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A few weeks ago a friend of mine had a motorcycle accident and tore himself up a bit. He was unconscious for about a week. During this time his parents signed away his organs in case of death. A few days after that, the doctors lost all hope for recovery and suggested that he be removed from life support. He was removed, then he died, then he was gutted.

My question is, how dead do you have to be before the MDs start eyeing your organs? I refuse to donate my organs for fear that I might be salvaged for parts before I've been given a sporting chance at recovery. Also, who all can sign a person's organs away? --Les Ware, Dallas, Texas

Sorry about your buddy, Les. Can't say as I blame you for being a little queasy about "organ harvests," as doctors call them. Even a surgeon friend of mine says they're weird.

This isn't going to make you feel any better, but chances are parts of your friend weren't very dead at all when they began dissecting him. Most likely, in fact, his heart was still beating and he was still breathing with the aid of a ventilator. If he were stone cold, his organs would have deteriorated too much to be usable.

What was dead was his brain. The classic transplant donor is an accident victim who has suffered severe head injury while the rest of him remains intact. Brain death can be determined several ways: a "flat line" EEG (little or no electrical activity in the brain), "doll's eyes" (eyes remain fixed straight ahead when the head is moved), no response to ice water squirted in the ear, etc. A neurologist and/or neurosurgeon is almost always consulted before the declaration of brain death is made.

What keeps doctors from deciding you're worth more dead than alive is the fact that the ones who determine you're transplant material aren't the same ones who stand to benefit financially from your demise. The attending physician notifies the organ bank only after he or she has decided your case is hopeless. The organ bank then notifies the transplant team, which sends surgeons out to collect the goods.

It's customary to notify the organ bank of a potential donor before the patient is legally declared dead because of the time that's required for transplant preparation. This occasionally puts doctors in the odd position of having a potential donor recover. But once in a while people in the organ procurement business really jump the gun. One of Cecil's sources recalls getting a call from a transplant coordinator who was shopping around a potential donor's parts. When asked how soon the donor would be ready, the coordinator replied, "I don't know--he's still breathing"--without the aid of a ventilator. This brought the conversation to an abrupt halt. You can't declare somebody dead if he's still breathing on his own. Fortunately transplant coordinators aren't the ones who decide about these things.

If you don't agree in advance to become an organ donor, by signing either a donor card or the back of your driver's license, donation can be authorized by your next of kin. Right of priority is set by the Uniform Anatomical Gift Act: (1) your spouse, (2) a child over the age of 18, (3) either parent, (4) any adult brother or sister, or (5) the party who will take custody of your body at death. As a practical matter, even if you signed a donor card, virtually no organ bank will take you without unanimous authorization from your immediate family.

An organ harvest ain't pretty. Time is of the essence; there may be several surgical teams, each waiting to remove a different part. So the body is simply sliced open. The blood vessels for each organ are tied off, preservative solution is pumped in, and the organ is removed. Depending on what's needed, the liver, kidneys, pancreas, corneas, and even the heart may be taken out, the heart naturally being the last to go. When everybody is done, the anesthesiologist switches off the ventilator, and you watch what's left of the patient die. The process is brutal, but the alternative is to do nothing. In that case not only does the potential donor die, so do the would-be recipients.

Art accompanying story in printed newspaper (not available in this archive): illustration/Slug Signorino.

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