Organ donation - When is a person really dead?

For a long time I thought that the definition of "death" was quite simple. My heart stops beating and then that's it.
But at least since 'Grey's Anatomy', I know better.

The definition of death, who owns it?

Is this a medical or religious question or both? Who has the sovereignty over this term?

The answer is simple: not a priest, but a doctor, determines death. I only know habits and rituals like "spreading holy water by a priest" from movies. This topic is actually a rather strong piece, that the orthodox medicine was the only one with the relay in its hand that crossed the finish line and left other theories and views far behind.

I never used to be concerned with questions like that.

They became important when I myself was confronted with death. The fact that I had no idea and only "just before I got close" to dealing with the questions and topics behind it seems to me very strange today. Almost stupid. One aspect of dying is organ donation. That's what this article is about.

Since my mother died last year, my vision has changed. For me, dying has meanwhile taken on a different dimension, which is about approaching this topic not only on a spiritual but also on an informative level.

My mother died at the age of eighty-six. At this age, no one at the hospital will tell you whether the patient is an organ donor or not. If my mother had been forty years younger, things would have been different. I found it rather strange that none of the doctors told us relatives that my mother was dying - considering she suffered a lung embolism plus various other serious illnesses. On the contrary, after about four weeks we were ordered to be discharged and asked to look for a place in a retirement home for her - it was clear to us that they wanted her bed and that nothing more could be done anyway.

The presence of doctors in the field of organ donation was not noticeable, as they make usually predictions about the survival of patients. I was angry at the idea of having to find a nursing home for my mother in a hurry. In my opinion, she would have belonged to a hospice. She died one day before she was released. I do not want to talk about my dissatisfaction and the grief with the way in which people in this hospital deal with the dying and relatives.

Cinema reality

Rather, I would like to say that the subject of organ transplantation and, as we see it today, due to the banishment of the topics of 'death' and 'dying', is "marketed" on a one-dimensional scale. There has been a certain amount of gullibility about organ donation. This rejection of death - as a taboo - began long before the possibility of transplanting organs.

I say this because I myself had thought for some time that after my death I would certainly help those who need my organs to be able to live on. However, I had not obtained a concrete idea or verifiable information about it, so I had "decided" very superficially. It was a spontaneous opinion rather than a real examination of my inner attitude and the facts.

I had this view because the public opinion is superficially talking or reporting about organ donation, at most there are heart-breaking documentaries about rescued children who have received a kidney or liver. I have confused the good doing about the subject from headlines and doctor series, somewhat quickly with reality; like everything that was consumed by the media in general, which I thought I could cleanly separate from what I called 'reality'. This is not the case, of course. I did not perceive reports of any other kind and if I did, I did not want to burden myself with such uncomfortable information.

This is different now. The fact that I dealt with death as though it did not affect me is much older than the modern age of medicine in which I move. However, this has to do with how I deal with medicine and technology today, in the present.

Transplantation Act

I did not know, for example, that the organs that someone is willing to donate must be in a body that is still alive (!) and that death cannot be caused by natural death, because if the organs are reused, the donor's life must be preserved until the doctors' schedules makes it possible to remove the organs.

It is thus the case that organ donation can only be successfully carried out if the patient is still alive - in other words, his or her vital functions are retained. If the patient dies, you can't use the organs anymore.

What does this mean?

It means that death logically occurs on the operating table respectively is caused there.

Where relatives have no access and cannot accompany the dying process. If I imagine that I am lying in a hospital bed and being told about myself, that I am very likely to die and that I may not be able to move and make myself understood, I can also imagine that I would no longer be entirely in agreement with my decision to donate organs.

In the event that I had no chance of survival, I would want the life support measures to be stopped - but these measures in particular must not be stopped, because my organs would then die with me. It takes my brain death - my patient rights end there.

Would I only be allowed to live further on if it were necessary for my to be donated organs and not for me? If I were in a coma, would that mean I wouldn't be able to get a sense of what's going on? But what if I do? Is there a guarantee that death of the brain really does not make the rest of my body feel anything?

What does "brain death" actually mean?

I know that science cannot really define consciousness. There is simply no universally accepted definition and no fixed 'place' for consciousness. My consciousness doesn't seem to be in the brain or anywhere else in my body.

"Consciousness is the state or quality of awareness, or, of being aware of an external object or something within oneself. It has been defined variously in terms of sentience, awareness, qualia, subjectivity, the ability to experience or to feel, wakefulness, having a sense of selfhood or soul, the fact that there is something "that it is like" to "have" or "be" it, and the executive control system of the mind. In contemporary philosophy its definition is often hinted at via the logical possibility of its absence, the philosophical zombie, which is defined as a being whose behavior and function are identical to one's own yet there is "no-one in there" experiencing it.

Despite the difficulty in definition, many philosophers believe that there is a broadly shared underlying intuition about what consciousness is. As Max Velmans and Susan Schneider wrote in The Blackwell Companion to Consciousness: "Anything that we are aware of at a given moment forms part of our consciousness, making conscious experience at once the most familiar and most mysterious aspect of our lives." (Source: Wikipedia)

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Consciousness research touches many areas and should not only be dominated by conventional medicine or the natural sciences.

I wondered how a physician could 'know' that someones consciousness was gone. I also dealt with the fact that even if brain death makes me insensitive to pain, my consciousness - of which I don't know whether it is still there or not - can still feel horror. Finally, I can cry when I look at a sad film and that, although I know that I am watching actors and my sadness was triggered by an illusion. A dream makes me feel horror.

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"While in the case of a classical anesthesia, in the case of a non
brain-dead patients the consciousness and the sensation of pain
be eliminated by blocking central receptors (must be), are no longer necessary after the detection of brain death
pain prevention measures, because with the onset of the
brain death the sensation of pain as well as consciousness
is irreversibly extinguished"

Page 28 - note: it's German/ English sites you'll find down below (http://www.ethikrat.org/dateien/pdf/stellungnahme-hirntod-und-entscheidung-zur-organspende.pdf)

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I consider the formulation of an "irreversibly extinct consciousness" in the paper of the German Ethics Council to be extremely daring and reject it for my sake. As I also find many other points as not sufficiently illuminated and perceive the language used for an ethics council to be too cool and distanced.

I have learned from medical measuring devices that they are always as good and reliable as the state of the art makes this possible and definable. I should be aware of the interests of those involved in interventions in hospitals.

The longer I think about brain death, the more absurd it seems to be to determine the onset of death.

It seems appropriate to me to call someone dead only when there are clear signs of death on the body, skin and face of a deceased person. For example, the rigidity of death or spots that only appear after a person's death. I also consider it inappropriate to denigrate all the feelings and experiences of relatives into the realm of superstition or sadness, which say that they could still feel the presence of a deceased relative in space.

Whether this is true or not is not relevant to me as long as it is meaningful to people who consider this experience important.

I think and have experienced that dying is a process and not an ad hoc event. Still alive in one minute, dead in the other.... dead? No, that's just not true.

The process of letting go of life is one that can drag on for months, weeks or days, depending on the cause of death.

Especially for those who die as a result of an accident, it seems to me of even greater importance that the suddenness of death makes it immensely important and must take place for the relatives.

However, anyone who dies in an accident and has an organ donor card will be included in the procedure of the organ removal procedure. The situation is therefore particularly sensitive, in which an accident victim is admitted alive to the intensive care unit of a hospital and immediately connected to the life-supporting equipment.

How can one determine whether a person can breathe independently?

I researched this: by turning off artificial respiration and seeing if the patient is able to breathe on his own. What do you have to imagine in a hospital? Are such experiments carried out with great care and sensitivity? Is there anyone with these relatives? How about finding out after removing the ventilator that the patient does not breathe by himself? And is it enough to test this once? Wouldn't it be necessary to repeat this test continuously and see whether something has changed? To carry out such attempts on a helpless person alone means that he is panicked if he is unable to breathe on his own.

Should we not allow a few weeks to pass before the patient's relatives have been given the opportunity to calm themselves down, attend regular visiting times or even stay in the patient's room for a long time, so that the patient can feel that someone who knows him well is taking care of him or her and is able to perceive the presence of one or more people - even if he or she is unconscious?

No matter how badly injured or comatose I am, I would definitely want to get the opportunity to feel visits and times of my relatives, no matter if they would say to me that I don't notice this!

I would attach great importance to it - as if I were awake - that I be treated as appropriate to my human dignity. I would need time to recover, to become aware of my situation, to realize that I am badly injured and that my life is in danger.

Everything should be the same as for a person with an alert consciousness or someone who is able to articulate.
One only has to imagine how a person who is in a coma wished to experience his situation while awake. It will be assumed that it would take a person a few weeks to get used to the fact that he is irreversibly injured - some may take months, some even years - because of how quickly or slowly the relatives want to let go of the dying person and how much the dying person is alive. One should assume this in doubt (!). In fact, I would find it absurd to think that there are people who would immediately comply with their fate and say:"All right. I'm badly hurt, and I'm probably doomed to die. Don't worry, so you might as well get me ready for organ donation now."

I don't live in a world that embraces death so joyfully and surrenders to it.

On the contrary, it looks more like death is an enemy.

Why there are relatives who release their deceased children for organ donation shortly after brain death has been detected may have something to do with the fact that they are in a state of great shock and that they cannot yet deal with the fact that their child has to die at all. All decisions in connection with organ donation that such parents have to make cannot actually be taken by them. It would take more time and time to get used to the idea that death may be inevitable. I explain why parents are urged or guilty of not donating their child's organs and thereby causing other children to "die", with lack of compassion and blunting. The medical reasons for acting quickly are on top of it.

That brain death is not as clear as I thought it was, has been demonstrated to me by my investigation and research.

Dead men who move

Taking organs from a person who is not dead - if you really (!) imagine it - gets something cruel, something completely unspeakable. Because someone is not dead (!) when he comes to the operation to present his warm, perfused and oxygenated body to the surgeons. If he were dead, his organs would be unusable. It is also strange that there are countries and corresponding provisions where the deceased are narcotized, as it has happened that the "dead" have moved their legs or arms, their blood pressure has risen or they have begun to sweat when they were strapped on the table and ready for removal. This is based on "spinal reflexes". An information campaign should contain all the details and distasteful details.

Consequently, it is a kind of trick to get the uninformed population, the relatives and probably even the doctors themselves to be able to carry out the necessary administrative acts, procedures and actions at all.

What about the use of language?

It is irritating if I don't use the word "donor", but I have to think about whether I say "deceased" or "dead" when the "body", which is still alive, is pushed into the operating room for organ removal. When I was writing, I had the feeling that I was cheating around something important if I only used the term "organ donor".

How do those who open a donor feel

How can people cut open other people with a scalpel who are strapped down in front of them still warm and pink, with functioning heartbeats and other signs of life (in Germany there is no need for narcotization), cut out their liver, kidneys, lungs, heart, eyes, bones and other parts of their bodies and fill the bloody emptiness - with what? Can you do that without having certain emotions? I can imagine that it is possible not to consider the person lying in front of you as such. You even have to have a different relationship than with a human being, more like a thing.

Examination of dead bodies with the Buddhists

In this context, it occurs to me that the ordained Buddhist monks had a tradition - I don't know if it exists in India or in other Buddhist countries - of looking at dead people or corpses in various stages of decay as often as possible. This has the background to face death in life, to get used to losing the shyness and disgust about it by getting used to dead people and to refer to the different processes of decomposition to the extent that one can say: That's how I will die, too. I will look like this after three days, my body will be decayed after one month and half a year.

The habitual confrontation with death and the human remains has nothing to do with dullness in the Buddhist tradition and not with lack of compassion. Compassion and habit are perfectly compatible. They even fit together very well. Without compassion, habit is a rather dangerous affair for those who take care of people through their medical skills.

Clothed under the ground
I have often thought about her body in the grave since my mother's death. I feel uncomfortable when I imagine the details. How far the wooden coffin shields the decay. That my mother's clothes and the clothes on the coffin, which are not made of natural materials, actually damage the ground. That it's very dark there. I wonder if the skin's already gone. Whether there's only bone left. How far nature has gone in her work. I want to get rid of introducing her to me in her black and white costume.

This being dressed as if dressed for everyday life... even though it's in the ground... somehow I don't think it's right. It's like putting a dead person in a room where he's waiting for his tea. I would find it more appropriate if my mother's body had been buried and burned on a boat or high frame, for example. So that I would have waited there for several hours. A few hours over the day of the funeral would have spent with saying goodbye. Maybe two or three days with a ceremonial after that.

I am missing some important trials related to her death.

Rite & Appropriateness
All in all, I find both the preparation for death and the way of dealing with it inadequate. I think our civilization is very bad at this. I miss rituals, appropriateness and dignity. I miss self-confidence and habit. I miss sovereign people who leave no doubt in their authority. I was - although I am not a churchgoer - very grateful for the pastor. He was one of the few people who were sure of themselves.

accountability

I will not donate any organs and will not allow foreign organs to be planted inside me if I should get into such a situation. I do not think it should be expected of me, my relatives or the workers in a hospital to burden themselves with such a responsibility. The responsibility that we all have to shoulder here is enormous. I might have a different attitude to it if I felt like I was living in an environment that handles it differently. Basically, I do not think that people who want to keep death out of their lives are in a position to address such a big and important issue as the government is doing through its legislation (transplantation law and organ donation campaign launched since 2012).

However, the fact that transplanting organs has become possible at all has made it necessary to make such decisions.

The effects of the transplantation application are present and will be increased.

The conditions we create to sustain or prolong a life do not, of course, protect us from the ultimate death. The "earlier" was replaced by "later".

Why should I be better able to let go of the people who are close to me in three, five or ten years' time than if I were to die next month? Probably because I am now - at this hour - closed to the subject of dying. If I look at it that way, I would not have gained anything by prolonging my life if I did not feel the willingness to accept my life as finite.

Perhaps there is a situation in which a person who has received an organ starts to become friends with death and needs this time as a living being, and perhaps even this drastic experience to lead himself to this subject.

I suspect that no one with a donated organ will ever be the same again. The consequences of the operation and the confrontation with the subject matter always intervene in his further life and influence his thinking and feeling. The medications that people have to take throughout their lives will always remind them that part of their body has been replaced. Perhaps then the "agreement" with the company will apply.

In this way, we are creating something like an irreversible situation in our civilisation.

The legislator has long since decided that transplants should be legal. That's why it has become a personal question: Do I want to be a donor or not. It would be wise to discuss this with yourself.

I am thinking of a future that does not necessarily affect myself, but rather those who come after me and what it will mean if we have an organ donation practice that would be enforced by the population without further consent, because at some point the habit of organ donations will become a customary law. What would this mean for people? Is anyone who dies with semi-healthy organs considered a potential donor?

Already today, the majority of deaths are not at home but in a hospital.
If it is not obvious that dying would then be reduced even more than it is at present to a medical process - putting the loved ones in second place.

Let's assume that well over half of the population carries an organ donation card.

What would the hospital staff focus on as soon as someone is admitted as a severely injured emergency? What are the consequences if someone has an operation appointment in hospital without being an emergency and is known as an organ donor? How would the surgeons treat him and operate knowing that he is? What lists would there be in the databases of a hospital and would not all organ donors be checked and compared in terms of the quality of their organs, which would be accepted as patients?

If we did not have an exceptional organ removal practice - as is the case at present - how would this become noticeable in the databases or medical records? There is a high probability that there would be an extensive range of information to be filled in which the donors and their organs and all the details of this information would be relevant.

We can see from the example of the immensely increased Caesarean sections, where a normal practice of cutting can lead. That natural processes are interrupted, influenced and calibrated for their economic efficiency.

We have already reduced the start of life to hospital births - except for two percent of women who have their babies at home or in the birth centre.

Mourning and shock are not a good basis

Making decisions in situations where we are usually incapable of making decisions without prior discussion is tricky. If someone threatens to die, we're in grief or shock. We are plagued by strong fears or pain. This makes us vulnerable and encourages careless or awkward decisions, which may be regretted afterwards. Or who produce so many feelings of guilt that the consequences of it are serious. Not only are we dealing with physical problems, but also with psychological problems. I was wondering if I consider this a good basis.

Provide security

I made my own decision - it's in my wallet as a negative organ donation tag where anyone can find it if something should happen to me. My view of life and death tells me that I have to bear the actions and omissions of my previous life choices and I will continue to bear them.

My relatives need to know how I feel about life support measures, just like organ donation.

They should not have to make these difficult decisions for me if they have doubts about my will. I want to be able to give and receive security in it. Ultimately, a superficial conversation does not provide this security. Clear statements of will are therefore necessary for everyone.

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Sources in English:
Uniform Anatomical Gift Act
https://en.wikipedia.org/wiki/Uniform_Anatomical_Gift_Act

http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=LEGISSUM:c11578

http://eur-lex.europa.eu/search.html?qid=1507553804351&text=transplantation%20act&scope=EU_SUMMARY&type=quick&lang=en

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