7.11.2013

Organ Harvesting and a Reminder of the Perverse Incentive Effect

From ABC News:

"It was exactly midnight when Caroline Burns eerily opened her eyes and looked at the operating lights above her, shocking doctors who believed she was dead and were about to remove her organs and donate them to patients on the transplant waiting list.
 
The Syracuse Post-Standard unearthed a report from the U.S. Department of Health and Human Services that chronicled the series of errors that led to the near-organ removal on a living patient at St. Joseph's Hospital Health Center in Syracuse, N.Y., in 2009.
 
"The patient did not suffer a cardiopulmonary arrest (as documented) and did not have irreversible brain damage," the HHS report concluded. "The patient did not meet criteria for withdrawal of care."
 
According to the report, doctors had inaccurately diagnosed Burns with irreversible brain damage and ignored nurses who'd noticed signs that Burns was improving: She curled her toes when touched, flared her nostrils and moved her mouth and tongue. She was also breathing on her own even though she was on a respirator."
 
While I certainly don't want to make accusations without a foundation, it does nonetheless remind me of an old story I posted on this site, first published here and reprinted in full below:
 
According to The Wall St. Journal, organ transplantation is a $20 billion per year business. The article linked to above goes on to note that, "Average recipients are charged $750,000 for a transplant, and at an average 3.3 organs, that is more than $2 million per body. Neither donors nor their families can be paid for organs." In other words, these procedures are big business for the hospitals where they occur.

Which may lead some to wonder if there are any inherent conflicts in the donor process. Of course, when you tell your friendly local registry of motor vehicles that you will volunteer as a donor, that is a conscious decision (unless some states I am not aware of have an opt-out as opposed to an opt-in process). However, when the actual time comes for the donation to occur, what decisions are made then?

Readers might be surprised by this question as many individuals assume that organ donations only occur once the donor, and the freedom of choice along with them, has expired. However, it turns out that as organs begin to lose their efficacy shortly after their host has expired, it is actually better to harvest organs from individuals who have not yet fully died. In other words, individuals who are on life support. Most such individuals have had severe brain trauma, and would not be able to function without the support of various machines, but they nonetheless serve the purpose of keeping organs viable.

Without diving into the semantics jungle surrounding the word 'alive,' at least some of our readers might nonetheless find it disturbing that some research has noted that certain patients who have been technically brain dead have re-acquired the ability to breath on their own. There are also some indications that brain wave activity can restart after a period of inactivity. Therefore, there is at least some chance that people who are classified as medically dead for the purposes of harvesting are not fully past any hope. Leading back to the question posed above with regards to choice.

While I will admit that I am no doctor, and therefore cannot begin to claim that I understand the sometimes fine line between life and death, the facts noted above struck me as a bit odd. It strikes me that others might feel the same for a variety of reasons, many of them personal, such as religion. Others might have no hesitation about being donors, particularly, it would seem, folks with iron-clad do not resuscitate orders in place.

However, when the fact that the very institutions which profit off of organ donation are making decisions about whether patients are 'dead' or 'alive' is factored in, it merely makes the analysis more complicated. While it is not my goal to discourage organ donation, this may at least provide some food for thought heading into the weekend.

Tip of the hat to S.W.

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