In 1844, Edgar Allen Poe's "The Premature Burial," enthralled readers with instances relating perhaps the most terrifying of human fears, that of being buried alive. Poe's narrator describes the phenomenon of catalepsy, a singular disorder that effects a death-like trance upon its sufferers, some who are mistakenly believed to have died and then buried. In some cases, the mistake was discovered upon re-opening the tomb to find the presumed corpse in the final death throes, trying to claw out. Other more forunate undead, were able to call attention to themselves from the depths in time for exhumation. The fear of being buried alive was common in Poe's time and public captivation culminated still in the Victorian era's organization of The Society for the Prevention of People Being Buried Alive and an obsession with vampires. Now, however, such nonsense is left for the likes of Tim Burton and Stephen King, or so I thought...
In the latest issue of The New England Journal of Medicine, several children's doctors confess to having removed hearts from infants just over a minute after they've stopped. The infant "donors" were declared dead of heart failure despite the fact that their hearts, once transplanted to lucky recipients, resumed beating like clockwork. The unenviable, ethical dilemma faced by doctors is the mission to do whatever possible to save the life of an infant measured against the risk of failing to use viable organs that could save the life of another infant. From either side a doctor could face accusations of lethal negligence.
Compounding the problem in the medical arena is the fact that nowadays anything is possible and miracles are becoming commonplace. That is, without the aid of advanced life support systems and high-tech medical treatment, the time of death was fairly definable. Now, however, the precise moment of death is becoming more difficult to pin down as medical advances easily counter the courses of nature. The NEJM piece reports that there isn't even a uniformly accepted lapse of time used by surgeons to measure when an infant goes from patient to donor. Some surgeons wait five minutes from the last heartbeat, others only two. The Children's Hospital in Denver, which the article focuses on, waits between 60 and 75 seconds. Note to infants: if you're going to get life-threateningly ill, stear clear of the Mile High City. Seriously, what's the real rush...have we impatiently foregone the ancient doctrines of "respect for the dead" in our haste to roll the dice with a donee? If we're going to play Gawd, doesn't that mean going both sides of the ball, offense and defense?
The truth is that every second counts dearly, and with organs already scarce, doctors are being forced to redefine, or at least reinterpret, the definition of death. Not long ago, doctors used the rule of "brain death," which permitted ganking organs from patients on ventilators. Now doctors are self-governed by the "donation after cardiac death" principle which permits donating based on heart stoppage rather than brain stoppage. In short, the time of death, the period of resuscitation, and the window of donation are three very distinct moments that overlap, but not necessarily as much as we'd want them to...for the sake of simplicity.
Bioethically, ought we consider standard forms that allow family members/power of attorneys to decide not only when doctors should continue resuscitation, life-support treatments but also clearly outlined periods of organ donation? If there is still such a thing as non-medical miracles, shouldn't we at least give them a chance to occur? Personally, I could imagine making the decision to suspend life-support systems for a loved one with the reservation that doctors provide a four minute window for a miracle to happen. It may be selfish and may even deny another patient the chance at a successful transplant, but depending upon the loved one in question I am willing to live with that regret. Kidding...erm...kind of.
For the record, I am sticking with my plan to be the plastinated drummer in von Hagen's rock band, however, should the band break-up before my audition, I hereby declare my organs available at the two-minute mark. Don't even bother with the liver...and the heart was never worth a damn to begin with...still got both kidneys though and I've never smoked a cigarette so the lungs are alright...good luck, and please no jumping the gun...I want all 120 seconds. JWD
Subscribe to:
Post Comments (Atom)
3 comments:
With simple signaling technology you could actually register all three events right into the risk management database. As for me - enter the code - gankable (that is - gank away)
I understand the concern, and while I'd like to think that my doctor might hover over my warm corpse for at least a minute before removing my organs, the bottom line is - we're not doctors. I'm assuming that after a certain amount of time without oxygen/bloodflow, organs begin to deteriorate and the chance of a sucessful transplant into a new body goes down. A stipulation that a doctor should wait a certain amount of time takes away his professional judgement and has the potential to render a well-meaning donor's donation useless. I think this might be a scenario where the needs of the living outweigh reverance for the dead. And doctors are in the best position to say with finality who is, and who is not, dead.
I liked the title!Eem is correct that the heart only has minutes without oxygen or freezing (that's another subject)before the cells die. I want to believe that these donor children died with other problems, and the heart was relatively healthy. Since they can only transplant an organ in a person of comparable size, the recipient also had to be very ill to receive an organ from a donor who died of "heart failure."
I'm finding that there are a lot of life and death instances that have no medical or legal guidelines- but need them. jl
Post a Comment