Family wants to keep life support for girl brain dead after tonsil surgery #7

[swilla2]

I'm unclear if jahi's mom wasn't asked about organ donation. I do know that no one asked me if I wanted to donate my mother's organs. So I may be a "law" but there must also be some type of process to narrow down candidates.

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[nursebeeme]

here is some basic info on how a vent works.

she is most likely on a set rate and not breathing (on her own) above that rate. If you read the doc from the DR in the op you will see that she has no cough and there is evidence of pulmonary decline (re: secretion description in suction.. plus they had to do "pulmonary toilet" two times a day as she was not coughing on her own while at the hospital)

http://www.nhlbi.nih.gov/health/health-topics/topics/vent/howdoes.html

 

[swilla2]

Sorry for typos....was or wasn't asked....

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[Donjeta]

I'm unclear if jahi's mom wasn't asked about organ donation. I do know that no one asked me if I wanted to donate my mother's organs. So I may be a "law" but there must also be some type of process to narrow down candidates.

Sent from my DROID RAZR using Tapatalk

It seems they may have been asked about it: ¨

From Dec 16:
http://www.ktvu.com/news/news/local/girl-left-brain-dead-after-tonsil-surgery-being-ta/ncMgG/

The family told KTVU that as of Monday evening there was no decision yet on whether to donate McMath's organs for transplant.

 

[Donjeta]

If any of the nurses had asked our family it would have been fine. The answer would still have been no, but we wouldn't have been herded into a cold room and forced to wait from 1am -2am for a stranger to ask for my fathers body. At that point even if there had been any viable organs left I would have said no. It was very upsetting to be treated that way.

I'm sorry you had a bad experience. I don't know if this will comfort you but I think the reason it was a stranger and not a nurse you knew who asked you about it could have been that there are guidelines about who may approach the family about organ donation, and it's possible none of the nurses you knew were qualified to do so. The team who cares for the patient may also feel that there is a role conflict since their primary responsibility is the patient and not anonymous organ recipients.

Because of this "overwhelming" statistical evidence,2 the federal government now requires that the person who approaches the family about organ donation be an organ procurement representative or a designated requestor. Designated requestors are individuals who have completed a course approved by an OPO on how to approach potential donor families to request organ or tissue donation.3

The ethical problem with physician-initiated requests—even by trained physicians—lies in a real or perceived conflict of allegiances.9 On one hand, physicians act as the principal advocate for patients, caring for their medical needs, maintaining vital functions as much as possible and providing palliative care as life comes to an end. As a designated organ donation requestor, on the other hand, a physician seemingly acts on behalf of potential organ recipients. This conflict may undermine physicians' ethical obligation of beneficence to their patients.

The ACP "Ethics Manual" gives specific directions in certain aspects of the issue: "The potential donor's physician should not be responsible for the care of the recipient nor be involved in retrieving the organs or tissue."6 Wearing two hats raises suspicion that a physician's attention to the needs of the organ recipient will compromise the care of the donor. Families might even worry that the patient has been declared brain dead prematurely in order to harvest his organs.

Because of the apparent conflict of roles, some have suggested that formal requests for organ donations be made by personnel not directly responsible for the clinical care of the potential donor.9 Others contend that there is in fact no conflict because the physician is merely offering the option of organ donation rather than making a literal request for donation.7 When a patient is in the final stages of dying or has recently died, however, the family may be too emotionally charged to register the subtle distinction between suggesting and requesting an organ donation.

http://www.acpinternist.org/archives/2000/02/organ.htm

http://organdonor.gov/about/organdonationprocess.html

Testing for Brain Death: When the medical team has exhausted all possible lifesaving efforts and the patient is not responding, a physician will perform a series of tests, usually on multiple occasions, to determine if brain death has occurred. This is usually done by a neurosurgeon or neurologist in compliance with accepted medical practice and state law. Patients who are brain dead have no brain activity and cannot breathe on their own. Brain death is not coma. Brain death is death.

Alerting the OPO: In compliance with federal regulations, a hospital notifies its local organ procurement organization (OPO) of every patient that has died or is nearing death. A hospital gives the OPO information about the deceased to confirm his or her potential to be a donor. If the patient is a potential candidate for donation, an OPO representative immediately travels to the hospital.

Obtaining Consent: The OPO representative will search the state's donor registry to see if the deceased had enrolled as a donor. If so, that will serve as legal consent. If the deceased had not registered and there was no other legal consent for donation such as a driver's license indicator, the OPO will seek consent from the next of kin. When consent is obtained, medical evaluation will continue, including obtaining the deceased's complete medical and social history from the family.

 

[BeginnersLuck]

I saw this touching story and it made me think about all the devotion in the medical community.

A doctor entered the hospital in hurry after being called in for an urgent surgery. He answered the call asap, changed his clothes & went directly to the surgery block. He found the boy’s father pacing in the hall waiting for the doctor. On seeing him, the dad yelled: “Why did you take all this time to come? Don’t you know that my son’s life is in danger? Don’t you have any sense of responsibility?” The doctor smiled & said: “I am sorry, I wasn’t in the hospital & I came as fast as I could after receiving the call…… And now, I wish you’d calm down so that I can do my work” “Calm down?! What if your son was in this room right now, would you calm down? If your own son dies now what will you do??” said the father angrily The doctor smiled again & replied: “I will say what Job said in the Holy Book “From dust we came & to dust we return, blessed be the name of God”. Doctors cannot prolong lives. Go & intercede for your son, we will do our best by God’s grace” “Giving advises when we’re not concerned is so easy” Murmured the father. The surgery took some hours after which the doctor went out happy, “Thank goodness!, your son is saved!” And without waiting for the father’s reply he carried on his way running. “If you have any questions, ask the nurse!!” “Why is he so arrogant? He couldn’t wait some minutes so that I ask about my son’s state” Commented the father when seeing the nurse minutes after the doctor left. The nurse answered, tears coming down her face: “His son died yesterday in a road accident, he was at the burial when we called him for your son’s surgery. And now that he saved your son’s life, he left running to finish his son’s burial.”

 

[threecrazykids]

I am wondering if there are any medical professionals could lead me to some statistics on mis-diagnosis of brain death.

Obviously our doctors aren't perfect. They make mistakes. I'm just wondering how many people have actually lived after being declared "brain dead" and then it was discovered that it was mis-diagnosed.

 

[MissJ]

This has never been about organ donation. Its about brain death. No one can recover. No one.

 

[MissJ]

I am wondering if there are any medical professionals could lead me to some statistics on mis-diagnosis of brain death.

Obviously our doctors aren't perfect. They make mistakes. I'm just wondering how many people have actually lived after being declared "brain dead" and then it was discovered that it was mis-diagnosed.

6 doctors can't be wrong.

 

[K_Z]

Here's my :twocents: on why hospitals put brain dead people back on life support after the apnea test:

First of all, it's what the apnea test instructions say. You disconnect the ventilator for a while and the connect it back once the test is over or has been aborted. The purpose of the test is not to get the patient's heart to stop, it's just to diagnose whether they're breathing or not. The apnea test may or may not be the last thing that needs to be done before confirming the diagnosis of brain death and you don't want to cause the heart to stop prematurely. You might still wait for the results of the scans to come back, or you need a second doctor to confirm your diagnosis later. And once the diagnosis is done you would probably want to discuss it with your colleagues and the family before doing anything final. Also, the doctors doing the brain death diagnosis aren't the ones who decide whether the brain dead could become an organ donor or not.

In California, it's the law that after the brain death diagnosis the hospital needs to allow a reasonable time for the family to gather and to say their goodbyes, and this is independent of their organ donor status.

Good explanation, Donjeta. I'd like to add that serial examinations of the patient are required (not just one), and are conducted by separate physicians. The first examining physician has to return the patient to the ventilator, to "put things back they way they were" for the second (and any subsequent physicians) to do their examinations.

The purpose of the apnea test is to determine if the central nervous system is capable of responding to a rise in CO2. The central nervous system trigger to breathe is mediated more by increased carbon dioxide, than low oxygen (except in some extreme disease states)

Here is a sample protocol from UCSD:
surgery.ucsd.edu/.../training/protocols/Documents/APNEA_Test.pdf

 

[PoirotryInMotion]

Forgive me if this has been addressed in an earlier thread, but someone directed my attention to this article this morning, about a brain-dead person who miraculously 'came back to life' 3 days after being declared brain-dead following a heart attack.

http://chinadailymail.com/2013/04/0...d-brain-dead-awakes-after-calls-to-pull-plug/

The difference I see in this situation is, that while she did have at least 2 neurologists agree on brain stem death, she also had a heart valve tear that miraculously healed. Her recovery happened within 3 days of the medical event, too.

I do believe God can do miracles, and because I do not believe the Bible to be the 'fairytale' so many others call it, I do believe that God can resurrect the dead (eg. Lazarus, and most importantly, Christ). The only question I'd have about comparing this story to Jahi's is that

1) there seems to be no medical info published 'backing' up this story (no scans, etc.) that would give it added substance, and

2) this woman was 'raised back to life' within 3 days. Since brain autolysis occurs 3-5 days after true brain death, this would seem to fit.

Any comments, especially from the medical professionals in here? (Heading out for a short bit, but will return asap to check on your thoughts).

 

[K_Z]

Here is the California statute about organ gifts, and organ procurement:

http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=07001-08000&file=7150-7151.40

Here is the Joint Commission standards related to organ donation that are used when they inspect a facility for accreditation:

www.sharenj.org/healthcare_professionals/pdf/JCAHO Standards.pdf

The first 3 relate to the family of the donor:

STANDARD R1.2

The organization, with the collaborative participation of the medical staff, has established and implemented a policy and mechanism(s) for the procurement and donation of organs and other tissues.

INTENT OF R1.2

The mechanism addressing procurement and donation of organs and other tissues includes at least the following:
„
-Criteria for identifying potential organ and tissue donors.
„
- A mechanism for notifying the family of each potential organ and tissue donor of the option to donate or to decline to donate any organs or tissues as well as a mechanism for recording the decision.
„
-The use of discretion and sensitivity, as appropriate, to the circumstances, beliefs, and desires of the families of potential donors.

EXAMPLE OF IMPLEMENTATION - R1.2

Specially trained members of the organization’s bioethics staff act as counselors for the families of potential donors and interface with the appropriate agencies.

EXAMPLES OF EVIDENCE OF PERFORMANCE - R1.2
„
-Document review of policies and procedures or other mechanisms concerning procurement and donation of organs and other tissues.

-Contract or affiliation agreement with organ or tissue procurement agency

-Lists of potential organ donors.

-Interviews with clinical staff

-Review of patient medical records

-Interviews with patients and families

 

[threecrazykids]

Forgive me if this has been addressed in an earlier thread, but someone directed my attention to this article this morning, about a brain-dead person who miraculously 'came back to life' 3 days after being declared brain-dead following a heart attack.

http://chinadailymail.com/2013/04/0...d-brain-dead-awakes-after-calls-to-pull-plug/

The difference I see in this situation is, that while she did have at least 2 neurologists agree on brain stem death, she also had a heart valve tear that miraculously healed. Her recovery happened within 3 days of the medical event, too.

I do believe God can do miracles, and because I do not believe the Bible to be the 'fairytale' so many others call it, I do believe that God can resurrect the dead (eg. Lazarus, and most importantly, Christ). The only question I'd have about comparing this story to Jahi's is that

1) there seems to be no medical info published 'backing' up this story (no scans, etc.) that would give it added substance, and

2) this woman was 'raised back to life' within 3 days. Since brain autolysis occurs 3-5 days after true brain death, this would seem to fit.

Any comments, especially from the medical professionals in here? (Heading out for a short bit, but will return asap to check on your thoughts).

Thank you for posting this - I was directed to this article regarding someone being declared brain dead as well where they survived.

http://joemiller.us/2012/11/brain-d...ely-before-organs-were-to-be-harvested-video/

I'm not saying all of these cases are miracles, what I'm saying is, I thought I read on here before that there hadn't been ANY cases of someone being declared brain dead and living...and here we have 2.

Yes, some could say "well clearly they were not brain dead or they wouldn't have survived". Ok fine...then is the reason "no one has ever lived" from brain death is because when these people DO apparently survive brain death it's recorded as a mis-diagnosis and the number of brain deaths surviving remains at zero?

I am NOT saying that 6 doctors are wrong. What I'm asking is how do we keep finding all these articles of people who apparently survived after their families were told they were brain dead if it has NEVER happened?

 

[Karmady]

Thank you for posting this - I was directed to this article regarding someone being declared brain dead as well where they survived.

http://joemiller.us/2012/11/brain-d...ely-before-organs-were-to-be-harvested-video/

I'm not saying all of these cases are miracles, what I'm saying is, I thought I read on here before that there hadn't been ANY cases of someone being declared brain dead and living...and here we have 2.

Yes, some could say "well clearly they were not brain dead or they wouldn't have survived". Ok fine...then is the reason "no one has ever lived" from brain death is because when these people DO apparently survive brain death it's recorded as a mis-diagnosis and the number of brain deaths surviving remains at zero?

I am NOT saying that 6 doctors are wrong. What I'm asking is how do we keep finding all these articles of people who apparently survived after their families were told they were brain dead if it has NEVER happened?

~bbm

Yes, I think that's it.

ETA: I think this quote from your link sums it up.

“We are overjoyed that the young woman survived and that she is moving on after the accident,” Claus Thomsen, the hospital’s chief medical officer, said. “But we made a mistake underway and made the family believe that their daughter and sister would die.”

The hospital acknowledged that the question of organ donation should not have been raised as there were no unambiguous signs that brain death would occur.



Read more: http://joemiller.us/2012/11/brain-d...ans-were-to-be-harvested-video/#ixzz2q1XGT1IG
Read more at http://joemiller.us/2012/11/brain-d...re-to-be-harvested-video/#a82GZDMvce3uUJ6F.99

 

[nursebeeme]

do NOT sleuth dad :nono: You can discuss what is in media reports.

thank you folks.

 

[BetteDavisEyes]

I've been bothered by something since Christopher Dolan announced in the presser earlier this week that "a Catholic facility" had agreed to care for Jahi. While I'm not a practicing Catholic, I spent 12 years in Catholic school so I'm familiar with Church doctrine. Desecration of a human body is against Catholic teaching. For the living, "sins" of drunkenness and gluttony are examples of how the Church values the body as the "temple of the Holy Spirit". The same respect is due the deceased, and there is specific doctrine regarding the proper disposition of human remains.

Ethical and legal arguments have been presented with regard to the medical procedures that were performed on Jahi after she had been declared brain-dead. If Dolan was truthful when he said that a Catholic facility is caring for Jahi, it baffles me no end that a Church-affiliated institution would participate in what is obviously desecration of the teen's body. :moo:

 

[Donjeta]

Forgive me if this has been addressed in an earlier thread, but someone directed my attention to this article this morning, about a brain-dead person who miraculously 'came back to life' 3 days after being declared brain-dead following a heart attack.

http://chinadailymail.com/2013/04/0...d-brain-dead-awakes-after-calls-to-pull-plug/

The difference I see in this situation is, that while she did have at least 2 neurologists agree on brain stem death, she also had a heart valve tear that miraculously healed. Her recovery happened within 3 days of the medical event, too.

I do believe God can do miracles, and because I do not believe the Bible to be the 'fairytale' so many others call it, I do believe that God can resurrect the dead (eg. Lazarus, and most importantly, Christ). The only question I'd have about comparing this story to Jahi's is that

1) there seems to be no medical info published 'backing' up this story (no scans, etc.) that would give it added substance, and

2) this woman was 'raised back to life' within 3 days. Since brain autolysis occurs 3-5 days after true brain death, this would seem to fit.

Any comments, especially from the medical professionals in here? (Heading out for a short bit, but will return asap to check on your thoughts).

A bit more medical information here. NB: it's a blog site so take it or leave it.

http://citizenswatch88.blogspot.com...howComment=1365917826194#c2399882102700788500

 

[janx]

Dolan is attempting damage control. See this video:

http://www.nbcbayarea.com/news/loca...Jahi-McMath-Case-Death-Threats-239538201.html

 

[Donjeta]

Thank you for posting this - I was directed to this article regarding someone being declared brain dead as well where they survived.

http://joemiller.us/2012/11/brain-d...ely-before-organs-were-to-be-harvested-video/

I'm not saying all of these cases are miracles, what I'm saying is, I thought I read on here before that there hadn't been ANY cases of someone being declared brain dead and living...and here we have 2.

Yes, some could say "well clearly they were not brain dead or they wouldn't have survived". Ok fine...then is the reason "no one has ever lived" from brain death is because when these people DO apparently survive brain death it's recorded as a mis-diagnosis and the number of brain deaths surviving remains at zero?

I am NOT saying that 6 doctors are wrong. What I'm asking is how do we keep finding all these articles of people who apparently survived after their families were told they were brain dead if it has NEVER happened?

A good question.

Some cases have been falsely diagnosed.

Some of these brain dead people who woke up were probably never diagnosed as brain dead IMO. The articles that only quote information from the family may be misleading, and if you'd dig deeper you'd find that the person was in a coma or considered PVS and the family were told that the prognosis was bad and the person would probably never wake up and maybe asked about organ donation, and took that to mean that it was brain death although it wasn't. Some might honestly not understand the difference. Some sources may be intentionally misleading because it serves their agenda (eg. anti-organ donation).

Some cases might have been miracles. But I suppose if there was a real world actual miracle and God resurrected a brain dead person the medical community would generally tend to think it was a false diagnosis. Brain death is by definition irreversible and if someone's condition gets reversed it couldn't have been brain death according to the diagnostic manuals (which don't take divine intervention into account). Individual practitioners might think it was a miracle, depending on their religious views. But ICD-10 would say it was something else.

 

[janx]

I've been bothered by something since Christopher Dolan announced in the presser earlier this week that "a Catholic facility" had agreed to care for Jahi. While I'm not a practicing Catholic, I spent 12 years in Catholic school so I'm familiar with Church doctrine. Desecration of a human body is against Catholic teaching. For the living, "sins" of drunkenness and gluttony are examples of how the Church values the body as the "temple of the Holy Spirit". The same respect is due the deceased, and there is specific doctrine regarding the proper disposition of human remains.

Ethical and legal arguments have been presented with regard to the medical procedures that were performed on Jahi after she had been declared brain-dead. If Dolan was truthful when he said that a Catholic facility is caring for Jahi, it baffles me no end that a Church-affiliated institution would participate in what is obviously desecration of the teen's body. :moo:

"If Dolan was truthful..." A big IF, wouldn't you say? :seeya:

Here's a link from NBC on the subject of the Catholic Church and Jahi's condition from some time ago:

http://www.nbcbayarea.com/news/loca...-Jahi-McMath-With-Jesus-Christ-239314591.html