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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Tuesday, August 07, 2007

    A Black Eye for Transplants: The case of the California transplant surgeon who directed the end of life care for his transplant donor certainly doesn't do much to advance the cause of organ donation:

    What happened in Sierra Vista's Operating Room 3 is now the subject of an unprecedented criminal case.

    San Luis Obispo County prosecutors filed three felony charges last week against San Francisco transplant surgeon Hootan Roozrokh, 33, alleging he tried to hasten the death of Ruben Navarro in order to harvest his organs.

    ...The documents paint a picture of disarray in the operating room, with some staffers concerned that Navarro was being mistreated and overmedicated by Roozrokh, one of two surgeons dispatched by the regional group that procures organs for much of Northern and Central California.

    ....For the most part, organs are not retrieved from patients until they are declared brain-dead. But that night at Sierra Vista, surgeons were attempting a different type of harvesting, known as "donation after cardiac death."

    In such situations, patients with irreversible brain damage are removed from life support. Their death is declared when their heart stops beating -- clearing the way for organ removal.

    ...According to state law and national standards, transplant physicians cannot direct the treatment of potential organ donors before they are declared dead.

    But it was clear that Roozrokh was in charge, witnesses told police.

    The patient's primary care physician says he had clearly documented in the chart that he thought the patient would live too long off life support to be a viable organ donor. That was just his opinion at the time, but in hindsight, he was right:

    Indeed, Navarro remained alive for more than seven hours after being removed from life support. His organs were not viable and were never removed.

    ....About 20 minutes after life support was removed, Roozrokh "was heard to say they needed more 'candy' " and placed an order for another 100 milligrams of morphine and 40 milligrams of Ativan -- the same doses that had been given to Navarro earlier, the police report said.

    The usual dose of Ativan is from 1/2 to one milligram; for morphine - 4 milligrams. Though both can be titrated upward as tolerated, those are very unusual doses.

    The cardiac death definition for organ donation seems to be a bit of a sticky wicket. The transplant team has to be called in while the patient is still alive and then wait for him to die so they can take the organs within a suitable time frame. That does put a lot of pressure on them to get the job done. By contrast, when a patient is brain dead, he's considered dead even while his heart continues to pump. No one has to stand around and wait for his heart to stop before they can start taking the organs. There's a lot less room for ethical slip-ups like this one.

    posted by Sydney on 8/07/2007 08:22:00 AM 3 comments


    When the American public reads stories like this one, it's too much to expect people to donate their organs without some sort of an incentive.

    Monetary incentives are illegal. But there is a legal non-monetary incentive that can get people to overcome whatever fears they have about donating their organs -- if you agree to donate your organs after you die, you'll get a better chance of receiving a transplant should you ever need one to live.

    This incentive is available through LifeSharers.

    LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. If you join LifeSharers you'll get preferred access to the organs of other members. This could literally save your life. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

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