

Need a Kidney? Not Iranian? You’ll Wait - heelhook
http://opinionator.blogs.nytimes.com/2015/07/31/need-a-kidney-not-iranian-youll-wait

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jweir
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...](http://www.nytimes.com/2015/05/03/magazine/the-great-american-
kidney-swap.html)

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...](http://www.econtalk.org/archives/2015/07/alvin_roth_on_m.html)

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

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invaliduser
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.

~~~
iofj
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...](http://www.wsj.com/articles/SB10001424052970204603004577269910906351598)

~~~
invaliduser
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.

------
endtime
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.

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

~~~
chad_oliver
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?

