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> Instead, my surgeon pioneered the idea of transplanting Hepatitis C infected livers into patients who needed transplant because of HepC-driven liver failure. His idea was that young people recently infected with HepC who die tragically are often in otherwise excellent health (HepC is a slowly progressing disease) and make good donors.

This idea saved my father's life. He wouldn't have normally qualified for a "perfect" liver, but was able to receive one that already had the same strain of Hep C, and if memory serves was also slightly fatty.

This is interesting but very, very ahead of its time. I know a couple of surgeons who have done a lot of research to prove that liver with a moderate degree of steatosis (fatty liver) is still viable as grafts, because every now and then they have had to cancel a scheduled transplant because the donor liver turned out to be more fatty than the standards would allow. They are optimistic but it would still take anywhere between 5-20 years for enough evidence to accumulate and change the view of regulators.

Interesting - actually saying yes to a transplant is a big step many people cant say yes the first time I could not for example.

I did pass on one kidney where the donor might have been hiv+ - the surgeons second line was don't worry they have really good drugs for HIV now. I still had ok kidney function so thought it was best to let some one else in worse health have the kidney.

I couldn't imagine accepting that. What about having sex? And the cost of drugs? That seems like a ridiculous options. Especially with the "might have"

Depends how ill you are - I was still managing without dialysis at that point.

There are many problems with organ donation. From moral problems with collecting organs (esp. in specific political environments, but even in the west, questions arise where doctors are paid for organs. Even when unpaid, delivering organs is very good for doctor's careers, which raises questions about decision making).

And on the receiving end there's also serious moral and practical questions. Should this organ go to A or B ? Both will die if they don't get it. It must suck badly to answer that question even if we have clearly advanced over the years. There's other issues, like what is the reward for the organ donor ? Can we allow (some) rewards ?

There's also big differences in the different possible procedures. Liver transplant and bone marrow transplant ... are merely painful for the donor. They don't result in the loss of an organ. Should we allow for compatible donor search and allow communication in these cases ? (granted, while a liver transplant is essentially a big needle in your abdomen for ~40 seconds with no ill effects, bone marrow transplant is ... very painful, even afterwards, so there's only so much sedation helps). I'd say yes. Others are resulting in the loss of a mostly redundant organ, like kidney or lung transplants, and then there's the transplants of organs that will result in the death of the donor, like heart or pancreas transplants.

It will be a very good day where we can just grow organs from a patients own cells, because they will solve essentially all the above problems, as well as eliminate most, almost all, quality problems with organs.

Err why is "delivering organs " good for a doctors career - and most organ donors (90% in the UK) are dead

Can we once and for all get that myth out of the air ? Organ donors are not dead. That'd be great ... but it's just not how the world works [1]. They are either "brain dead", or in "circulatory death" (usually referred to as "awaiting cardiac arrest" internationally) (definitions here [2]), which is not entirely unrelated but very different from dead. Most are not brain dead (if they didn't have injuries they would be expected to recover), and there is, for example, a significant chance they'd wake up if left without sedation (they have however been diagnosed with essentially a serious blood leak and cannot reasonably be expected to survive an operation. But for several hours, all that will happen is a slow and steady drop in the oxygen content of their blood (and I'm not even mentioning that at times the problem with the operation is that the infrastructure and/or personnel for an operation is not available rather than it being impossible to execute)).

You cannot transplant organs that have not been oxygenated (meaning heart beats, lungs work) for ~20 seconds. That has essentially zero chance of success. (and no, oxygenation doesn't stop when they take out the organ, obviously that's one thing they prevent from happening)

You cannot transplant most organs that have been in a body that's "brain dead" for ~2 hours. That has near zero chance of success.

So transplanting an organ from a person that has stopped breathing 20 seconds before the organ was taken out, or that stopped controlling their body 2 hours before the organ was taken out ... is no more than a death sentence for the organ receiver (even in the case of a not-immediately-critical organ, a failed organ donation procedure will weaken a receiver so much that their survival is in doubt. Kidneys ... perhaps you can suvive 2 failed donations. Anything else ... no way). In practice, in most cases doctors need to make the decision to proceed with organ donation at least 1 hour before the organs are actually taken out, and the donor body needs to function during that time (meaning heart beating, lungs pumping, at least partially operational spinal cord).

[1] https://tonic.vice.com/en_us/article/zmv853/exactly-what-hap...

[2] https://en.wikipedia.org/wiki/Non-heart-beating_donation

I started to try to explain in detail why this is wrong, but it is so incoherent I gave up.

First you say organ donors are either "brain dead" or in "ciruclatory death", but according to the Wikipedia article only a few organs can be harvested in the latter case. Then you say "Most are not brain dead". But your Vice reference specifically describes the definition of brain dead and says that two doctors must agree it has happened. Are you alleging widespread murder or merely contradicting yourself? At best, this is not supported by your references.

You say that you cannot use organs ~2 hours after brain death. That is not supported by your references.

Yes, the donor body needs to "function" as far as keeping the organs oxygenated, but that merely needs a pumping heart and a ventilator. Hearts pump on their own without any nervous system control, and the lungs carry on working because a ventilator is pumping air in and out. Spinal activity is not required.

Exactly I saw the recent stats for kidney transplants for my nhs trust and only a tiny number where from donors kept alive on ventilators.

Wanna bet that's because those stats are talking about different things. First, it's kidney transplants. Significant numbers are voluntary donors.

Second those stats are about people being kept alive a significant amount of time before the doctors considered them as donors.

Amount of organs (with the donor dying as a result, so kidney ... not a great example) with the donor being kept alive for some amount of hours before the donation ? 100%.

No they are not it was low single figures >6% or so

> Are you alleging widespread murder or merely contradicting yourself?

Look there is quite a range between these 2 options. And the 2 options, thank you very much, are obviously 2 doctors agreeing correctly, and "widespread murder". I am alleging that the basis for these decisions is important to the moral problems inherent in transplants.

Also you can link to the definition and treat it like it is as accurate as a theoretical mathematical definition, but in medicine ... it just isn't. Braindead is "irreversible brain damage", and aside from the general agreement that for a short-term diagnosis (autonomous) breathing must have stopped, as well as some reflexes, there is very little agreement on what exactly is required. Can you tell the difference between the brain not giving instructions for breathing and sufficiently damaged muscles (or a subtle mechanical problem) resulting it not much actual movement ? Not in all cases. For a long-term braindead diagnosis, it is not required that the patient has stopped breathing, and reflexes can just be perfectly fine as well. And of course, doctors are to make this diagnosis with varying (lack of) equipment. Can you tell if an EEG would be flat by testing reflexes ? I can't. Can you tell blood flow through the brain based on an EEG ? (I get that if a person is awake then yes, you can. You can't tell if a brain is at 1% or 0% of normal functioning on an EEG (even 5%). You just can't. Not possible. And a scanner to diagnose brain death is just not going to happen. Even an EEG is not always going to happen)

So doctors have to, at some point, make a guess based on very incomplete information, with all sorts of pressure. Time pressure, tiredness, lack of equipment, lack of correct information, lack of staff and indeed the effect of either outcome on their relationships and eventually on their careers. This presents moral hazards. And just saying, a doctor is not going to get fired by an hospital board if they declare an alcohol overdosed patient braindead, even if he wakes up while waiting for transplant, unless it happens repeatedly (and even then) (I'm not saying it's a positive either). And are they going to be convicted in a court ? Sure. Probably. But doctors get convicted regularly for making correct decisions so that's not a factor in the decision. Hospitals and/or insurance will take care of their defense, and any consequence.

So whilst I'm saying that in your way too extreme comparison it's obviously not anywhere close to "widespread murder", I am claiming that it's not 100% correct decisions either. For a few good reasons it's not ... for a few "can't be helped" reasons it's not ... and for a few bad reasons it's not.

> You cannot transplant most organs that have been in a body that's "brain dead" for ~2 hours. That has near zero chance of success.

I'd be very interested in any links (especially papers) that discuss this.

So would I. That runs counter to everything I've heard about the subject.

This is certainly false, and a lot of that comment is completely incoherent.

Per the original Harvard Med rules, brain death for beating-heart donors couldn't even be declared without 24 hours of ventilated observation of the patient.

Per DCI Donor Services (a large organ donation org), brain-dead patients today are regularly ventilators for several days while maintaining transplant-worthy status. The minimum turnaround for a donor is about 12 hours from brain death, since a full disease screen takes around 8 hours. And the maximum turnaround time after removal for even the shortest-lived organs like lungs is 4+ hours.

Possibly the commenter is trying to say that patients who enter unventilated brain death will cease to be viable donors within two hours? But that position is even more incoherent; the problem with unventilated brain death is that it promptly becomes cardiac death also.

That's only possible in cases of very limited braindead. "Mostly" a braindead person will have a slowly lowering heartbeat, and once it hits 20 or so, they die. This usually takes hours, not days.

Now, there's a gazillion different ways to be braindead. It can be that the spine is disconnected somewhere (in fact this is the most common reason, thank you traffic), and on the other end there is no sharp cutoff between braindead and in coma, where we see no damage whatsoever and can even be brought on by a normally unrelated disease (but often some form of poisoning is suspected). Therefore there can be very weird phenomena in a significant number of cases. Also the symptoms depend on the exact point the disconnection occurs. If it's deep in your back (10th vertebra or lower), you're dead in minutes, unless it's very, very deep (18+).

But mostly, you don't survive braindead for very long. Even an artifical "braindead" state (which is what barbiturate overdose patients die from) normally doesn't last more than 3-4 hours before death occurs, including the period where activity slows (so starting from the point the overdose was administered).

I tried to discuss this with oncologists, not organ transplants but the idea of controlled failure to buy time. They only cared about protocol etc etc..

In fairness, most patient-facing doctors have approximately zero freedom around ideas like these. For a particularly vivid lesson, it's worth checking this out: http://slatestarcodex.com/2017/08/29/my-irb-nightmare/

The short version is that a psychiatrist noticed there's a screening test for bipolar disorder which is used without any solid study backing it up. He proposed running a test; give a bunch of patients formal, full-length diagnoses, give them the screening also, and see how often they match. This is the easiest thing in the world. Both the screening test and the full diagnostic were already in use, and could be deployed without any justification. The only 'study' here was to do both and compare them.

Except. Except that this is medicine, and it's overseen by IRBs, not doctors or researchers, and there isn't a non-study treatment plan in the country that would stand up to the rules of IRBs. After a year of bureaucratic crap, our intrepid protagonist managed to scrape together a study-worthy amount of data. And then it got audited, and after another nine months, was halted for an impossible-to-fulfill list of idiotic revisions.

That was to administer an already-in-place questionnaire, without using it for diagnosis. I'm pretty sure the assignment "experiment with controlled failure in cancer patients" would drive most IRB victims to quit medicine and become subsistence farmers.

(I'm on a soapbox here, I know, and I'm sorry. It doesn't make the idea bad. But I have a lot of sympathy for why doctors would respond to research ideas like they're being asked to wrestle a tiger.)

recently there was a piece saying oncology should get a bit back to early days strategies. less bureaucracy, less layers and instead more science and more care.