Saving children’s lives with world-first ‘dead’ heart transplants(thetimes.co.uk)
thetimes.co.uk
Saving children’s lives with world-first ‘dead’ heart transplants
https://www.thetimes.co.uk/article/nhs-saves-childrens-lives-with-world-first-dead-heart-transplants-b0httn8lb
68 comments
twitter thread without a paywall: https://twitter.com/thesundaytimes/status/136340724792211046...
With The Times website, if you add an extra "/" at the end of the URL, it will bypass the paywall.
i.e. https://www.thetimes.co.uk/article/nhs-saves-childrens-lives...
i.e. https://www.thetimes.co.uk/article/nhs-saves-childrens-lives...
Hilarious and brilliant tip, thank you!
[deleted]
The UK study seems to be the pioneer but it is worth noting that this procedure is also being tested out in the US now https://www.statnews.com/2020/01/16/heart-transplant-donatio...
It’s a good sign that the procedure is spreading
It’s a good sign that the procedure is spreading
From their page it seems like it's from the US...?
https://www.transmedics.com/ocs-hcp-heart/
https://www.transmedics.com/our-company/
https://www.transmedics.com/ocs-hcp-heart/
https://www.transmedics.com/our-company/
The device used is extraordinary. The US has been using it for a year and a half in adult trials. Transmedics also has devices for the lungs and liver. Livers and to a lesser extent lungs already get transplanted after cardiac death when they’re judged to be viable— the key being that this device could quality of those organs and therefore more could be transplanted! This could benefit a lot of people— not just hearts!
https://www.transmedics.com/ocs-hcp-heart/
https://www.transmedics.com/ocs-hcp-heart/
This is the UK, so the parents would have ended up with a hospital bill of £0 and an ambulance bill of £0.
The NHS is generally pretty good at this kind of operation, the rot is really around things like mental health which don't fit a beveridge model very well
I didn't know about the name of the model, so I went on a quick search of the models and found this[0] short explanation for any other curious reader.
[0] https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...
[0] https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...
I'd be interested in how the other systems work with mental health issues.
That link says that US Veterans get proper healthcare -- free at the point of use, paid for by the tax payer. Is that right? Last I heard it was controversial (in America) to give healthcare to 9/11 responders.
That link says that US Veterans get proper healthcare -- free at the point of use, paid for by the tax payer. Is that right? Last I heard it was controversial (in America) to give healthcare to 9/11 responders.
> Is that right?
Yes, although it has a history of controversial mismanagement/underfunding.
That said, in the US, the typical story is that large, social welfare programs like SSA, VA, etc. were created in the early 20th century and remain very popular. Today, new similar programs are very controversial.
Yes, although it has a history of controversial mismanagement/underfunding.
That said, in the US, the typical story is that large, social welfare programs like SSA, VA, etc. were created in the early 20th century and remain very popular. Today, new similar programs are very controversial.
Although there are similarities 9/11 responders generaly aren't veterans(former soldiers) but police and firefighters and medics (some overlap exists because some were previously soldiers before leaving and becoming firefighters/policemen/etc)
There were several seperate laws passed to pay for their healthcare especially due to toxic air conditions after the attack
There were several seperate laws passed to pay for their healthcare especially due to toxic air conditions after the attack
TIL the Beveridge Model is a health care system in which the government provides health care for all its citizens through income tax payments.
... and unnecessary middlemen playing casino with human lives (aka health insurers) don't extract a huge payday.
Bill is included in the income tax. Funnily enough it does not apply to people living off shares, they truly pay £0 or close.
Do you mean stock dividends? They are taxed - and not lightly: https://www.gov.uk/tax-on-dividends
Well, capital gains is taxed much lower. Also combined with the ISA limits (20k put into ISA's each year - do it every year and your returns start adding up), you can get quite significant returns without paying tax at all. The UK tax system looks a lot more progressive on the surface than it is once you earn enough to take advantage of the various tax breaks.
That said, few people will pay nothing - what they won't be paying if they live off share return (be it dividends or capital gains) is national insurance. I'm assuming that's what the person you replied to meant.
However that means nothing in terms of NHS funding any more, as NI just goes into the general treasury fund in practice.
It's become part of a convenient fiction about UK tax rates, given that most people are unaware of the way NI is structured. In effect the "20%" marginal tax band is roughly 32% marginal when you factor in NI, and the "40%" marginal tax band is really 42%, and the 45% band is effectively 47%.
The 20/40/45 looks a lot less progressive when it's actually about 32/42/47 (even less so when you factor in the many tax breaks those of us on the higher or additional rate can afford to take advantage of that lower earners can't)
That said, few people will pay nothing - what they won't be paying if they live off share return (be it dividends or capital gains) is national insurance. I'm assuming that's what the person you replied to meant.
However that means nothing in terms of NHS funding any more, as NI just goes into the general treasury fund in practice.
It's become part of a convenient fiction about UK tax rates, given that most people are unaware of the way NI is structured. In effect the "20%" marginal tax band is roughly 32% marginal when you factor in NI, and the "40%" marginal tax band is really 42%, and the 45% band is effectively 47%.
The 20/40/45 looks a lot less progressive when it's actually about 32/42/47 (even less so when you factor in the many tax breaks those of us on the higher or additional rate can afford to take advantage of that lower earners can't)
Dividends are mildly taxed now.
Capital gains are. Dividends ends up effectively taxed similarly to income when you factor in that dividends are taxed after corporation tax. This is very intentional in that it closed much of the loophole of paying yourself via a limited company paying dividends. Still a bit cheaper but not much.
This. I wish people would stop saying the NHS is free because it's not.
It's equal for everyone regardless of your income and that's awesome as far as I'm concerned. Some others, not so much, particularly those who think that they shouldn't pay for someone else's treatment.
It's equal for everyone regardless of your income and that's awesome as far as I'm concerned. Some others, not so much, particularly those who think that they shouldn't pay for someone else's treatment.
The NHS is free at the point of delivery. https://en.m.wikipedia.org/wiki/National_Health_Service_(Eng...
It is not free like a free buffet.
But if you have a need, and a doctor/nurse agrees, then you get the treatment at no cost/free.
It is not free like a free buffet.
But if you have a need, and a doctor/nurse agrees, then you get the treatment at no cost/free.
> It's equal for everyone regardless of your income
Are you familiar with the term 'postcode lottery'?
And what impacts which postcodes you can live in? Your income.
Are you familiar with the term 'postcode lottery'?
And what impacts which postcodes you can live in? Your income.
Yes. That's why there is the NHS Choices Framework which allows you to choose both GP and outpatients. My GP is 40 miles away. My daughter is treated for her condition at Guys even though we're 20 miles away and there is a different local hospital.
The postcode lottery doesn't exist unless you're dragged into an A&E.
The postcode lottery doesn't exist unless you're dragged into an A&E.
Honestly that whole system is nice idea on the surface that rapidly becomes a nightmare - in my view doing little except encouraging health inequality.
One of the big problems is that "choice" is much more expensive for some people than others; this means that while I might be able to take a day off an visit a hospital a couple of hours away, it's much harder for someone who does't have access to transport, healthcare, funds or whatever else is required. So that system ends up offering choice only to people who can afford it, and you end up shuffling the poor people off to the less effective local healthcare facilities and your postcode lottery is back.
One of the big problems is that "choice" is much more expensive for some people than others; this means that while I might be able to take a day off an visit a hospital a couple of hours away, it's much harder for someone who does't have access to transport, healthcare, funds or whatever else is required. So that system ends up offering choice only to people who can afford it, and you end up shuffling the poor people off to the less effective local healthcare facilities and your postcode lottery is back.
Are there countries/cities you would point to that have gotten this right? (i.e. proximity of everyone to better quality care regardless of neighborhood?). I mean, some of it is just a function of where doctors prefer to live when they are successful enough to have a say in the matter. Those with a say, like all of us, probably prefer nicer neighborhoods/offices.
> My GP is 40 miles away...
Great! Everyone can afford the time and expense of travelling far away to a better GP... oh no wait that also depends on income.
Great! Everyone can afford the time and expense of travelling far away to a better GP... oh no wait that also depends on income.
Erm no it doesn't
You think I actually go and see the GP? No they call me instead and talk any problems through. I haven't been to a GP for about 10 years and have had a few appointments and referrals.
As for the transport costs, for referred appointments that's covered under HTCS if you can't afford to travel.
You think I actually go and see the GP? No they call me instead and talk any problems through. I haven't been to a GP for about 10 years and have had a few appointments and referrals.
As for the transport costs, for referred appointments that's covered under HTCS if you can't afford to travel.
> I haven't been to a GP for about 10 years and have had a few appointments and referrals.
Good for you? What about people who do need to regularly go and see their GP?
> As for the transport costs, for referred appointments that's covered under HTCS if you can't afford to travel.
What about those GP visits some people less fortunate than yourself need?
And HTCS is for extremely low-income people. It doesn't cover normal working class people's extra costs.
People less fortunate than yourself struggle to get equality in the NHS. Sometimes they don't even have the knowledge and confidence that you do to use the systems you're talking about.
Fundamentally they shouldn't be required, rather than fortunate people saying 'I'm alright Jack'.
Good for you? What about people who do need to regularly go and see their GP?
> As for the transport costs, for referred appointments that's covered under HTCS if you can't afford to travel.
What about those GP visits some people less fortunate than yourself need?
And HTCS is for extremely low-income people. It doesn't cover normal working class people's extra costs.
People less fortunate than yourself struggle to get equality in the NHS. Sometimes they don't even have the knowledge and confidence that you do to use the systems you're talking about.
Fundamentally they shouldn't be required, rather than fortunate people saying 'I'm alright Jack'.
While I absolutely agree with you in principle, it's still worthwhile for people to know that a growing number of GPs offer permanent (as in not just during covid) video consultations, and that they can choose treatment, and GPs, further away.
Though I think we agree it'd be much better if they didn't need to.
Though I think we agree it'd be much better if they didn't need to.
GP registration in England is a little bit complex.
If you live within the GP catchment area, and their list is open, they must register you and there are very limited reasons why they can decline that registration. GPs must offer certain services to this group of patients, including home visits if needed and an out of hours service (although that's often contracted out).
If you live outside the catchment area they have a choice. They can either:
register you and provide full service, or
register you but not provide out of hours or home visits, or
not register you.
Full details are in the Primary Medical Care Policy and Guidance Manual (PGM): https://www.england.nhs.uk/publication/primary-medical-care-...
If you live within the GP catchment area, and their list is open, they must register you and there are very limited reasons why they can decline that registration. GPs must offer certain services to this group of patients, including home visits if needed and an out of hours service (although that's often contracted out).
If you live outside the catchment area they have a choice. They can either:
register you and provide full service, or
register you but not provide out of hours or home visits, or
not register you.
Full details are in the Primary Medical Care Policy and Guidance Manual (PGM): https://www.england.nhs.uk/publication/primary-medical-care-...
But sometimes NHS won't pay and will forbid you from paying yourself: https://edition.cnn.com/2018/04/25/health/alfie-evans-appeal...
NHS won't forbid you from paying, such an order would come from the Courts. It's an exceptional case that a family would have this kind of rule imposed on them, but Courts will consider the patient's best interests before the family's.
Yes, the publicity around the case overshadowed that this wasn't a case about health resources, but about what was right and best for the patient.
Please do not spread misinformation – this was not a case about the health service paying for treatments. It was specifically about whether or not life support should continue to be provided, or whether doing so was inhumane.
NHS has nothing to do with electing to pay for your own treatment - people do it sometimes for elective stuff.
That was a court of law which ruled in that case (and then again for multiple appeals processes), the NHS has no such power.
That was a court of law which ruled in that case (and then again for multiple appeals processes), the NHS has no such power.
This is exactly right. Where the NHS won't pay you're free to go private. This case, and that of Charlie Gard, were quite different. The dispute was a welfare one: whether the best interests of the child (Alfie) were to be allowed to die, or to undergo experimental treatment where it was pretty clear it would have no benefit. There's quite a good explainer (which sets out why it was both complicated and emotional) in Vox[0].
But it can't be stressed enough that this was about who makes the decisions, not about who pays for care. The money was there to pay for the alternative treatment (fundraised, in this case).
The question was whether the parents have the right to make the final decision, or the courts. And English law is very clear that in the end the High Court has the power to make care decisions in place of the parents when it believes it is acting in the best interests of the child. And that extends to withdrawing care and allowing the child to die.
You may not want judges to have that degree of power. That, honestly, they exercise it extremely carefully may not be a comfort. You may think that the parents' view should always control. That's fine. But that has nothing to do with the NHS and its funding system. The same issues would arise even if the child was in a private hospital and the parents wanted to pursue futile treatment against the advice of the medical staff.
https://www.vox.com/policy-and-politics/2018/4/27/17286168/a...
But it can't be stressed enough that this was about who makes the decisions, not about who pays for care. The money was there to pay for the alternative treatment (fundraised, in this case).
The question was whether the parents have the right to make the final decision, or the courts. And English law is very clear that in the end the High Court has the power to make care decisions in place of the parents when it believes it is acting in the best interests of the child. And that extends to withdrawing care and allowing the child to die.
You may not want judges to have that degree of power. That, honestly, they exercise it extremely carefully may not be a comfort. You may think that the parents' view should always control. That's fine. But that has nothing to do with the NHS and its funding system. The same issues would arise even if the child was in a private hospital and the parents wanted to pursue futile treatment against the advice of the medical staff.
https://www.vox.com/policy-and-politics/2018/4/27/17286168/a...
>But that has nothing to do with the NHS and its funding system.
It does. It is much more legitimized to delegate these kinds of decisions to the state when the state is paying for the health care. In other words, the state paying for care is a pre-requisite to the state having the ability to make these kinds of extreme/overruling decisions about care. Otherwise people wouldn't tolerate it. The state paying for care is a power dynamic.
Consider the opposite, of a state that doesn't pay for any care, telling Alfie Evans parents that they have to take him off of life support, and tell me that you think the social reaction would be the same and people would just accept it. They wouldn't, and that shows you how much the issues are linked. Again, it's a power dynamic that increases legitimacy.
It does. It is much more legitimized to delegate these kinds of decisions to the state when the state is paying for the health care. In other words, the state paying for care is a pre-requisite to the state having the ability to make these kinds of extreme/overruling decisions about care. Otherwise people wouldn't tolerate it. The state paying for care is a power dynamic.
Consider the opposite, of a state that doesn't pay for any care, telling Alfie Evans parents that they have to take him off of life support, and tell me that you think the social reaction would be the same and people would just accept it. They wouldn't, and that shows you how much the issues are linked. Again, it's a power dynamic that increases legitimacy.
The state's parens patriae jurisdiction (where originally the King, as 'father of the country' and latterly the courts can take decisions on behalf of those who cannot take care of themselves) goes back centuries - far longer than the NHS does.
And for what it's worth, these cases are basically never discussed even outside the courts in the UK on the basis of 'can we afford it?', but rather 'is it the right thing to do?'. There are financial constraints on the NHS, particularly on the provision of care for chronic conditions and expensive new drugs with positive but marginal utility, but these kinds of 'right to life' cases are not where it bites.
And for what it's worth, these cases are basically never discussed even outside the courts in the UK on the basis of 'can we afford it?', but rather 'is it the right thing to do?'. There are financial constraints on the NHS, particularly on the provision of care for chronic conditions and expensive new drugs with positive but marginal utility, but these kinds of 'right to life' cases are not where it bites.
I don't know enough about UK history, but was the king also expected to provide for the people? In that case, I would argue that my power dynamic argument still applies. In other words, a king that provides is seen as having more legitimacy to the people over one that doesn't, and so their decisions are more willingly accepted.
Arguably they were expected to provide security against external threats, but otherwise no: any social services were the responsibility of the parish in the early history of England. National poor relief laws date to the late 16th Century, but the responsibility falls locally, not from the King. This doesn't really begin to change until the early 20th Century, with the national provision of old-age pensions. Most of the sense of the national government as directly providing for the people comes post-World War 2, not before.
There are several cases in the US where courts override parents wishes, while it's true US courts tend to give more rights to the parent than the courts in determining what's best for the child - at least for middle class parents - in Custody of a Minor (and other cases), the court held that family autonomy is not absolute.
For your "opposite" case, where a court could order removal of a baby from life support, there have been several cases in America
https://www.chron.com/news/houston-texas/article/Baby-dies-a...
"Sun's death marks the first time a U.S. judge has allowed a hospital to discontinue an infant's life-sustaining care against a parent's wishes, according to bioethical experts. A similar case involving a 68-year-old man in a vegetative state at another Houston hospital is before a court now."
For your "opposite" case, where a court could order removal of a baby from life support, there have been several cases in America
https://www.chron.com/news/houston-texas/article/Baby-dies-a...
"Sun's death marks the first time a U.S. judge has allowed a hospital to discontinue an infant's life-sustaining care against a parent's wishes, according to bioethical experts. A similar case involving a 68-year-old man in a vegetative state at another Houston hospital is before a court now."
I'm not arguing that it has never/will never happen in America. I was trying to be careful with my wording, eg "more legitimized." I think that a place where healthcare is government funded is more likely to accept decisions that other places consider overreaching by the state.
My underlying point is the power dynamic between a government and its people, and the argument that a government "providing" more things increases that dynamic in the favor of the government. This makes any decisions related to that dynamic more legitimized.
My underlying point is the power dynamic between a government and its people, and the argument that a government "providing" more things increases that dynamic in the favor of the government. This makes any decisions related to that dynamic more legitimized.
Do you have any evidence to back up your claim?
The US government provides 27% of things in the US (budget vs GDP), about the same as South Korea and Switzerland, more than Ireland (23%), less than New Zealand (32%), UK (33%), Spain (34%), but not by an extreme amount.
The US government provides 27% of things in the US (budget vs GDP), about the same as South Korea and Switzerland, more than Ireland (23%), less than New Zealand (32%), UK (33%), Spain (34%), but not by an extreme amount.
>The US government provides 27% of things in the US (budget vs GDP)
This is silly. Budget vs GDP is not how you measure how much a government provides. You're not controlling for waste.
This is silly. Budget vs GDP is not how you measure how much a government provides. You're not controlling for waste.
That was not a dispute about payment.
That’s an obscene example of government interference with family and human life. This is an extreme example but there are many more misery inducing circumstances that are by products of a single payer system wedded to government. One of the most pervasive is a general rationing of care with long delays before procedures or even basic diagnostic tests but there are others like having to be assigned a doctor or having little to no choice of hospitals or clinics. The modern world needs a system that provides options for everyone and there must be a way to structure healthcare so that those who can’t afford it still receive it while those who can are able to buy the service they want. Everyone should receive the best care but you have to allow the market to find the best solutions do everyone can benefit from them. It’s just like taxing the rich if you want to look at it that way, they shell out gobs of money to create a demand for top notch doctors and facilities and the government then legislates that those resources must also provide care for everyone in exchange for access to something only the government can provide like tax breaks etc.
This has nothing to do with the specific of the healthcare system, but about child protection measures.
The NHS had no power to stop them, and did not. The courts did because the parents were taking actions that were not supported by medical evidence.
As for the rest of what you're saying, it is also unsupported both by evidence, and by the fact that the UK does have a free market for medical treatment, one that is far cheaper than the US, and for health insurance, that is far cheaper than the US. One might argue it would be paying twice, but the NHS costs about the same per capita as Medicare and Medicaid combined, so Americans pay twice. But the NHS offers universal cover for that price.
UK health insurance is in general cheaper than in the US because there's no demand for comprehensive cover - almost all the cover is "top up" and "queue jumping" type cover that assumes people go to the NHS first and get referred private if they need something that can't be offered quickly enough by the NHS or that isn't covered.
Yet despite the low cost, only about 10% of people in the UK feel a need to obtain private health insurance.
The free market has spoken - for most it does not offer compelling alternatives to the NHS.
The NHS had no power to stop them, and did not. The courts did because the parents were taking actions that were not supported by medical evidence.
As for the rest of what you're saying, it is also unsupported both by evidence, and by the fact that the UK does have a free market for medical treatment, one that is far cheaper than the US, and for health insurance, that is far cheaper than the US. One might argue it would be paying twice, but the NHS costs about the same per capita as Medicare and Medicaid combined, so Americans pay twice. But the NHS offers universal cover for that price.
UK health insurance is in general cheaper than in the US because there's no demand for comprehensive cover - almost all the cover is "top up" and "queue jumping" type cover that assumes people go to the NHS first and get referred private if they need something that can't be offered quickly enough by the NHS or that isn't covered.
Yet despite the low cost, only about 10% of people in the UK feel a need to obtain private health insurance.
The free market has spoken - for most it does not offer compelling alternatives to the NHS.
'Family' and 'human life' does not over-ride all else, which is obvious in cases of abuse or neglect. It's more complicated when medical experts and parents disagree on what is best for the child. What you understand as the 'best care' may not be the same as what an expert in that area may understand as 'best care'.
'Everyone should receive the best care' - so how do you suggest this is best done?
'Everyone should receive the best care' - so how do you suggest this is best done?
How do they know that the dead heart will not die again? Do they repair it before transplant ?
Also shouldn't the heart be from an equally aged human?
Broadly speaking, two types of death are recognized with organ donation. Brain death, where there's no brain function at all and cardiac death, where there's no cardiopulmonary function.
Brain death in isolation generally provides the most viable organs, since it minimizes so-called "warm ischemia" time, which is the time that the organs are warm and without viable blood flow. However, sometimes patients don't meet brain death criteria strictly, or they do but the donor next of kin decides to donate after cardiac death (actually, the next of kin/family determines what the donor would have wanted and there is a strict legal/ethical precedence on what opinions count). In those cases, cardiac death is initiated by stopping life support and waiting 2-10 minutes after "death" to initiate organ harvest.
So, it's not that the heart caused death, it's just that it stopped beating, generally, due to lack of oxygen. Which means some of its cells certainly died, but by minimizing the warm ischemia time (by hooking up to a kind of life-support machine), that damage can be limited.
Patients do not have to matched strictly by age. Anatomically-speaking, body-size is the most important criterion. Obviously, matching needs to happen on antibodies/rejection and several other factors as well.
Brain death in isolation generally provides the most viable organs, since it minimizes so-called "warm ischemia" time, which is the time that the organs are warm and without viable blood flow. However, sometimes patients don't meet brain death criteria strictly, or they do but the donor next of kin decides to donate after cardiac death (actually, the next of kin/family determines what the donor would have wanted and there is a strict legal/ethical precedence on what opinions count). In those cases, cardiac death is initiated by stopping life support and waiting 2-10 minutes after "death" to initiate organ harvest.
So, it's not that the heart caused death, it's just that it stopped beating, generally, due to lack of oxygen. Which means some of its cells certainly died, but by minimizing the warm ischemia time (by hooking up to a kind of life-support machine), that damage can be limited.
Patients do not have to matched strictly by age. Anatomically-speaking, body-size is the most important criterion. Obviously, matching needs to happen on antibodies/rejection and several other factors as well.
There is always a risk that the grafted organ may fail or be rejected or even bring new problems with it (e.g. smokers can donate lungs). But the recipients are typically gravely ill, and an imperfect donor organ may provide longer or higher quality life than doing nothing.
Sone transplantees go on to live full lives for many decades. Others might need a retransplant.
But while complications may occur, the fact transplantation works at all is a minor miracle that we should celebrate.
Some patients die on the waiting list. If you haven’t already, please register to donate your organs. It costs you nothing.
Sone transplantees go on to live full lives for many decades. Others might need a retransplant.
But while complications may occur, the fact transplantation works at all is a minor miracle that we should celebrate.
Some patients die on the waiting list. If you haven’t already, please register to donate your organs. It costs you nothing.
Fascinating about the smoker lungs. I wonder if a non-smoker with aged smoker lungs ever tastes “smoke”/tobacco in the subsequent weeks/months. So many questions.
In what sense were previous heart transplants not dead? Would they only use hearts that were kept pumping right up until they were surgically removed from the donor? I thought they were previously transported on ice, and assumed their must be some period of time during which the hard was considered dead - wondering what's so fundamentally different beyond the device that circulates donor blood through the heart.
> Would they only use hearts that were kept pumping right up until they were surgically removed from the donor?
Correct. I went through this with a family member who was struck by a car and later declared brain-dead in hospital—but his heart was still beating, and thus a candidate for heart donation. We said our final goodbyes before he was wheeled away for surgery, heart still beating and looking as alive as ever. The anonymous recipient underwent surgery simultaneously in the same hospital, so presumably the heart only stopped beating for a very short period of time before it was re-started, and it continues on beating to this day (it's a funny feeling, knowing that).
Correct. I went through this with a family member who was struck by a car and later declared brain-dead in hospital—but his heart was still beating, and thus a candidate for heart donation. We said our final goodbyes before he was wheeled away for surgery, heart still beating and looking as alive as ever. The anonymous recipient underwent surgery simultaneously in the same hospital, so presumably the heart only stopped beating for a very short period of time before it was re-started, and it continues on beating to this day (it's a funny feeling, knowing that).
I think this is an important question. Donation of organs after death can happen when people are declared dead due to brain death, or when they are declared dead due to classical criteria including cardiac death.
"Donation after cardiac death", as you might imagine, seems a bit weird when the heart is the organ being donated. And so it's a recent invention for the heart (though it has been around for a long time for other organs such as the kidney[1]). There is a free access article from 2018 about the necessity and ethical considerations of cardiac donation after cardiac death in Circ: Heart Failure [2].
1 = https://health.ucdavis.edu/transplant/nonlivingdonors/donati...
2 = https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118...
"Donation after cardiac death", as you might imagine, seems a bit weird when the heart is the organ being donated. And so it's a recent invention for the heart (though it has been around for a long time for other organs such as the kidney[1]). There is a free access article from 2018 about the necessity and ethical considerations of cardiac donation after cardiac death in Circ: Heart Failure [2].
1 = https://health.ucdavis.edu/transplant/nonlivingdonors/donati...
2 = https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118...
It seems like most other hearts were removed live after brain stem death. My take is that in this process, hearts that had stopped beating in a donor due to death from other causes were revived after removal.
Another relevant point is that England has changed its organ donation policy to opt-out [1], with Scotland to follow next month. Wales is 'deemed consent', which doesn't sound too different to opt-out. Northern Ireland is opt-in.
[1] https://www.organdonation.nhs.uk/uk-laws/
[1] https://www.organdonation.nhs.uk/uk-laws/
Unfortunately here in New Zealand we have essentially neither opt in or opt out. It is technically opt in, but if you opt in they wil only take them with family consent. So in effect it requires a pre and post death opt in.
This puts grieving parents or other loved ones in a horrible position of having to make a decision concerning the person they just lost. It also means I don't have the final determination on my own organs.
There is talk about making it opt out... But that would make it even less useful when next of kin get the final say.
This puts grieving parents or other loved ones in a horrible position of having to make a decision concerning the person they just lost. It also means I don't have the final determination on my own organs.
There is talk about making it opt out... But that would make it even less useful when next of kin get the final say.
Good reminder to talk about it (and other death-related things like funeral) with your family. They're more likely to respect your wish if you told them explicitely, than if a doctor they don't know tells them "they opted in, do you consent"
Click the link, content loads, then is immediately obscured by a “we need your consent” pop up. But content had already been loaded so why can’t I just read the thing?
I have better things to do with my time. (Like whining here hahah).
I have better things to do with my time. (Like whining here hahah).
I just use Bypass Paywalls[0] and Web Annoyances Ultralist (blocks cookie banners, autoplaying videos, sticky navs). https://jameslu.substack.com/p/hide-cookie-banners-paywalls-...
[0]: https://github.com/iamadamdev/bypass-paywalls-chrome/blob/ma... [1]: https://github.com/yourduskquibbles/webannoyances
[0]: https://github.com/iamadamdev/bypass-paywalls-chrome/blob/ma... [1]: https://github.com/yourduskquibbles/webannoyances