
‘Bloodless’ Lung Transplants Offer Hint at Surgery’s Future - interconnector
http://www.nytimes.com/2013/02/25/us/bloodless-lung-transplants-for-jehovahs-witnesses.html?pagewanted=all
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thedufer
As good of an idea as reducing transfusions is, I can't help but think that
this is the wrong way to do it.

> He said his focus was intensified by the knowledge that if a patient died
> for lack of blood, a second life might hang in the balance — the wait-listed
> patient who would otherwise have received the organ.

Doctors should not be adrenaline junkies playing with other peoples' lives,
especially those who aren't even their patient. This looks like a pretty clear
breach of the ethics I expect from doctors.

~~~
jessriedel
There's nothing wrong with acknowledging the base motivations that drive
people so long as clear ethical decision procedures are maintained. The
typical neurosurgeons _relishes_ pressure much more than the average human,
and this is a contributor to them entering the specialty and to them being
successful at it. (My father is a neurosurgeon.) Those kind of personality
traits should be harnessed for good rather than eliminated.

This isn't to say that a doctor's decisions can't be colored. Evidence-backed,
community accepted guidelines are very desirable, as are second opinions. But
once the decision is made that someone needs surgery, I would want a guy who's
_excited_ to operate.

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obeattie
> By cherry-picking patients with low odds of complications, Dr. Scheinin felt
> he could operate almost as safely without blood as with it.

And what does he suppose the odds would be if he applied the same cherry-
picking whilst operating _with_ the option of a blood transfusion?

I'm not necessarily advocating for reliance on blood transfusions here, but
the logic (and ethics) of this seem highly questionable.

~~~
jessriedel
I think the point is that if you have few complicating factor, then the risk
of the bloodless (vs. normal) surgery is much reduced and possibly acceptable.
On the other hand, if you have these factors, then the additional risk might
be too high. I think you might just be responding to the loaded word
"cherrypicked"; the poor wording is chosen by the NYTimes, not the doctor.

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DasIch
I don't really see what is so interesting about this. As I understand it those
are just normal lung transplants, the difference is that you simply select
patients so that complications that would require blood transfusions are
minimal, to keep everyone concerned about the ethics of it happy.

It might be somewhat helpful to have doctors who are less trigger happy when
it comes to giving blood transfusion but I don't see how that is particularly
innovative or hinting in any way at the future. This only helps a couple of
not too ill people who want to keep their imaginary friend happy.

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M4v3R
You can think that this is insane, but because Jehovah's Witnesses being
stubborn about blood transfusions, much progress has been made in bloodless
procedures. Most of the time they cost less, and there are less complications
after the procedures. Even the US army was interested lately [1] in how to
incorporate these procedures.

Full disclosure: I'm a Jehovah's Witness.

[1] <http://www.youtube.com/watch?v=JAWhRqCjT9w>

~~~
jtheory
It's not insane that progress is being made -- that's pretty sensible (because
more guinea pigs = more data, and in normal circumstances patients don't
volunteer for more dangerous paths). Deciding to be the guinea pigs is...
well, not insane (people simply don't behave logically much at all, for
religious as well as non-religious reasons), but sure, somewhat foolish.

In this case, JWs are presenting themselves as the control group for
experimenting with blood transfusions... in a "study" that would be utterly
unethical.

Imagine a doctor that _refused_ a blood transfusion that would normally be
called for in a serious surgery, because the patient was part of a study and
fell into the "no transfusions even in dire need" group.

A randomized study like that is (still) impossible and unethical, but because
we have this group of people who _place themselves_ onto the higher-risk path,
doctors can test out the actual boundaries of where transfusions are needed --
and indeed, seriously advance the science.

The Jehovah's Witnesses _are_ at higher risk, and more of them will die
because of this decision, but we're getting quite useful data in the meantime.

You mentioned the Army -- medicine is also advanced by the normally-unethical
medical approaches to medicine that are required by battlefield medicine.
There's some overlap with the real requirements there, and the self-imposed
requirement of JWs refusing transfusions that actually are available -- so
certainly they'd be interested.

Now we just need a new L Ron Hubbard to invent a religion that requires
adherents to go all the way -- and always take the most-data-rich path through
medical treatment -- then we'll be making progress in leaps & bounds (though
of course more guinea pigs will die along the way).

~~~
kbenson
> The Jehovah's Witnesses are at higher risk, and more of them will die
> because of this decision, but we're getting quite useful data in the
> meantime.

The article mentions that there's some evidence that transfusions carry their
own risk. How closely has this been studied, and what are the risks? Without
accurate knowledge of that, how can we make definitive statements as to the
negative repercussions to people that opt out of transfusions?

Additionally, I fail to see how more Jehovah's Witnesses die because of this
decision, which allows the operation to continue, when the alternative is that
they don't get the procedure at all, which I believe results in death?

~~~
jtheory
Because of their decision, certainly more will die that could have lived.

The grey area, where getting a transfusion might actually be riskier than not
getting one, is what they're finding out more about. That's useful to know.

There are also cases that are not at all grey areas, where refusing
transfusions means they will die. They're still refusing them (and
unfortunately, that death doesn't provide any useful data, beyond "yes, what
we were sure would happen, happened").

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derekp7
I don't know if you can register that your organs only go to people of a
particular group (religious beliefs, for example), but if that is possible
then it would solve the ethical issue of giving an organ to someone who is a
less suitable candidate (due to them refusing other life-saving treatment in
the case of complications). Just have the various religious groups put on
their organ donation form that they are to be donated only to others with
similar beliefs.

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mikec3k
It seems bizarre that they would allow an organ transplant but not a blood
transfusion.

~~~
Tuna-Fish
They believe that the protestant canon of the bible is the inspired, inerrant
word of god, and that it should be taken literally. All commandments given
should be followed without question.

One such commandment is in acts 15:28-29:

    
    
        For it seemed good to the Holy Ghost, and to us, to lay 
        upon you no greater burden than these necessary things;
    
        That ye abstain from meats offered to idols, and from 
        blood, and from things strangled, and from fornication: 
        from which if ye keep yourselves, ye shall do well. 
        Fare ye well.
    

For them, that's enough. Since organs are not mentioned, they are A-OK.

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ars
This is what the United States was founded on. Jumping through hoops to
respect other peoples' beliefs even when they make no sense to you.

~~~
ClayM
...

as it mentions in the article, there is " a growing body of research that
transfusions often pose unnecessary risks and should be avoided when possible,
even in complicated cases".

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Mz
It is an interesting read, especially in terms of the surgeon's framing of the
ethical question. I just wish medicine focused more on helping people keep
their own organs functional. But that isn't heroic and headline-worthy. Sigh.

