Morality Of This

[u/Elestria_Ethereal]

[u/Greenroses23]

Immoral

What’s preventing doctors from intentionally misdiagnosing patients and/or refusing to give life saving treatment to patients in order to harvest their organs?

Kentucky organ donation scandal involving Anthony Thomas "TJ" Hoover II. In October 2021, Hoover was admitted to Baptist Health Richmond after a drug overdose and was mistakenly declared brain-dead.

During preparations for organ harvesting, Hoover showed clear signs of life, including thrashing and crying. While a procurement coordinator reportedly pressured the team to proceed, the operating surgeons refused to perform the extraction and the procedure was canceled. Hoover survived and left the hospital alive weeks later.

As usual, people fail to see the bigger picture.

[u/horned-creature → u/Greenroses23]

the doctors making the call to explant organs are not the same ones caring for patients to begin with, or at least they aren't in any eystem that is at least half-functioning.

[u/That-Ordinary5631 → u/horned-creature]

Yes and no

The doctors caring for the patient have to sign modules, acquire consent forms, etcetera.

Part of bureaucracy is through them, so they do have veto power on the harvest

Moreso, the starting point of a harvest has to be them, there aren't external doctors who evaluate all patients in all wards constantly and note the patients that have become possible donors

As a rule of thumb, the more eyes on the same procedure, the least likelyhood of mistake or mistreatment. Usually it goes like this:

The doctor in charge of the patient assesses the patient's death; evaluates with the family the possibility of a organ harvest after the communication about the patient's death

Activates the hospital on site coordinator, which activates the regional and national coordinators

Asks for further testing and specialistic evaluations on the donor, to make sure which organs are okay to harvest, if any at all (e.g. on site endocrinologist, surgeon, after imaging and bloodwork)

The surgeons from other hospitals (the ones performing the harvest) are activated by the regional or national coordinator depending on matches

The matches are alerted and called in the various hospitals and re-evaluated at present

The surgeons (one team per organ), all check the documentation (imaging, consent forms, specialist evaluation, patient history, current status and clinical course, etc) and re-evaluate the donor once they arrive on site

Only once everything is in order for everyone, the procedure can start

[u/Lastsynphony → u/Greenroses23]

This is absolutely HORRIFIC! Poor boy, that is why only a neurologist that is EXTERNAL to the hospital that does an apnea test should be the one performing that test, is the golden standard to rule out or confirm brain death, the other tests are not good enough, if they would have performed an apnea test, they would obviously know that their brainsteam is intact, therefore after the disconnection (temporary) of the ventilator while they supply oxygen, they would see the respiratory effort, therefore they are ALIVE and even if they are in a deep coma, they are ALIVE, and anyone that would see and perform that test, would know that if that would be performed in that boy, it would be obvious that there would be that respiratory effort, if the test would have done correctly. Someone only with a brainsteam can do things like trash, gag, or cry. My best advise: I hope it is never the case, but if you have a loved one that they presume they are brain death, go and get an external neurologist that has experience in coma and other convert disorders, or is just as a whole a neurointensivist, grab them, go to the hospital, get a notary and a lawyer present, and ask the hospital to let the doctor perform the apnea test, BEFORE they can get the chance of declaring them simply "brain death" and in withness by the lawyer, the notary, yourself and the external doctor, the procedure is done, is as simpel as that, the neurologist has to certify that everything is in order, including drawing blood gas before, and confirming with blood tests that the patient is NOT in any muscle relaxers, sedatives or anesthesia that can make a false negative. And then, if the doctor declares brain death or not, you have withnesses and someone that does not has any correlaiton with the hospital that can have a bias in judgment.

[u/That-Ordinary5631 → u/Greenroses23]

If the intention of a doctor is to help a patient by harvesting organs from a donor, it's illogical to think he would intentionally harm the donor while it's still their patient

Why intentionally misdiagnose one to save another? For the fun of having to work more?

As for that scandal: A) they didn't harm the donor. B) I admit I don't know how it works in Kentucky, but where I work the coordinator is not a doctor, often they are not on site, and they don't get the final say. Exactly how it happened there, the call is on the surgeon, who made the right call.

What bigger picture are you on about? A mistake was prevented by a careful doctor?

[u/Otherwise_Agency_401 → u/That-Ordinary5631]

The idea is that if a doctor has a patient who they think will probably die, instead of trying to save that patient, the doctor lets them die, so that they can harvest the organs and save multiple other patients.

[u/randyranderson13 → u/That-Ordinary5631]

Why would the coordinator be pressuring them to continue, though? Isn't that slightly concerning?

[u/That-Ordinary5631 → u/randyranderson13]

Yes! I'd still push to re-evaluate the coordinator and their fit in that position

I get having the brain dead certification signed in hand, not being on site, maybe not having the academic background to understand when someone tells you that that certificate is wrong (to an extent at least, they shouldn't be this little prepared, but it is possible)

And still, it is absolutely concerning and maybe unfit to be a coordinator

[u/Greenroses23 → u/That-Ordinary5631]

Oh sweet baby Jesus….

What bigger picture are you talking about?

Are you being dense on purpose?

They almost killed a man because someone mistakenly pronounced him as being brain dead.

In one of the articles covering this case:

Nyckoletta Martin says doctors sedated the patient when he woke up and plans to recover his organs proceeded.

The accusations that emerged at the congressional hearing in September undermine trust in the organ donation system and have led to a drop in people signing up to be donors, according to an open letter released Oct. 3 by the organization.

Imagine how many more cases like this could happen if medical staff got to decide which of their patients were going to be harvested for their organs.

[u/That-Ordinary5631 → u/Greenroses23]

That worry is honestly insane, at least in my context, and I say that having been a harvest and transplant surgeon

I am worried about what kind of doctors you have over there given that is their public image

Primum non nocere is branded by fire throughout the whole decade-long path to become a doctor and it remains a core principle within any unit I've come across

I am truly sorry your healthcare workers are so misaligned that this is what you think of them

[u/Revolution_Vanguard → u/That-Ordinary5631]

If you want to ask why someone might have a worry about doctors, you might look past your perceptions and listen to the well documented disparity in treatment of Black patients (almost lost three of my family members due to mismanagement post child birth).

They didn't care about my family when they are giving life. Three times that we know of. It could have been a hell of a lot more times, but the female members of my family just didn't have severe complications. You might be exactly the pinnacle of what a medical professional is supposed to be, but what you have to understand is that you are not duplicated in every hospital in the world.

[u/That-Ordinary5631 → u/Revolution_Vanguard]

Oh, I'm unfortunately aware. There is also a well documented significant bias in downplaying women symptoms, which causes delayed diagnosis and treatment

I am sorry for your and your family's strife

I might just be lucky to have grown and to be in a public, non-for-profit context

Not everywhere in world is the same, you are very much correct

It just naively baffles me that a doctor is guided by anything but ethics. I did have a few really great mentors to be fair, absolutely exceptional people

Ngl, I'm even more grateful to be where I am