musculoskeletal disease, pulmonary disease or high spinal cord injury.


Dammit, my link didn't come through:
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2009.02739.x/ pd f
 
2014-03-21 10:55:35 AM  

draypresct: believe the article was a bit misleading, though. They talk about wait times without a heart beat of 75 seconds to 10 minutes, then state that people have come back after 5 minutes without a heartbeat with CPR. The problem I have is that I think that the people who have responded to CPR after 5 minutes typically had very lowered temperature (e.g. fished out of a frozen lake) and no other severe injuries.


Speaking from practical experience, the majority of non-traumatic resuscitation with return of spontaneous circulation (ROSC), which occurs in the United States is either in people who have had bystander or HCP initiated CPR from the moment of collapse, or who were found down with an unknown duration of arrest (certainly any longer than five minutes) and were successfully resuscitated with drug therapy and defibrillation/cardioversion. The problem is, while the survival with a Cerebral Performance Category of 1 or 2 is about 33% in the first category, most in the second do not survive to discharge, or if so have profound neurological disability or secondary organ dysfunction from the cardiac arrest. After 72 hours of therapeutic hypothermia, if they have no meaningful reflexes, a flat EEG, and even if they have a CT Angiogram which shows no blood flow above the neck, they're dead. Their heart just hasn't gotten the message yet. There is little to no hope of a meaningful recovery beyond having a pulse.

draypresct: While wait-times and other standard may vary from hospital to hospital, they're limiting the choice to people the treating physician (not the transplant team) have decided have "no expectation of meaningful survival".


In the United States, the transplant/organ donation team is prohibited by law from intervening in the care of a patient until the determination of brain death is made, and the decision is made to make the person an organ donor in conjunction with discussion between the nurse from the regional organ donation network and the family. In addition, it is against the law and medical board regulations/ethics for a doctor determining brain death to have any connection with that organ donation team or the process.

In most places, we have a problem with them doing too much past the point of medical futility, not too little.
 
2014-03-21 12:14:38 PM  

hardinparamedic: Speaking from practical experience, the majority of non-traumatic resuscitation with return of spontaneous circulation (ROSC), which occurs in the United States is either in people who have had bystander or HCP initiated CPR from the moment of collapse, or who were found down with an unknown duration of arrest (certainly any longer than five minutes) and were successfully resuscitated with drug therapy and defibrillation/cardioversion. The problem is, while the survival with a Cerebral Performance Category of 1 or 2 is about 33% in the first category, most in the second do not survive to discharge, or if so have profound neurological disability or secondary organ dysfunction from the cardiac arrest. After 72 hours of therapeutic hypothermia, if they have no meaningful reflexes, a flat EEG, and even if they have a CT Angiogram which shows no blood flow above the neck, they're dead. Their heart just hasn't gotten the message yet. There is little to no hope of a meaningful recovery beyond having a pulse.


Thanks - that was informative.

hardinparamedic: In the United States, the transplant/organ donation team is prohibited by law from intervening in the care of a patient until the determination of brain death is made


While I fully support organ donation (yes, I've registered and have the little note on my license), I would like to quibble a bit with you on this one. If you check out my link above, you'll see discussion of donation after cardiac death. From the article:
Controlled DCD offers the patient and the family the opportunity to donate when criteria for brain death declaration will not have been met prior to cardiac death. It also specifically states that for these donors Brain death criteria not met.

 I completely agree about the separation between transplant team and the team taking care of the patient. Again from the article: The transplant community has no say in whether or when support will be withdrawn.

In one way, I'm picking a meaningless quibble. Either way (DCD or DBD) deceased-donor organ transplantation occurs only after every effort is made to determine that the donor is irreversibly dead.

hardinparamedic: In most places, we have a problem with them doing too much past the point of medical futility, not too little.


I completely agree with this statement.
 
F42
2014-03-21 12:29:39 PM  
in 2005, the guidelines for declaring death were changed, so that more organs could be donated and procured.

That is absolutely terrifying.
 
2014-03-21 12:40:11 PM  

F42: in 2005, the guidelines for declaring death were changed, so that more organs could be donated and procured.

That is absolutely terrifying.


It really shouldn't be. Take a look at my link above, which lists some of the specific guidelines and procedures.

If you wouldn't mind, please post any that you disagree with, or that you think don't go far enough.

/Keep in mind that, as hardinparamedic pointed out, the team taking care of the patient and declaring death is completely separate from the transplant team. The doctor who declares death receives no money for doing so.
 
2014-03-21 12:46:05 PM  

F42: That is absolutely terrifying.


It's only terrifying if you don't know what you're talking about.

The problem with previous guidelines is that by the time that the UNOS regional group were able to evaluate and place the patient on the organ donation list with a match, patients had been in a state that even though they were brain dead with no hope of a recovery, their organs were subjected to acidosis and hypoxia, as well as the sequela of injury at a cellular level for much longer - making the organs less likely to succeed in transplant.

They aren't letting people who have a hope of recovery die so they can get their organs. In fact, as an organ donor, you could argue you would be getting better care because they WANT to preserve those organs.

In addition, the doctors caring for that patient have no involvement in the organ donation process. The process is totally separated.
 
2014-03-21 03:04:55 PM  
I'm Canadian and I would like to say sorry for dying.
 
2014-03-21 04:56:00 PM  
Awkwardly feminine?
 
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