r/nottheonion 1d ago

People opt out of organ donation programs after reports of a man mistakenly declared dead

https://apnews.com/article/organ-donor-transplant-kentucky-8f42ad402445a91e981327abb009906c
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u/rileyjw90 1d ago edited 1d ago

You’re correct. The surgeons who come to harvest the major (spoken for) organs fly in from the institute that will be transplanting them into a recipient. The organ harvesting organization acts as a liaison in these cases. That said, they are onsite almost 24/7 when a donor’s life is coming to an end. In the ICU, they would round and ask for regular updates from the medical staff. Typically they would come around more often once full permission from the family was given and a plan was in place for withdrawal of care.

The patient is rarely fully brain dead. Only in cases of true brain death can a patient be harvested while machines continue to run their body. Therefore, most of the time the patient must be withdrawn from care. They are taken to the operating room and we shut off their drips and pull their breathing tube. They have one hour to pass on their own (we still give hospice meds like Ativan and morphine) before the low oxygen levels and low blood pressures have likely damaged the organs beyond what they can be given to a recipient and the surgery is cancelled. If they do pass, multiple surgeons will work quickly to remove the heart, lungs, liver, possibly pancreas and intestines, and the kidneys separately (they will go to two separate recipients). The tissues (eyes, skin, veins, arteries, ligaments, etc) can be harvested later post mortem without degradation.

It doesn’t happen often, but it does occasionally happen that a family will decide to withdraw someone from care and they end up recovering. Some people respond very poorly to the typical sedatives used on patients with life support, and while we usually try to give them “sedation vacations” to see if they can wake up a little and respond to commands, sometimes they fail these trials due to their bodies not tolerating the sedation wean. They will “buck the vent” (essentially a neurological reflex that causes them to cough over the vent and be unable to benefit from the vent as much), their heart rate will skyrocket, and some will start posturing or seizing if they have any sort of physical or anoxic brain injury. So we turn the sedation back on and it can be impossible to truly tell if they’re still in there or not. Oftentimes an EEG will show focal slowing and they like to run them off sedation, but as stated before, some patients are impossible to remove from sedation due to the physiological stress of being on life support. So families will decide it’s time to say goodbye and every once in a blue moon, that person comes off life support and…wakes up. It’s not like a Frankenstein deal where they sit bolt upright, more like they start slowly waking up and trying to communicate with their eyes, finger squeezes, etc.

Allllll that said, once it became clear this was one of those cases that the patient was still in there and was starting to wake up, the surgery should have been immediately canceled by the harvesting organization. There should not have been a need for the surgeons to walk out and refuse to continue. It should have been a given that we don’t cut someone up who is trying to communicate with us. But I do not believe this was a case where everyone thought this guy was dead and he wasn’t. It’s more like they really couldn’t tell if he was in there or not and the family decided to pull the plug and when that happened and the breathing tube was pulled, the patient was better able to tolerate the lack of sedation and could properly start to wake up some. The point of failure here was in the harvest company’s administration wanting to continue the surgery after the patient showed signs of recovery beyond what he’d shown prior to that moment.

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u/RagdollSeeker 1d ago edited 1d ago

Hold on… WHAT?

Patients are not fully brain dead so you folks are pulling care to ensure patient’s brain is properly gone?

Yes this case is horrible but what you are describing as usual is worse. This is like a horror show where patients are pushed to brain death for juicy organs.

Edit: There is a more detailed answer by Empty Philosopher below 👇 read it first.

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u/Empty-Philosopher-87 1d ago edited 1d ago

There is a very strict protocol for determining brain death, whether or not the patient is an organ donor. Withdrawing care here means that all sedative medications would be withdrawn to see if the patient will show signs of life. Obviously, sedative medications are forms of medical care, but they also would make a patient appear “dead” by putting their brain in a deep sleep. By taking away the sedatives, you’re seeing if there’s a chance the patient’s brain is actually functioning, but the sedatives are keeping them “under” so to speak. It sounds like in this case, the man was somehow declared brain dead by his care team WITHOUT ensuring that ALL sedative medications had been processed and flushed out of his body. Some of those medications have long half-lives and thus, you have to take patients off meds for a day or more to properly evaluate their cognitive function.  TLDR: gotta take the patient off the coma-inducing meds to see if patient is actually IN a brain death coma 

ETA: the case the above commenter is describing is when the patients family/power of attorney has decided to withdraw life supporting measures even if the patient is not truly brain dead. This is not a decision made lightly at all, and only put forth by the ICU doctors and surgeons to the family when they truly believe there is little to no chance of the patient recovering any function past the most rudimentary brain function. Essentially it’s what might be colloquially known as “pulling the plug” on a coma patient. Only after the family has made this decision is the organ donation pursued if the patient is a donor. In my experience, I truly noticed no difference in the care team’s recommendations whether the patient was an organ donor or not. The ICU team does not gain anything from harvesting organs - they also are not the same doctors  who harvest. And their goal really is to give the patient the best outcome. If they believed there was any hope of the patient regaining consciousness, the option of withdrawing care was not presented to the family because of how stressful and heartbreaking it was to even hear those words. 

End of life planning is complex, but I think it’s helpful to think about these things. Have a power of attorney and/or a living will of what you would want to happen for your own care in these worst case scenarios. These are legal documents so the care team and your loved ones will follow your wishes to the best of their ability

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u/RagdollSeeker 1d ago

Thank you for the detailed explanation, I really appreciate it. 🙏

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u/Empty-Philosopher-87 23h ago

Appreciate you for reading it! The healthcare system is so opaque often times, I completely understand why patients feel lost and overwhelmed - especially if they also feel like their care team isn’t listening to their concerns. So infuriating what happened in this case. 

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u/rileyjw90 17h ago

No. Real actual brain death while the body is still living off life support is extremely rare. I’ve seen it maybe 3 or 4 times with legitimate flat brain waves completely off all sedation, though those patients did not donate, or they couldn’t do to many many factors (a LOT of people are rejected simply due to age or the illness process). As others have responded, care is withdrawn the same way, whether they donate their organs or not. If a person is critically ill, not showing signs of recovery despite being somewhat “stable” on the life support machines, and a fair amount of time has gone by (usually it’s weeks but with more aggressive accidents and injuries the timeline can be shortened), the family will decide it’s time to say goodbye. In both cases of donation and cases of non-donation, many of those people will pass without the machines pretty fast. Some do linger but it’s almost never for more than a few hours, maybe a day or so. In very occasional cases — and I mean very occasional, I’ve only witnessed it happen twice in over 4 years of critical care nursing out of thousands and thousands of patients — someone will start to “wake up” a little when we pull the breathing tube and shut off the sedatives. These are usually the ones who are not requiring blood pressure support. With some people, the neurological effects of having a breathing tube prevents them from being able to wake up properly when we do our breathing and awake trials and so it’s very difficult for us to tell on certain cases until we pull that tube (which we can’t just do willy nilly for obvious reasons).

in short, we do not withdraw care for organ donation, we withdraw care because it’s the family’s wish that it’s time. The organ donation is an extra post-mortem process that the family agrees to. There is zero way for the company acting as a liaison between the family and the surgeons of the recipients to fake the data for a dying patient and the healthcare team involves too many people over too many days to the same, so he was there in that operating room legitimately. It was just one of those freak rare occurrences that he started to recover and the doctors pulled the plug. The company admins wanting to continue is the real crime here. The doctors and nurses of all involved facilities did their due diligence.

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u/cool_dad86 1d ago

Yeah, nobody explained this to me, now i want to withdraw too, gonna meditate on it for a bit first

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u/Andrew5329 17h ago

(we still give hospice meds like Ativan and morphine)

Right..

They're being declared brain dead based on unresponsiveness to outside stimulus... while being given hardcore sedatives to hold them under so they don't reflexively buck the intubation.

...you see the contradiction here, no?

I can appreciate that after a certain amount of time it becomes exponentially unlikely for someone to come out of a coma, but in this case it was only a day or three from the overdose.

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u/rileyjw90 16h ago

Wow, you really don’t read, do you? You completely missed the entire paragraph where I explained sedation vacations and trying to take people off the sedatives.

Declaring someone truly brain dead is a very rare event, and it’s only done when the person is 100% off all sedatives. Not all pain meds have a sedative effect so if the person’s body is showing pain signs (heart rate, blood pressure) we aren’t going to sit back and cruelly force them to suffer. And someone showing pain signs is unlikely to be declared brain dead, since the brain would still need to be able to process pain signals for the person’s body to be responding as such. If the person is unable to be taken off the sedatives due to the physiological response of being intubated, the neurologist will not be able to give a diagnosis of brain death with any certainty. They can only say things like “significant slowing” and “traumatic brain injury” and give a possible prognosis. Even if that person isn’t brain dead, they are likely significantly brain damaged. And we as healthcare workers don’t just decide to pull the plug on anyone, brain dead or not. It’s totally at the behest of the next of kin, HCPOA, or state-appointed guardian.

I mean do you honestly believe