Surgery professor Marty Sellers and colleagues at Emory have a forthcoming piece on "Deterrents to Organ Donation."They recount the familiar story that because of a shortage of organs, "patients often wait years for transplantation, are at increased risk of dying on the waitlist, and have more advanced organ failure at the time of transplantation – which increases the risk of post-transplant morbidity/mortality, length of hospital stay/resource utilization, and post-transplant recovery time.
The authors further note that "a major factor limiting the number of transplants performed is lack of authorization (consent) to organ donation." Specifically, they explore how "myths and knowledge deficiencies surrounding organ donation and transplantation" interfere with willingness to be an organ donor.
One misunderstanding concerns the "finality of brain death . . . thinking a patient can recover from brain death." This was not as big a barrier as "concerns over getting inadequate care from paramedics and physicians if one is registered as an organ donor." But brain death mistrust was "independently significant overall."
It seems that the high salience and visibility of the Jahi McMath case has already increased misunderstanding and mistrust of brain death. As the case and attention on it continue, so will misunderstanding and mistrust. In turn, that will negatively impact organ donation. Of course, if the family wins the case, distrust will increase even more significantly.
In Plaintiff's 12/22 motion to bifurcate they have stated that Jahi will most likely fail a formal neurological examination equal to the one performed in December of 2013 because they allege she is only intermittently responsive. They have no choice but to challenge the validity of the AAN and AAP guidelines because as of now that is the accepted medical standard. The family of Aden Hailu successfully challenged the standard in Nevada but the point was rendered moot when Ms. Hailu's heart stopped.
ReplyDeleteIn your opinion what would the outcome be if the court ruled in favor of plaintiff's challenge to the CA standard? By what standard would Jahi's status be determined?
If she is responsive at all then she is not dead on current criteria.
ReplyDeleteIf the standard medical criteria are legally inadequate then we must revise either the law or the Medical criteria or both.
Transplant community defense of brain death" is the Fox guarding the Henhouse
ReplyDeleteYou must forgive my tendency to cynicism when I read the appeal to humanitarian reasons for sympathy to those awaiting organ transplantation. The medical profession lost some of its credibility when it abandoned the Hippocratic Oath.
ReplyDeleteThat combined with the fact that organ transplantation has become big business with a total billing according to the 2017 Milliman Report. The Millman Report of 2017 discloses that the amount of money billed for all of the organ transplants for the covered year was $34,729,776,300.00. When that much money changes hands 'brain death' becomes a valuable means of increasing profit.
I join Bishop Gracida's anxiety on this point. Certainly people waiting for organ transplants suffer additional delay when increased care is taken that the "donors" of these organs are truly dead (not merely nearly so). However, that is not a good reason to brush aside genuine questions about "brain death."
ReplyDeleteDr. Pope's summary in these comments is short and to the point. If Jahi is responsive at all at any time, she is not dead. (One should not have to even say this.) That someone decided several years ago that she WAS dead is irrelevant. Obviously in that case they were wrong. If she is responding now she is not dead now, and since no one is contending that she has now resurrected, she was not dead then either, and those facts must be recognized. If the standards we have been using in this matter are not working we should revise the standards.
I would remind us all that we as yet have no proof that Jahi is responding to her mother or to anyone else. In light of everything else we know, we should be presented with some evidence beyond the bare assertions of her family.
Of course if she is at all responsive she is obviously not brain dead. Even the current standard says a patient must remain unresponsive. My question is how do we determine this? Should brief home videos taken by family out of any meaningful context be taken at face value? We know from the Terri Schiavo case that family videos can be misleading.
ReplyDeleteThere's also the issue of the MRI which is now nearly 4 years old yet Shewmon relies heavily on its findings. Wouldn't a current MRI be more indicative of her status today?