Question about organ donation

[cbrsmurf]

So I was reading this article:

 

http://online.wsj.com/article/SB10001424052970204603004577269910906351598.html?KEYWORDS=dick+teresi

 

I naturally had a gut reaction of this article being biased and misinformative, especially since it seems to be written by a person not in the medical field. However, I have never observed an organ harvest or worked in transplant, so I realized I do not know much about it. Can someone provide some info on:

1) Which tests are actually performed to verify brain death? cardiac death?

2) Is anesthesia used on a non-living donor? If not, what the additional cost would be?

[cbrsmurf]

So I was reading this article:

 

http://online.wsj.com/article/SB10001424052970204603004577269910906351598.html?KEYWORDS=dick+teresi

 

I naturally had a gut reaction of this article being biased and misinformative, especially since it seems to be written by a person not in the medical field. However, I have never observed an organ harvest or worked in transplant, so I realized I do not know much about it. Can someone provide some info on:

1) Which tests are actually performed to verify brain death? cardiac death?

2) Is anesthesia used on a non-living donor? If not, what the additional cost would be?

[flyingsquirrel]

These are two reasonable responses, the first is an NPR piece with both the author of the WSJ article and a transplant surgeon

http://www.npr.org/2012/03/19/148296627/blurring-the-line-between-life-and-death

and the second is a response from an organ procurement organization

http://www.lifelineofohio.org/2012/03/a-response-to-dick-teresis-claims-about-brain-death/

[flyingsquirrel]

These are two reasonable responses, the first is an NPR piece with both the author of the WSJ article and a transplant surgeon

http://www.npr.org/2012/03/19/148296627/blurring-the-line-between-life-and-death

and the second is a response from an organ procurement organization

http://www.lifelineofohio.org/2012/03/a-response-to-dick-teresis-claims-about-brain-death/

[coloradopa]

So I was reading this article:

 

http://online.wsj.com/article/SB10001424052970204603004577269910906351598.html?KEYWORDS=dick+teresi

 

I naturally had a gut reaction of this article being biased and misinformative, especially since it seems to be written by a person not in the medical field. However, I have never observed an organ harvest or worked in transplant, so I realized I do not know much about it. Can someone provide some info on:

1) Which tests are actually performed to verify brain death? cardiac death?

2) Is anesthesia used on a non-living donor? If not, what the additional cost would be?

1. The brain death testing that most hospitals use is listed here:

http://www.neurology.org/content/74/23/1911.full.pdf

The actually testing is toward the end of the article. The rest of the article lists the rationale which pretty much directly contradicts the article.

Its not simple and must be done by a neurologist, neurosurgeon or intensivist.

 

2. Anesthesia is used during procurement for two reasons. One is that the patient can be unstable and the anesthesiologist needs to titrate gtts until the end. The other is that paralysis is helpful to get the abdomen open due to involuntary muscle twitch. One the abdomen is open and the organs are exposed Wisconsin solution is flushed through the system. At that point the anesthesiologist turns off the machine and leaves.

 

Basically the entire article is sensationalist and plays off a Victorian fear of unrecognized life after death. As the AAN article describes there has never been a documented case of recovery after brain death has been declared. There are isolated cases of Lazarus type behavior (including one from my institution - see below) but never any recovery.

 

Objective: To describe a patient with transient reversal of findings of brain death after cardiopulmonary arrest and attempted therapeutic hypothermia.

Design: Case report.

Setting: Intensive care unit of an academic tertiary care hospital.

Patient: A 55-yr-old man presented with cardiac arrest preceded by respiratory arrest. Cardiopulmonary resuscitation was performed, spontaneous perfusion restored, and therapeutic hypothermia was attempted for neural protection. After rewarming to 36.5°C, neurologic examination showed no eye opening or response to pain, spontaneous myoclonic movements, sluggishly reactive pupils, absent corneal reflexes, and intact gag and spontaneous respirations. Over 24 hrs, remaining cranial nerve function was lost. The neurologic examination was consistent with brain death. Apnea test and repeat clinical examination after a duration of 6 hrs confirmed brain death. Death was pronounced and the family consented to organ donation. Twenty-four hrs after brain death pronouncement, on arrival to the operating room for organ procurement, the patient was found to have regained corneal reflexes, cough reflex, and spontaneous respirations. The care team faced the challenge of offering an adequate explanation to the patient's family and other healthcare professionals involved.

Interventions: Induced hypothermia and brain death determination.

Measurements and Main Results: This represents the first published report in an adult patient of reversal of a diagnosis of brain death made in full adherence to American Academy of Neurology guidelines. Although the reversal was transient and did not impact the patient's prognosis, it impacted his eligibility for organ donation and cast doubt about the ability to determine irreversibility of brain death findings in patients treated with hypothermia after cardiac arrest.

Conclusions: We strongly recommend caution in the determination of brain death after cardiac arrest when induced hypothermia is used. Confirmatory testing should be considered and a minimum observation period after rewarming before brain death testing ensues should be established.

[coloradopa]

So I was reading this article:

 

http://online.wsj.com/article/SB10001424052970204603004577269910906351598.html?KEYWORDS=dick+teresi

 

I naturally had a gut reaction of this article being biased and misinformative, especially since it seems to be written by a person not in the medical field. However, I have never observed an organ harvest or worked in transplant, so I realized I do not know much about it. Can someone provide some info on:

1) Which tests are actually performed to verify brain death? cardiac death?

2) Is anesthesia used on a non-living donor? If not, what the additional cost would be?

1. The brain death testing that most hospitals use is listed here:

http://www.neurology.org/content/74/23/1911.full.pdf

The actually testing is toward the end of the article. The rest of the article lists the rationale which pretty much directly contradicts the article.

Its not simple and must be done by a neurologist, neurosurgeon or intensivist.

 

2. Anesthesia is used during procurement for two reasons. One is that the patient can be unstable and the anesthesiologist needs to titrate gtts until the end. The other is that paralysis is helpful to get the abdomen open due to involuntary muscle twitch. One the abdomen is open and the organs are exposed Wisconsin solution is flushed through the system. At that point the anesthesiologist turns off the machine and leaves.

 

Basically the entire article is sensationalist and plays off a Victorian fear of unrecognized life after death. As the AAN article describes there has never been a documented case of recovery after brain death has been declared. There are isolated cases of Lazarus type behavior (including one from my institution - see below) but never any recovery.

 

Objective: To describe a patient with transient reversal of findings of brain death after cardiopulmonary arrest and attempted therapeutic hypothermia.

Design: Case report.

Setting: Intensive care unit of an academic tertiary care hospital.

Patient: A 55-yr-old man presented with cardiac arrest preceded by respiratory arrest. Cardiopulmonary resuscitation was performed, spontaneous perfusion restored, and therapeutic hypothermia was attempted for neural protection. After rewarming to 36.5°C, neurologic examination showed no eye opening or response to pain, spontaneous myoclonic movements, sluggishly reactive pupils, absent corneal reflexes, and intact gag and spontaneous respirations. Over 24 hrs, remaining cranial nerve function was lost. The neurologic examination was consistent with brain death. Apnea test and repeat clinical examination after a duration of 6 hrs confirmed brain death. Death was pronounced and the family consented to organ donation. Twenty-four hrs after brain death pronouncement, on arrival to the operating room for organ procurement, the patient was found to have regained corneal reflexes, cough reflex, and spontaneous respirations. The care team faced the challenge of offering an adequate explanation to the patient's family and other healthcare professionals involved.

Interventions: Induced hypothermia and brain death determination.

Measurements and Main Results: This represents the first published report in an adult patient of reversal of a diagnosis of brain death made in full adherence to American Academy of Neurology guidelines. Although the reversal was transient and did not impact the patient's prognosis, it impacted his eligibility for organ donation and cast doubt about the ability to determine irreversibility of brain death findings in patients treated with hypothermia after cardiac arrest.

Conclusions: We strongly recommend caution in the determination of brain death after cardiac arrest when induced hypothermia is used. Confirmatory testing should be considered and a minimum observation period after rewarming before brain death testing ensues should be established.

[cbrsmurf]

thank you, very enlightening.

[cbrsmurf]

thank you, very enlightening.