Whenever I watch Mythbusters, I think how great I would be as a cast member. It would be perfect - I love busting myths, I think Adam Savage and Tori Bellici would be great to hang out with, I think Jamie Hyneman and Grant Imahara would be great to have a conversation with, and I think Kari Byron is ridiculously attractive. Sorry Kari, but it's true. But just when I'm ready to apply for the job, I realise that I have no idea how to build any of the contraptions they build, I know pitifully little about robotics and physics, and I don't live anywhere close to San Francisco.
So instead I have to settle for being a trauma surgeon and busting medical myths in my free time. This time I'll be focusing on brain death and organ transplantation and YES I'M STILL STUCK ON JAHI MCMATH, DAMN IT! Sue me! And stop interrupting. Anyway, in my last post I did an informal Q & A session, answering some questions about Jahi specifically. I'm casting a wider net this time, focusing on some more general issues. So without further ado...
Myth: Patients' families are the ones who determine when their loved one has died, not doctors.
Reality: No. No no no no no. NO. Have I said that enough? NO! According to this report, Jahi's mother's lawyer Christopher Dolan said it is "the right of a parent to make health care decisions relating to whether or not a ventilator gets removed from their child." With that I fully agree. However, he went on to say that families should be the ones to determine death, and here is where he is venturing into territories where he does not belong. Determining death in some situations is quite simple - if the heart is ripped out of the body, the head has been detached from the body, etc. But it takes a doctor with years of training to diagnose brain death. Who wants families deciding when someone dies? What if a family decides gramps is dead while he's still watching reruns of Matlock and Murder, She Wrote because they want his 1965 Aston Martin DB5? Should they be able to declare him dead? The fact of the matter is this: the family should have full control over their loved ones' healthcare decisions while they are alive, but that control ends when the patient dies. Lawyers don't determine when people die. Families don't determine when people die. Judges don't determine when people die. Doctors do. End of story.
Myth: If you are an organ donor, the hospital will not treat you as aggressively as if you weren't because they want your organs.
Reality: Uh, no. Some people seem to think that the first thing we do when we see a new patient is look for a donor card. Of the thousands of patients I have seen (and I see some VERY sick, often actively-dying patients), I have looked for exactly ZERO donor cards. While I am repairing a liver laceration or opening a chest, I guaran-damn-tee you I am NOT wondering, "Is this person an organ donor? Maybe I shouldn't suture that liver all the way. And maybe I should leave a little hole in the heart so this guy bleeds to death. I know someone who could really use his kidney!" Accusing doctors of this is not just disheartening, it is sickening and questions our very moral fibre.
Myth: Brain dead organ donors are not actually dead when their organs are removed, and they suffer tremendously during the procedure. That is why they are paralysed during organ harvesting - so they can't get up and walk out of the operating theatre.
Reality: Anaesthesiologists administer a neuromuscular blocking agent (a medication that paralyses the body) to prevent the reflex muscle contraction that is initiated in the spinal cord.
Myth: Brain dead organ donors' heart rates and blood pressure go up during organ harvesting, a sure sign they are feeling PAIN.
Reality: No, the increase in blood pressure and heart rate are reflexes from the spinal cord. The pain centre, which is located in the brain, is dead, so a pain sensation is impossible. This explains why donors are given anaesthetic agents (sedatives) during the procedure - to prevent this from happening.
Myth: The concept of "brain death" was made up by a bunch of Harvard lunatics who wanted to increase the number of available organs for transplantation and knew that brain-dead people aren't dead.
Reality: This bit of absurdity refers to the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. Unfortunately for those who believe this nonsense, organ transplantation and brain death, as concepts, were developed entirely separately. The idea of brain death started evolving as early as 1892, well before any organ transplantation was ever done. Read this for more information.
Myth: The criteria for determining brain death were established in the 1960's, so they are obsolete.
Reality: Brain death in the 60's is the same as it is now. Brain's haven't evolved the ability to heal since then, so the clinical criteria are still completely valid. Regardless, we now have confirmatory tests for brain death which are often done, including EEG (which was available in 1968), cerebral angiography, and radionuclide brain scans. There is debate about whether or not any of these confirmatory tests are necessary to confirm brain death.
Myth: Catholics don't believe in brain death, so removing even a brain-dead Catholic patient from a ventilator is murder.
Reality: False. Pope John Paul II himself agreed that the use of neurological criteria for determination of death was legitimate. If you choose not to believe me, you can read the National Catholic Bioethics Center's FAQ on brain death for confirmation.
Myth: Hospitals profit from organ donation. If a patient dies and donates their organs, the hospital gets to keep them and profit from doing 10 more operations. So hospitals are financially encouraged to call people "brain dead", even when they may not be.
Reality: Conspiracy theories don't look good on you. The vast majority of hospitals do NOT have organ transplantation programs, so if a patient dies and donates their organs, chances are very high that the hospital will not keep the organs. For example, there are well over 2000 hospitals in Germany, but only 33 of them perform kidney transplants, 16 perform heart transplants, and 18 do liver transplants. Of the 4000 hospitals in the US, about 5% of them have transplant programs (heart, lung, kidney, pancreas, liver, and intestine). These are just two examples, but the statistics worldwide are similar.
Myth: Hospitals can sell donated organs to the highest bidder.
Reality: Organs are not bought or sold. They are donated and then routed to the patient most in need. Nearly every country that participates in organ transplantation has a national register, so that every organ can be traced from its donor to its recipient.
Myth: There is a large black market dealing in human organs.
Reality: This one is partially true. It is illegal to sell human organs in all countries worldwide except one (GET YOUR HEAD OUT OF YOUR ASS, IRAN!). However, there is still an international black market where organs are bought, usually from a poor, desperate victim, and then sold to the highest bidder. The Declaration of Istanbul was drafted in 2008 and adopted by over 100 countries in an attempt to shut down the illegal organ trade. No word yet on its effectiveness.
Myth: Organs are harvested from executed prisoners in China.
Reality: This is unfortunately true. However, the country is banning the practice starting later this year.