Need a Kidney? Not Iranian? You’ll Wait | Hacker News Reader

Need a Kidney? Not Iranian? You’ll Wait

opinionator.blogs.nytimes.com

11 pointsheelhook8 comments

The article is incorrect

> In every country that does transplants — except one — patients have two legal ways to get a new kidney. One is to have a friend or relative who is a blood and tissue match donate a kidney. The other is to get on the waiting list for a deceased donor.

There are also kidney exchanges. If you have a friend or loved one whose kidney is not an exact match, they can exchange it for a matching one in an exchange market.

The NYTimes covers it some here http://www.nytimes.com/2015/05/03/magazine/the-great-america...

There is an excellent EconTalk about matching economies as well. At 10:32 in is the kidney discussion http://www.econtalk.org/archives/2015/07/alvin_roth_on_m.htm...

UCLA's kidney exchange program http://transplants.ucla.edu/site.cfm?id=112

There should be more focus on the deceased donors issue: even when a dead person explicitly stated they were willing to donate organs, the administration still asks family, and they often refuse, mostly for religious reasons. Look what happened in France when the government tried to make deceased donation the default: all the religious zelots went postal about it, and it didn't happened. As a result, people continue to die by dialysis.

The real stink is about the problems of organ donation from somebody who is dying (contrary to intuition, you cannot get an organ from a dead person, even if they've only been dead 15 minutes. Chances of success are not zero, but so low it's only done as a very last resort). So what people think happens, that when you die organs are harvested, is not what happens. Sadly, that just doesn't work in the real world. Organs are harvested from live people.

The main reason people that you want organs from die is heart failure, doubly so for young people (if you bleed to death, say a large open wound, what kills you is failure of the heart to maintain pressure in your circulatory system. Internal bleeding ? Ditto ... So most accidental deaths are heart failure. ). Things like car accidents, falling of a building, stabbings accidental and otherwise, getting shot, ... all of these generally lead to heart failure.

If you die from heart failure, at the point where your brain stops working all the organs except the heart and lungs will have failed (the body has a priority system for blood distribution : first the heart and lungs. Then, for pregnant women, the baby and the womb and muscles involved in birth, then the brain, then the systems and organs in your trunk, then your extremities. If you intend to ever have a kid, I suggest you never read the medical literature on what can happen to a woman during childbirth, and learn this by hard: NEVER, for any reason whatsoever pull on a birth cord or cut it. Just put the baby on top of the woman, cover with a blanket, wait (even if the woman is hurt or even dead, just don't take the chance).

This means that, in the very common case of circulatory failure, if you wait for a patient to die, there will be no organ transplants available from that person. So in the usual case, the decision to harvest organs must be made before the brain fails, sometimes long before the brain fails. Can be hours before the brain fails in the case of internal bleeding.

In addition to that, a number of treatments that can work to save your life in the case of heart failure, such as lowering your body temperature by a lot, or simply operating on you for a few hours, will screw up any chance of successful transplants. Therefore, for donors they are not done.

Another thing that seriously lowers the chances of successful transplantation is using anaesthetics. It is not done. Organs are harvested without any kind of pain relief.

And also here's the difference between signing a donor card and not signing it. With a signed donor card, you are a donor. It's in the doctor's hands to take the decision to harvest your organs without any consultation (given the factors previously mentioned).

Without a signed card, doctors can still harvest your organs if either you or your next of kin agrees. Doctors will have to fairly explain the situation to you (if possible) or your next of kin, and then they get to make a decision, aware of the factors above. Needless to say, almost everybody says no.

Why ? At that time, "Yes" means certain death, and cessation of all medical efforts to save your life, "No" usually means 80-90% chance of death.

Example article on the subject : http://www.wsj.com/articles/SB100014240529702046030045772699...

The WSI article seems pretty biased but ok, everybody is entitled to an opinion.

However please note that we differ on two important things:

- You seem to think that "dead" means the heart is not working anymore. For a lot of people, me included, if my brain is dead, then I'm dead, period, even if my heart is still pumping. Consequently, you misrepresent reflex (like the legs of a frog still able to have a reflex even if it's dead) with pain, which is not.

- Your "80-90% chance of death" are unsourced and seem invented, which makes me question most of your arguments.

So basically you're just against deceased donation, and that's your right, but please do not mislead people with erroneous informations.

Ironic to see a particular kind of freedom we'll likely never see in the US in a country which is less free in so many other ways.

Poor people selling their organs really doesn't qualify as "freedom" except in the most meaningless, pedantic sense.

Why not? That's a serious question; I'd love to hear your opinion.

It seems to me that if they freely consent to sell their kidney, then they'll only do it because it's a better option than not doing it. Sure, in a perfect world everyone would have enough money to survive, and there would be no need for this. But is it really ethical to deny them options?

But you are ok with the "Freedom" to die on needless waiting lists, while willing donors would be available if payment was possible?

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