Saving children’s lives with world-first ‘dead’ heart transplants
thetimes.co.uk
thetimes.co.uk
I have better things to do with my time. (Like whining here hahah).
[0]: https://github.com/iamadamdev/bypass-paywalls-chrome/blob/ma... [1]: https://github.com/yourduskquibbles/webannoyances
"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...
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).
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.
It’s a good sign that the procedure is spreading
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.
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.
i.e. https://www.thetimes.co.uk/article/nhs-saves-childrens-lives...
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)
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.
Are you familiar with the term 'postcode lottery'?
And what impacts which postcodes you can live in? Your income.
The postcode lottery doesn't exist unless you're dragged into an A&E.
Great! Everyone can afford the time and expense of travelling far away to a better GP... oh no wait that also depends on income.
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.
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'.
Though I think we agree it'd be much better if they didn't need to.
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-...
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.
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.
[0] https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...
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.
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.
There were several seperate laws passed to pay for their healthcare especially due to toxic air conditions after the attack
That was a court of law which ruled in that case (and then again for multiple appeals processes), the NHS has no such power.
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...
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.
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."
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.
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.
This is silly. Budget vs GDP is not how you measure how much a government provides. You're not controlling for waste.
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.
'Everyone should receive the best care' - so how do you suggest this is best done?
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.