Thursday, 9 January 2014

Brain death and organ transplantation Mythbusters

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.

Damn.

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.

67 comments:

  1. Hard facts that will, unfortunately, be lost on the clueless.

    I posted on the previous thread that the family found someone to place a trach and feeding tube in the dead body of Jahi. They're claiming she's doing much better now. This is really turning more and more into a horror show.

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    1. Want a horror show? Look at the hand - this is one week old, and I'm scared to go to the bed (it's 2 AM here), after imaginig the state "she" must be in right now.
      http://instagram.com/p/ikT4vbo0gq/#

      This is seriously out of control...

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    2. Absolutely none of this makes sense to me. I'm an RN and I'd love to know the whole truth once it comes out. Here is the ambulance chasers's twitter account
      https://mobile.twitter.com/cbdlaw

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  2. Okay, this is completely irrelevant to your article but i noticed something strange, which was the publication date. It was posted a few minutes into January 9, but for me its 3:09pm January 8. I thought it was pretty cool seeing this article from the "future" haha. Anyways huge fan for a few years now and yea idiots all over the world, even "Paradise" . Have fun at work :D you're awesome &someone i admire

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  3. I just saw too that the trach and feeding tube are in and shes "improving". I want to smack these people and shout it their faces "SHES DEAD SHES DEAD SHES DEAD!!!!!". I cannot believe how disturbing this has become.

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    1. Bree, I know!
      Poor Jahi. Her fameho mom said she was a shy girl, I think she would be embarrassed at all this. There is a rumor that Jahi did not want this surgery she thought she might not wake up. I don't think she would want the media circus the family is putting on.
      On the other hand teh stupid out there, yes I want to slap some faces...this is what happens when you take science out of the classroom or homeschool your kids with christian nonsense. Thanks To DB and other thoughtful bloggers trying to get the FACTS out there b/c the news people sure aren't, they just repeat over and over the nonsense the family & lawyer spew.
      What a mess. FUBAR. And what about that JUDGE????
      He needs to get his head out of HIS ass b/c without him Jahi would be peacefully RIP.

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    2. I seriously think the family needs some psychological testing. They have a corpse just hanging out in the living room. Theres got to be something seriously wrong with them. She's decomposing right next to them while they eat their dinner every night. I don't even want to think about the damage its doing to the other siblings. Isn't this a biohazard by now?

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    3. I don't think she is at her mom's house but I can't be sure? In the old days early 1900's people used to have "viewing" and services (funeral) at home. I don't believe they did embalming, but they did not keep the body hanging around for 3 wks.
      Its so "funny" they will not give the name of the "DR." that did the trach sx or G tube? But I guess anyone can do sx on a corpse the grandma prob did it since she knows so much more than any dr. at CHO! <---*extreme snark there*
      I also love how the news is not bothering to report... just parroting what all the parents say therefor perpetuating the myth the dead can dance! Or at least eat.

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    4. No need to insult Christians and homeschoolers who outperform public school children.

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    5. No need to insult children who go to public schools where they socialize and do very well, mainly at college.

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  4. Love the education and understanding you're offering us. Thanks for this well-written and thorough post.

    Have I missed info regarding the optimal window for harvesting organs from a brain-dead donor? And are prospective donors ever missed because families seek multiple opinions of brain death declaration?

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    1. The optimal window is "as soon as possible". Organs start to deteriorate very soon after brain death.

      I'm sure many donations are missed due to families wanting a second opinion. However, second opinions are never a bad idea, especially for something as devastating as this. Wanting 6 or 7 opininions is excessive, to say the least.

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  5. Another excellent article, Doc. It's a shame that the people that are donating money to this charade are choosing to ignore reality. The latest is that they have inserted a FEEDING TUBE into Jahi's body, even though she is decomposing. This macabre charade just gets worse and worse.

    http://www.cbsnews.com/news/jahi-mcmath-gets-feeding-and-breathing-tubes/

    Uncle says "If her heart stops beating while she is on the respirator, we can accept that because it means she is done fighting," he said. "We couldn't accept them pulling the plug on her early."

    THE ONLY REASON IT'S BEATING IS BECAUSE SHE IS HOOKED UP TO A MACHINE.

    Sorry for shouting but this is really making my blood boil. I have no medical or nursing qualifications but it doesn't take a genius to work that out.

    And if you look at this pic and compare it to the other one that was taken a few weeks ago, you can see that her hands are showing signs of decomposition - hell, it even looks as if one of her fingertips is missing!!!!

    https://twitter.com/VP_Renewsit/status/421141476559450112/photo/1

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    1. Hekate you're doing a fine job with your blog. The news is not reporting as usual so its up to the bloggers like you and DocB to report FACT not fiction! THANK YOU!

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  6. Doc' you know that I enjoy and respect your posts greatly but I have to take issue with one or two things in this one....

    Firstly, and most importantly, you seem to imply that there are people in the world who would not kill for a 1965 DB5. Really? What are you thinking?

    Secondly, and this is largely a matter of language, I have to disagree on doctors deciding when a person is dead. A person is dead or not dead. There is no in-between and there is no decision to make. It is a fact, plain and simple.

    The question is one of who analyses the person to determine whether they have died or not and reports on that fact. Hopefully they will get this right every time but that report does not change whether a person is in fact dead or alive. Just because a family member, or a doctor, or anyone else says you are dead doesn't make it so. Try it Doc' - declare me dead. I'll risk it!

    Where I completely agree is that the people best qualified to report on whether a person is dead or alive are doctors. And this is the whole point: Because it is a report rather than a decision you need knowledge and understanding and evidence to make that report. Doctors have that. In general, families do not.

    I knowingly misrepresent you somewhat here Doc' because you did say "determine" at the end of your post rather than "decide" but I think it's a distinction that is being largely overlooked. Death is death and neither a gung-ho tendency to declare it nor a stubborn refusal to accept it changes that.

    Additionally, I think "murder" is a legal question. Whether someone is murdered or not depends upon the circumstances and the laws of the relevant country but takes no account of that person's faith. You cannot murder a Catholic in any way that would not also be murder to anyone else. Whether that person, or others of the same faith, consider what you do to break any commandments or similar is an issue of their faith but does not relate to the question of murder.

    Amazed and appalled by the China thing!

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    1. ah, thank you. I knew something struck me as off about the "Doctors deciding death" bit, but I couldn't quite put my finger on what it was. of course it was the semantics. it's always semantics, with me. I understand completely what you're saying, and it is an important distinction, especially for people like the McMath family, who seem likely to feel or believe that the doctors did DECIDE Jahi was dead rather than simply determine that.

      I do however disagree with your assessment of "murder" as far as linguistics goes. what is death in one faith, religion, or culture may be different than in another. personally, I'm agnostic, and the only concept of murder and death I have are the legal and bodily related ones, but that doesn't mean someone else might define them differently. and because the only words we really have for that sort of thing are "kill" and "murder", I feel that murder is more apt, because kill could be used in much broader ways, and doesn't really convey the same thing. you kill someone through an unintentional act, you murder them through an intentional one. whether we're talking legally or colloquially.

      I agree about the China thing. though if they're going to keep executing people (really wish they wouldn't), and the executees signed consent forms (I doubt that's feasible, informed consent in a prison)...no. that should just stop, really. the executing and the organ harvesting, all of it.

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    2. Just gonna say it, what if some of those executions are for people like baby rapist murderers? While no most arent and most are probably to be considered probably minor offeses here, yes the organ harvesting is awful but just some food for thought- and hey, its not like theyre north korea either.

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    3. Interesting Anathema - do you believe that you can "murder" a catholic in a way that would not be murder to a non-catholic? I would take the view that people are people and murder is murder and neither is changed by the religion of either the person killed or the observer.

      Catholics may consider it murder to remove a BD body from the machine. However, logically that is not affected by whether the patient is Catholic or not. At least that would seem to be the case from my non-religious point of view. Through history, however, many groups of people, religious and non-religious, have considered those not in their group to be sub-human so logic is a fairly weak assumption in this type of case.

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  7. Death is a diagnosis. I go to the doctor for a diagnosis, not rely on my mom's opinion or my lawyer's.

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    1. I would maintain that death or not is a state of being and thus fact. The diagnosis is the medical and/or legal opinion as to whether someone is in a state of death or not.

      A diagnosis of death can be wrong, just as any other diagnosis can (although perhaps a diagnosis of decapitation is hard to mess up). Death, however, is either the case or not and is unaffected by the correctness of the opinion. You can be incorrectly diagnosed with a head-cold or with death. However in both cases you either are in that state or not.

      It is, however, largely a matter of linguistics.

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    2. Hello!!! UGI! DEAD is DEAD! Jahi is a corpse! Her body although it is severely decomposing is being kept breathing and heart beating by the VENT ONLY! I have read that some Drs consider BRAINDEATH a type of decapitation kind of like when you cut off a chickens head and it keeps running around for a few mins.
      I see morbid fascination in Jahi's condition under the guise of "discussion of life & dead" there is NO discussion here.
      She is dead.
      All of you who doubt it.... get a fuckin' clue!

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    3. Crystal - let's please keep things civil here. The moment commenting threads get out of control, it turns into a side show, and I mean this blog to be informative and humourous (hopefully), but never confrontational.

      What Ugi says is perfectly valid. S/he may be referring to the other supposed cases of brain death (ie Zach Dunlap) who were misdiagnosed as dead when they clearly never were. I don't think Ugi meant that brain death doesn't equal death. Ugi is way too smart to think that.

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    4. Thanks Doc' - you have it spot on as usual.

      My point was not at all that Jahi was alive. For all that it's possible to have a bad diagnosis - and I would probably ask for a second opinion if she was my daughter - I would not even think of disputing seven separate opinions and all the data that have accompanied those. You don't need to be a doctor to know that no blood-flow to the brain for any significant time is sufficient for death.

      My point was simply that there is a distinction between the fact of death and the diagnosis of death. Jahi's family want to be the ones to make the diagnosis but it appears that they believe by doing so they will change the fact. Sad though it is, nobody can change that now.

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  8. This whole thing is really wearing me out. I've been concerned about the medical and legal precedents being set, particularly with the insistence of some that families should decide when death occurs. OMG. I think it's time to pull my knitting out and finish the baby dress for my little grand niece (18 months, utterly adorable).

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  9. Thank you for your excellent coverage.

    I've a question:

    Why isn't inability to breathe on one's own a determining factor for death?

    This would be in addition to brain death and heart death.

    If it were, the whole "deciding to take someone off the ventilator" issue would be moot, no?

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    1. There are certain conditions when a person cannot breath on his/her own temporarily. However, with time and correct treatment they can get better and not require ventilation anymore.

      Not the case for the brain death, of course.

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    2. Doc B covers the "apnea test" in a earlier blog. It was done by one of the Stanford Docs and is documented and one of the tests they did on Jahi.
      We have a very unfortunate situation here where a judge stepped in and stopped the hospital from disconnecting the vent. They are under no obligation to keep it going when a patient is declared Brain dead (especially by 6 Drs.) but the judge stepped in setting a very bad precedent which has of course not been covered by the news media....And of course the Ambulance chasing lawyer...wanting the TRO. If you go back on a prior blog post you can find the doc that tells all the tests that were done on Jahi documented by this specialist from Stanford. Keep in mind 5 other Drs. came to same conclusion. Usually only Two are needed if the patient fits the criteria of "braindead".

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    3. What I'm asking is why that "apnea test" isn't valid as evidence of death, in and of itself. If someone can't breathe on their own, they're dead.

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    4. It is. A failed apnea test is diagnostic for brainstem death.

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    5. TerryTowels, you asked about the inability to breathe on one's own at first, right? Isn't that why ventilators were invented in the first place? Because it does not mean you are dead? Please, DB, correct me if I am wrong, because as I understood it, the apnea test showed that the body had no reflex to even try to breathe (choking, gasping,..) and thus brainstem death was confirmed?

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    6. The gag reflex is a separate brain stem reflex. The breathing center is also in the brain stem, and it initiates a breath when carbon dioxide levels rise. Hers rose precipitously, and she did not initiate a breath. Thus, she failed.

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    7. "What I'm asking is why that "apnea test" isn't valid as evidence of death, in and of itself. If someone can't breathe on their own, they're dead."
      in and of itself, I don't think it could be. I'm not the doctor here, but I'm pretty sure there are some conditions where you can't breathe on your own, but you're not dead. ALS in its late stages. other diseases/conditions that affect your lungs, muscles, nerves.
      it does prove/corroborate brain death. if you're brain dead, you fail the test, but if you fail the test you aren't automatically brain dead? correct me, Doc/other more knowledgeable people, if I'm wrong, please.

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    8. Many schools for some reason teach the exact WRONG THING to teach. Some schools in the us still teach creationism INSTEAD OF, not alongside as a history of science kind of thing, in place of evolution. Many teachers over the years have been and still are fired for teaching evolution, either because the schools say its wrong or crazy parents do. Considering this, the ways schools are handling it is in a way...not that surprising.

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    9. I'm not the doctor here but I think the difference is between the reflex to breathe and the ability to do so.

      If your brain is alive then the build up of waste (carbon dioxide) in your blood triggers your body to try to breathe it out. The problem is that you may be incapable of doing that and so have a machine to help. If your lungs are in bad shape you can be perfectly well alive but incapable of breathing. Your body will keep trying, however, for as long as your brain stem can sense and react to the carbon dioxide level.

      In Jahli's case, her body is physically capable of breathing but doesn't try to do so. That is because her brain stem has lost the ability to sense and react to carbon dioxide.

      It is the fact that she doesn't try to breathe rather than her ability to do so that indicates death. As I understand it.

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    10. Hi
      I know I'm really late to the comment thread however i would like to share a personal experience relating to being alive but unable to breathe for myself

      I was in a road accident a while ago. i had to have surgery to repair breaks (thinking of sending this story to db) there was a surgical complication and i got fat embolism syndrome in my lungs and brain.
      i was put in icu post surgery during this time i was sedated and had oxygen given to me at all times. however when i woke from sedation (i don't really remember but have been told) i would remove the oxygen mask or prongs during the time i was not being given oxygen even though i was very much alive (and fighting apparently) i could not get oxygen into my blood stream so my o2 sats dropped rapidly until they sedated me and re attached the oxygen.

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  10. This, like so many other things, will not be seen, let alone comprehended by those who need to know it… Thanks for all your work

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  11. Doc, you should check out the interview Dr. Drew did on CNN. He was blunt, poignant, and said what needed to be said to address the horrible ignorance in this case. Finally a public voice of reason! Dr. Drew: Jahi McMath won't wake up
    http://www.cnn.com/video/data/2.0/video/us/2014/01/10/hln-drew-jahi-mcmath-brain-dead-panel.hln.html

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    1. love how he had the "magical thinking" concern trolls on there..Thanks for posting.
      The one after is about the Lady in TX keep on a Vent b/c she is preg. :( She was a EMT and did not want this as her husband is also EMT. Dr. Drew says it cost 10K a day on a vent!

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    2. Just because we have the medical technology to extend life doesn't mean we should use it. I'm thinking of the horrifying story out of Texas of the brain dead woman who is being kept alive so that the fetus in her body can develop. This is being done against her wishes (DNR, no extreme measures, etc) by state law. We've only a meat-ax technology available to supply the hormones needed to keep her body going past brain death; who knows what sort of damage the fetus is being subject to, and then, who will take responsibility for the child (if any). The husband is also opposed to this extension--they were both in the medical field. Who is going to pay for the costs of this very expensive treatment? If she's dead, the insurance company will probably bail. Will the husband be forced to pay for this state-ordered desecration of a body?

      Just as an example, in CA, when one is involuntarily placed in a hospital by the government, one is responsible for the bills incurred, not the state.

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    3. Wow, that blew my mind a little. I was unaware that a hospital or government office could actually force someone to keep a loved one on life support. I read an article and no one wanted her to be kept alive.

      In this case, I feel the family does have a right to choose whether the person stays on the ventilator. What they are doing is not only causing the family more grief, but possibly causing the baby to be under extreme stress. Is the baby receiving food or nutrients? I cannot imagine they are able to put in a g-tube while she is pregnant. This just baffles me.

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    4. Putting a feeding tube in her would be no problem at all. I'm certain they did this weeks ago.

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    5. I just imagined it would be difficult. Clearly not, as you stated.

      But in this case, Doc, what good are advanced directives if they can be completely ignored? Should I be prepared to tell my husband if I ever become brain dead while pregnant to smother me when people aren't looking just so I can die peacefully?

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    6. It's an intriguing question. I wish I had an answer.

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    7. @Ashly, if you live in a state or country where fetus rights trump women's rights, then yeah, that might not be a bad idea.
      I had managed to not hear about that story, and I am so disgusted and more than a little terrified right now. that is so awful.

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  12. You are a voice of reason when it comes to this case. Thank you.

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  13. http://www.nbcbayarea.com/news/local/Jahi-McMath-Brain-Death-Tonsillectomy-EC-Reems-Academy-Friends-Believe-Alive-239629891.html

    It is hard to believe the way they are handling it at her school. UGG. The San Francisco Bay Area is a tale of two cities.

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    1. "If you don't know a damn thing about something, listen to the person, who clearly does", "biology" and "your decisions should have some rational reasoning" are the things, they should teach them, instead of plain bulshit.

      I guess the teachers should find this out too...

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    2. There is going to be a whole bunch of kids who will soon learn that adults are wrong, and that sometimes they LIE.
      Also a perfect example as to why religion should not be in public schools.

      Thirteen is old enough to know some basic human physiology. No one is helping those kids properly grieve.

      And WHY is that even a newsworthy story? (I live close to the SF Bay area, and there is no place like it on earth. It's not exactly a hotbed of proper investigative journalism.)

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  14. Doc, thank you for being the voice of reason. For me it's like watching a train wreck getting ready to happened and you know you should look away but can't.

    I'm a police chaplain and an investigator so I've seen my share of trauma and tragedy enough for a couple of life times.

    I am sickened by the fact that this girl's body is basically decaying they actually found someone to do a trach and a feeding tube? Doing surgery on dead bodies is just creepy.

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  15. I'm so obsessed with this story that I found your blog. I appreciate what you're doing, but want to quibble over one thing. You wrote: "the family should have full control over their loved ones' healthcare decisions while they are alive." Not if the patient has made her wishes known. Some people may want to amend their living wills to state that, if they are brain dead, they do not want to remain on a ventilator any longer than it takes to harvest their organs.

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    1. An excellent point. Perhaps I should have said "the patient and their family". But you are correct, of course.

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  16. Hey Doc, have you heard the suctioning accusations, that the family performed suction on Jahi either before, or after, the haemorrhage began? It's briefly mentioned in this article. http://www.nbcbayarea.com/news/local/Oakland-8th-Grader-Brain-Dead-After-236015681.html

    I also came across a few comments stating that someone in the family may have fed her some Big Mac not long after surgery, but I'm not sure how much truth is in that story.

    You've got me addicted to following this story now too, I look forward to your further insight on the matter.

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    1. I have. But rumours are just that until they are substantiated.

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    2. Actually Doc. there is a video of granny {LVN?) in an interview where she says she suctioned Jahi and the girl also suctioned herself. I am familiar with CHO and I am positive they did NOT do this with the permission of the ICU staff.

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    3. http://www.hlntv.com/video/2013/12/18/grandma-just-pray-jahi-please

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  17. My understanding of the hamburger issue is that someone posted it in a comment section of one of the first reports on this case on CNN....of course it is just a rumor, but it does raise a question I have and haven't really seen anyone discuss it.

    I have been awakened many a night to come in for emergency surgery for a post-op tonsillectomy patient to control bleeding after they decided to eat a bag of chips a few days after surgery. I would assume if she had enough time to receive 4 units of blood (heresay) there would have been enough time for her to get back into the OR for post-op control of bleeding. I'm wondering why she wasn't taken back? First thing that comes to mind, of course, is that she was fed something by the family. What other issues could you think of Doc that would have prevented her from going back to surgery to stop the bleeding?

    Also, I am wondering if her being in the PICU was planned since it was a risky surgery and she needed extra monitoring. I think I read that they knew she would stay overnight and I assumed the PICU was planned. But I'm confused as to if she went to a regular recovery room before going to the PICU. The hospital I worked in (stay at home mom now) was small but patients who were to be in ICU afterwards, were taken directly there and bypassed the recovery room.

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  18. Hi, I think this is an important issue, and one I've mentioned before. African Americans are less likely to trust white doctors and hospitals that predominantly have whites in charge.

    This story has a startling statistic from the Pew Research Center: "... only 33 percent of blacks said that there are circumstances in which patients should be allowed to die, compared with 65 percent of non-Hispanic white Americans. Another 61 percent of blacks told Pew researchers that doctors should be obligated to continue and provide any type of care possible, while just 26 percent of whites agreed."

    That may help explain why white people are much more outraged at the family and attorney in the Jahi case. It also has to do with why the media is writing so little about the cost and who's paying. Many black people think hospitals will pull the plug because they don't want to pay for the continuing treatment of black people. Talk of the cost would only reinforce the idea that CHO declared her dead to curtail costs.

    This case also goes to the question of national health care and health-care costs. I'm a survivor of a rare cancer (metastatic leiomyosarcoma) and a longtime patient advocate. I've helped patients fight to get better treatment as well as to rebut friends and families who are telling them to fight, fight, fight. Because I raise money to help patients, I also understand that health-care funds are not limitless.

    I also have friends in health care and it seems unethical to obligate doctors to perform any care available. How can you force a surgeon to perform a surgery she thinks will cause harm? Should a medical oncologist be forced to give chemo he thinks will kill a patient?

    Poor and lower-income people may have fought for medical care in the past, and in a sense, they have less to lose by demanding every expensive treatment available. People with money in the bank will see it eaten up by out-of-pocket costs, and they may end up ruining their credit. So, it makes more sense for them to consider if an expensive test or procedure is really worth it, especially if their doctors are saying it isn't. But if you have little money and bad credit, what more can you lose?

    I hope no one thinks I'm hard-hearted. I live on SSDI, I have two sisters who are poor, and I've worked with a lot of poor people. The difference, of course, is that I'm not encouraging anyone to demand care that is questionable.

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    1. An excellent comment. Those statistics are very interesting, and quite disturbing.

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    2. just wanted to let you know that this was a really interesting and informative comment. not in the least bit cold-hearted. on the contrary, you sound quite compassionate and understanding, and the fact that you don't encourage or advocate questionable care is evidence of that.

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  19. Thanks so much for providing a medical point of view into this hideous crisis. I hardly know what to think about it most of the time. In the event, if you could cast your eye on this piece over at the DailyBeast - the commenters on the McMath case are enough to try the patience of a saint. They have neither education nor common sense.

    Have at it, sir: http://www.thedailybeast.com/articles/2014/01/14/families-and-physicians-debate-the-true-meaning-of-brain-death.html

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  20. I am terribly sorry that your parents were not married when you were born,That is a horrible word to call yourself,It was not your fault.

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    1. Thankfully it's April Fools' Day, so I'm going to let that go.

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  21. http://www.ccm-l.org/discussion1/Ethics/uncoop.html I have only just found this again... i lost the link. Love this blog. But don't really know how to bring this to attention so hope ok post here. Its really re: Jahi Mcmath. Came across this actual, it seems, conversation by doctors. Got to say, it gave me a little more sympathy for the mother. Some of these medical professionals have nothing but contempt for families. The opening one asking for advice...I am just appalled. http://www.ccm-l.org/discussion1/Ethics/uncoop.html

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  22. Actually, all of the conversation shed light for me on the whole "What don't you understand? She is dead, dead, dead" stuff. And also at just how unreasonable Nailah Winkfield's demands were from the start. I didn't realize hospitals needed to switch off vents so fast, not even keeping them on til morning , nor how often families say relatives are going to arrive who never do (Still, a comment like "They all have a brother in Australia" again..just contemptuous). Nailah wanted her child kept on the vent from December 12 all the way til Xmas so she could have a party and bring a gift and "How could you not let me have my child through Christmas?" Two weeks, when it's usually just a few hours. I understand now better about the whole "We need to do this quickly" that made the Winkfield/Mcmaths so angry. Maybe the hospital could have done a better job of compassionate communication to a thunderstruck woman who had just lost her child.
    Actually, what are the reasons for haste? Why can't vents stay on til relatives arrive? Why cant they keep up the illusion for a day or two? Are the vents always in demand? Is it a lot of work?

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    1. Typically brain dead patients are kept on machines for some reasonable length of time (up to a day or two) for exactly that reason, to accommodate family members who want to say their goodbyes. The perceived "haste" is usually only present in the minds and memory of family members who haven't come to terms with the tragedy. Doctors and nurses don't push to turn the machines off immediately.

      Keep in mind that the only perspective we have on this case is Jahi's family's. I find it very hard to believe that the ICU team tried to push them to turn the machines off quickly. From the little information that the hospital has been allowed to release, they made every effort to accommodate this family up to and beyond what most would consider reasonable.

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  23. I know this is an old post, but one thing really really stood out to me in the 3rd Myth you posted about how they paralyze Brain Dead people when removing the organs. Obviously you explained why they did that but you completely skipped over the part where they said "So they can't get up and walk out of the operating theater."

    I don't work in the medical field, but I think the day I hear about someone who is brain dead getting up to walk, at all, is the day I will actually believe that Zombies can actually become a thing. (I mean if Rabies isn't a widespread issue, and the faster dead things move, the more they decay, Zombies aren't gonna happen folks)

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