[HN Gopher] Saving children's lives with world-first 'dead' hear...
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Saving children's lives with world-first 'dead' heart transplants
Author : blacktulip
Score : 68 points
Date : 2021-02-21 11:24 UTC (11 hours ago)
(HTM) web link (www.thetimes.co.uk)
(TXT) w3m dump (www.thetimes.co.uk)
| blacktulip wrote:
| twitter thread without a paywall:
| https://twitter.com/thesundaytimes/status/136340724792211046...
| sefrost wrote:
| With The Times website, if you add an extra "/" at the end of
| the URL, it will bypass the paywall.
|
| i.e. https://www.thetimes.co.uk/article/nhs-saves-childrens-
| lives...
| hkt wrote:
| Hilarious and brilliant tip, thank you!
| dm319 wrote:
| Another relevant point is that England has changed its organ
| donation policy to opt-out [1], with Scotland to follow next
| month. Wales is 'deemed consent', which doesn't sound too
| different to opt-out. Northern Ireland is opt-in.
|
| [1] https://www.organdonation.nhs.uk/uk-laws/
| teruakohatu wrote:
| Unfortunately here in New Zealand we have essentially neither
| opt in or opt out. It is technically opt in, but if you opt in
| they wil only take them with family consent. So in effect it
| requires a pre and post death opt in.
|
| This puts grieving parents or other loved ones in a horrible
| position of having to make a decision concerning the person
| they just lost. It also means I don't have the final
| determination on my own organs.
|
| There is talk about making it opt out... But that would make it
| even less useful when next of kin get the final say.
| williamdclt wrote:
| Good reminder to talk about it (and other death-related
| things like funeral) with your family. They're more likely to
| respect your wish if you told them explicitely, than if a
| doctor they don't know tells them "they opted in, do you
| consent"
| CapriciousCptl wrote:
| The device used is extraordinary. The US has been using it for a
| year and a half in adult trials. Transmedics also has devices for
| the lungs and liver. Livers and to a lesser extent lungs already
| get transplanted after cardiac death when they're judged to be
| viable-- the key being that this device could quality of those
| organs and therefore more could be transplanted! This could
| benefit a lot of people-- not just hearts!
|
| https://www.transmedics.com/ocs-hcp-heart/
| neonate wrote:
| https://archive.is/AzPtF
| macksd wrote:
| In what sense were previous heart transplants _not_ dead? Would
| they only use hearts that were kept pumping right up until they
| were surgically removed from the donor? I thought they were
| previously transported on ice, and assumed their must be some
| period of time during which the hard was considered dead -
| wondering what 's so fundamentally different beyond the device
| that circulates donor blood through the heart.
| pontifier wrote:
| It seems like most other hearts were removed live after brain
| stem death. My take is that in this process, hearts that had
| stopped beating in a donor due to death from other causes were
| revived after removal.
| carbocation wrote:
| I think this is an important question. Donation of organs after
| death can happen when people are declared dead due to brain
| death, or when they are declared dead due to classical criteria
| including cardiac death.
|
| "Donation after cardiac death", as you might imagine, seems a
| bit weird when the heart is the organ being donated. And so
| it's a recent invention for the heart (though it has been
| around for a long time for other organs such as the kidney[1]).
| There is a free access article from 2018 about the necessity
| and ethical considerations of cardiac donation after cardiac
| death in Circ: Heart Failure [2].
|
| 1 =
| https://health.ucdavis.edu/transplant/nonlivingdonors/donati...
|
| 2 =
| https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.118...
| frosted-flakes wrote:
| > Would they only use hearts that were kept pumping right up
| until they were surgically removed from the donor?
|
| Correct. I went through this with a family member who was
| struck by a car and later declared brain-dead in hospital--but
| his heart was still beating, and thus a candidate for heart
| donation. We said our final goodbyes before he was wheeled away
| for surgery, heart still beating and looking as alive as ever.
| The anonymous recipient underwent surgery simultaneously in the
| same hospital, so presumably the heart only stopped beating for
| a very short period of time before it was re-started, and it
| continues on beating to this day (it's a funny feeling, knowing
| that).
| loloquwowndueo wrote:
| Click the link, content loads, then is immediately obscured by a
| "we need your consent" pop up. But content had already been
| loaded so why can't I just read the thing?
|
| I have better things to do with my time. (Like whining here
| hahah).
| crazypython wrote:
| I just use Bypass Paywalls[0] and Web Annoyances Ultralist
| (blocks cookie banners, autoplaying videos, sticky navs).
| https://jameslu.substack.com/p/hide-cookie-banners-paywalls-...
|
| [0]: https://github.com/iamadamdev/bypass-paywalls-
| chrome/blob/ma... [1]:
| https://github.com/yourduskquibbles/webannoyances
| spyridonas wrote:
| How do they know that the dead heart will not die again? Do they
| repair it before transplant ? Also shouldn't the heart be from an
| equally aged human?
| jl6 wrote:
| There is always a risk that the grafted organ may fail or be
| rejected or even bring new problems with it (e.g. smokers can
| donate lungs). But the recipients are typically gravely ill,
| and an imperfect donor organ may provide longer or higher
| quality life than doing nothing.
|
| Sone transplantees go on to live full lives for many decades.
| Others might need a retransplant.
|
| But while complications may occur, the fact transplantation
| works at all is a minor miracle that we should celebrate.
|
| Some patients die on the waiting list. If you haven't already,
| please register to donate your organs. It costs you nothing.
| aksss wrote:
| Fascinating about the smoker lungs. I wonder if a non-smoker
| with aged smoker lungs ever tastes "smoke"/tobacco in the
| subsequent weeks/months. So many questions.
| intricatedetail wrote:
| The heart fills in a questionnaire using cut off aortas as
| bloody limbs.
| TheAdamAndChe wrote:
| This comment hurts the signal-to-noise ratio of this site.
| slovette wrote:
| This is probably THE most HN comment I've ever seen.
| [deleted]
| [deleted]
| CapriciousCptl wrote:
| Broadly speaking, two types of death are recognized with organ
| donation. Brain death, where there's no brain function at all
| and cardiac death, where there's no cardiopulmonary function.
|
| Brain death in isolation generally provides the most viable
| organs, since it minimizes so-called "warm ischemia" time,
| which is the time that the organs are warm and without viable
| blood flow. However, sometimes patients don't meet brain death
| criteria strictly, or they do but the donor next of kin decides
| to donate after cardiac death (actually, the next of kin/family
| _determines_ what the donor would have wanted and there is a
| strict legal /ethical precedence on what opinions count). In
| those cases, cardiac death is initiated by stopping life
| support and waiting 2-10 minutes after "death" to initiate
| organ harvest.
|
| So, it's not that the heart _caused_ death, it 's just that it
| stopped beating, generally, due to lack of oxygen. Which means
| some of its cells certainly died, but by minimizing the warm
| ischemia time (by hooking up to a kind of life-support
| machine), that damage can be limited.
|
| Patients do not have to matched strictly by age. Anatomically-
| speaking, body-size is the most important criterion. Obviously,
| matching needs to happen on antibodies/rejection and several
| other factors as well.
| scsilver wrote:
| I've been very impressed with Dr. Frankenstein's work.
| iso1210 wrote:
| This is the UK, so the parents would have ended up with a
| hospital bill of PS0 and an ambulance bill of PS0.
| mhh__ wrote:
| The NHS is generally pretty good at this kind of operation, the
| rot is really around things like mental health which don't fit
| a beveridge model very well
| cmehdy wrote:
| I didn't know about the name of the model, so I went on a
| quick search of the models and found this[0] short
| explanation for any other curious reader.
|
| [0] https://www.pbs.org/wgbh/pages/frontline/sickaroundthewor
| ld/...
| iso1210 wrote:
| I'd be interested in how the other systems work with mental
| health issues.
|
| That link says that US Veterans get proper healthcare --
| free at the point of use, paid for by the tax payer. Is
| that right? Last I heard it was controversial (in America)
| to give healthcare to 9/11 responders.
| rat87 wrote:
| Although there are similarities 9/11 responders generaly
| aren't veterans(former soldiers) but police and
| firefighters and medics (some overlap exists because some
| were previously soldiers before leaving and becoming
| firefighters/policemen/etc)
|
| There were several seperate laws passed to pay for their
| healthcare especially due to toxic air conditions after
| the attack
| whimsicalism wrote:
| > Is that right?
|
| Yes, although it has a history of controversial
| mismanagement/underfunding.
|
| That said, in the US, the typical story is that large,
| social welfare programs like SSA, VA, etc. were created
| in the early 20th century and remain very popular. Today,
| new similar programs are very controversial.
| moritonal wrote:
| TIL the Beveridge Model is a health care system in which the
| government provides health care for all its citizens through
| income tax payments.
| emteycz wrote:
| But sometimes NHS won't pay and will forbid you from paying
| yourself: https://edition.cnn.com/2018/04/25/health/alfie-
| evans-appeal...
| throwaway316943 wrote:
| That's an obscene example of government interference with
| family and human life. This is an extreme example but there
| are many more misery inducing circumstances that are by
| products of a single payer system wedded to government. One
| of the most pervasive is a general rationing of care with
| long delays before procedures or even basic diagnostic tests
| but there are others like having to be assigned a doctor or
| having little to no choice of hospitals or clinics. The
| modern world needs a system that provides options for
| everyone and there must be a way to structure healthcare so
| that those who can't afford it still receive it while those
| who can are able to buy the service they want. Everyone
| should receive the best care but you have to allow the market
| to find the best solutions do everyone can benefit from them.
| It's just like taxing the rich if you want to look at it that
| way, they shell out gobs of money to create a demand for top
| notch doctors and facilities and the government then
| legislates that those resources must also provide care for
| everyone in exchange for access to something only the
| government can provide like tax breaks etc.
| dm319 wrote:
| 'Family' and 'human life' does not over-ride all else,
| which is obvious in cases of abuse or neglect. It's more
| complicated when medical experts and parents disagree on
| what is best for the child. What you understand as the
| 'best care' may not be the same as what an expert in that
| area may understand as 'best care'.
|
| 'Everyone should receive the best care' - so how do you
| suggest this is best done?
| vidarh wrote:
| This has nothing to do with the specific of the healthcare
| system, but about child protection measures.
|
| The NHS had no power to stop them, and did not. The courts
| did because the parents were taking actions that were not
| supported by medical evidence.
|
| As for the rest of what you're saying, it is also
| unsupported both by evidence, and by the fact that the UK
| does have a free market for medical treatment, one that is
| _far cheaper_ than the US, and for health insurance, that
| is far cheaper than the US. One might argue it would be
| paying twice, but the NHS costs about the same per capita
| as Medicare and Medicaid combined, so _Americans_ pay
| twice. But the NHS offers universal cover for that price.
|
| UK health insurance is in general cheaper than in the US
| because there's no demand for comprehensive cover - almost
| all the cover is "top up" and "queue jumping" type cover
| that assumes people go to the NHS first and get referred
| private if they need something that can't be offered
| quickly enough by the NHS or that isn't covered.
|
| Yet despite the low cost, only about 10% of people in the
| UK feel a need to obtain private health insurance.
|
| The free market has spoken - for most it does not offer
| compelling alternatives to the NHS.
| CraigJPerry wrote:
| NHS has nothing to do with electing to pay for your own
| treatment - people do it sometimes for elective stuff.
|
| That was a court of law which ruled in that case (and then
| again for multiple appeals processes), the NHS has no such
| power.
| pmyteh wrote:
| This is exactly right. Where the NHS won't pay you're free
| to go private. This case, and that of Charlie Gard, were
| quite different. The dispute was a welfare one: whether the
| best interests of the child (Alfie) were to be allowed to
| die, or to undergo experimental treatment where it was
| pretty clear it would have no benefit. There's quite a good
| explainer (which sets out why it was both complicated and
| emotional) in Vox[0].
|
| But it can't be stressed enough that this was about _who
| makes the decisions_ , not about who pays for care. The
| money was there to pay for the alternative treatment
| (fundraised, in this case).
|
| The question was whether the parents have the right to make
| the final decision, or the courts. And English law is very
| clear that in the end the High Court has the power to make
| care decisions in place of the parents when it believes it
| is acting in the best interests of the child. And that
| extends to withdrawing care and allowing the child to die.
|
| You may not want judges to have that degree of power. That,
| honestly, they exercise it extremely carefully may not be a
| comfort. You may think that the parents' view should always
| control. That's fine. But that has _nothing_ to do with the
| NHS and its funding system. The same issues would arise
| even if the child was in a private hospital and the parents
| wanted to pursue futile treatment against the advice of the
| medical staff.
|
| https://www.vox.com/policy-and-
| politics/2018/4/27/17286168/a...
| daenz wrote:
| >But that has nothing to do with the NHS and its funding
| system.
|
| It does. It is much more legitimized to delegate these
| kinds of decisions to the state when the state is paying
| for the health care. In other words, the state paying for
| care is a pre-requisite to the state having the ability
| to make these kinds of extreme/overruling decisions about
| care. Otherwise people wouldn't tolerate it. The state
| paying for care is a power dynamic.
|
| Consider the opposite, of a state that doesn't pay for
| any care, telling Alfie Evans parents that they have to
| take him off of life support, and tell me that you think
| the social reaction would be the same and people would
| just accept it. They wouldn't, and that shows you how
| much the issues are linked. Again, it's a power dynamic
| that increases legitimacy.
| iso1210 wrote:
| There are several cases in the US where courts override
| parents wishes, while it's true US courts tend to give
| more rights to the parent than the courts in determining
| what's best for the child - at least for middle class
| parents - in _Custody of a Minor_ (and other cases), the
| court held that family autonomy is not absolute.
|
| For your "opposite" case, where a court could order
| removal of a baby from life support, there have been
| several cases in America
|
| https://www.chron.com/news/houston-texas/article/Baby-
| dies-a...
|
| "Sun's death marks the first time a U.S. judge has
| allowed a hospital to discontinue an infant's life-
| sustaining care against a parent's wishes, according to
| bioethical experts. A similar case involving a 68-year-
| old man in a vegetative state at another Houston hospital
| is before a court now."
| daenz wrote:
| I'm not arguing that it has never/will never happen in
| America. I was trying to be careful with my wording, eg "
| _more_ legitimized. " I think that a place where
| healthcare is government funded is more likely to accept
| decisions that other places consider overreaching by the
| state.
|
| My underlying point is the power dynamic between a
| government and its people, and the argument that a
| government "providing" more things increases that dynamic
| in the favor of the government. This makes any decisions
| related to that dynamic more legitimized.
| iso1210 wrote:
| Do you have any evidence to back up your claim?
|
| The US government provides 27% of things in the US
| (budget vs GDP), about the same as South Korea and
| Switzerland, more than Ireland (23%), less than New
| Zealand (32%), UK (33%), Spain (34%), but not by an
| extreme amount.
| daenz wrote:
| >The US government provides 27% of things in the US
| (budget vs GDP)
|
| This is silly. Budget vs GDP is not how you measure how
| much a government provides. You're not controlling for
| waste.
| pmyteh wrote:
| The state's _parens patriae_ jurisdiction (where
| originally the King, as 'father of the country' and
| latterly the courts can take decisions on behalf of those
| who cannot take care of themselves) goes back centuries -
| far longer than the NHS does.
|
| And for what it's worth, these cases are basically never
| discussed even outside the courts in the UK on the basis
| of 'can we afford it?', but rather 'is it the right thing
| to do?'. There _are_ financial constraints on the NHS,
| particularly on the provision of care for chronic
| conditions and expensive new drugs with positive but
| marginal utility, but these kinds of 'right to life'
| cases are not where it bites.
| daenz wrote:
| I don't know enough about UK history, but was the king
| also expected to provide for the people? In that case, I
| would argue that my power dynamic argument still applies.
| In other words, a king that provides is seen as having
| more legitimacy to the people over one that doesn't, and
| so their decisions are more willingly accepted.
| pmyteh wrote:
| Arguably they were expected to provide security against
| external threats, but otherwise no: any social services
| were the responsibility of the parish in the early
| history of England. National poor relief laws date to the
| late 16th Century, but the responsibility falls locally,
| not from the King. This doesn't really begin to change
| until the early 20th Century, with the national provision
| of old-age pensions. Most of the sense of the national
| government as directly providing for the people comes
| post-World War 2, not before.
| ealexhudson wrote:
| NHS won't forbid you from paying, such an order would come
| from the Courts. It's an exceptional case that a family would
| have this kind of rule imposed on them, but Courts will
| consider the patient's best interests before the family's.
| dm319 wrote:
| Yes, the publicity around the case overshadowed that this
| wasn't a case about health resources, but about what was
| right and best for the patient.
| nkoren wrote:
| That was not a dispute about payment.
| matthewmacleod wrote:
| Please do not spread misinformation - this was not a case
| about the health service paying for treatments. It was
| specifically about whether or not life support should
| continue to be provided, or whether doing so was inhumane.
| godelzilla wrote:
| ... and unnecessary middlemen playing casino with human lives
| (aka health insurers) don't extract a huge payday.
| intricatedetail wrote:
| Bill is included in the income tax. Funnily enough it does not
| apply to people living off shares, they truly pay PS0 or close.
| blacktulip wrote:
| Do you mean stock dividends? They are taxed - and not
| lightly: https://www.gov.uk/tax-on-dividends
| vidarh wrote:
| Well, capital gains is taxed much lower. Also combined with
| the ISA limits (20k _put into ISA 's_ each year - do it
| every year and your returns start adding up), you can get
| quite significant returns without paying tax at all. The UK
| tax system looks a lot more progressive on the surface than
| it is once you earn enough to take advantage of the various
| tax breaks.
|
| That said, few people will pay nothing - what they won't be
| paying if they live off share return (be it dividends or
| capital gains) is _national insurance_. I 'm assuming
| that's what the person you replied to meant.
|
| However that means nothing in terms of NHS funding any
| more, as NI just goes into the general treasury fund in
| practice.
|
| It's become part of a convenient fiction about UK tax
| rates, given that most people are unaware of the way NI is
| structured. In effect the "20%" marginal tax band is
| roughly 32% marginal when you factor in NI, and the "40%"
| marginal tax band is really 42%, and the 45% band is
| effectively 47%.
|
| The 20/40/45 looks a lot less progressive when it's
| actually about 32/42/47 (even less so when you factor in
| the many tax breaks those of us on the higher or additional
| rate can afford to take advantage of that lower earners
| can't)
| geden wrote:
| Dividends are mildly taxed now.
| vidarh wrote:
| Capital gains are. Dividends ends up effectively taxed
| similarly to income when you factor in that dividends are
| taxed after corporation tax. This is very intentional in
| that it closed much of the loophole of paying yourself via
| a limited company paying dividends. Still a bit cheaper but
| not much.
| uncledave wrote:
| This. I wish people would stop saying the NHS is free because
| it's not.
|
| It's _equal_ for everyone regardless of your income and that
| 's awesome as far as I'm concerned. Some others, not so much,
| particularly those who think that they shouldn't pay for
| someone else's treatment.
| chrisseaton wrote:
| > It's equal for everyone regardless of your income
|
| Are you familiar with the term 'postcode lottery'?
|
| And what impacts which postcodes you can live in? Your
| income.
| uncledave wrote:
| Yes. That's why there is the NHS Choices Framework which
| allows you to choose both GP and outpatients. My GP is 40
| miles away. My daughter is treated for her condition at
| Guys even though we're 20 miles away and there is a
| different local hospital.
|
| The postcode lottery doesn't exist unless you're dragged
| into an A&E.
| chrisseaton wrote:
| > My GP is 40 miles away...
|
| Great! Everyone can afford the time and expense of
| travelling far away to a better GP... oh no wait that
| also depends on income.
| uncledave wrote:
| Erm no it doesn't
|
| You think I actually go and see the GP? No they call me
| instead and talk any problems through. I haven't been to
| a GP for about 10 years and have had a few appointments
| and referrals.
|
| As for the transport costs, for referred appointments
| that's covered under HTCS if you can't afford to travel.
| chrisseaton wrote:
| > I haven't been to a GP for about 10 years and have had
| a few appointments and referrals.
|
| Good for you? What about people who do need to regularly
| go and see their GP?
|
| > As for the transport costs, for referred appointments
| that's covered under HTCS if you can't afford to travel.
|
| What about those GP visits some people less fortunate
| than yourself need?
|
| And HTCS is for extremely low-income people. It doesn't
| cover normal working class people's extra costs.
|
| People less fortunate than yourself struggle to get
| equality in the NHS. Sometimes they don't even have the
| knowledge and confidence that you do to use the systems
| you're talking about.
|
| Fundamentally they shouldn't be required, rather than
| fortunate people saying 'I'm alright Jack'.
| vidarh wrote:
| While I absolutely agree with you in principle, it's
| still worthwhile for people to know that a growing number
| of GPs offer permanent (as in not just during covid)
| video consultations, and that they can choose treatment,
| and GPs, further away.
|
| Though I think we agree it'd be much better if they
| didn't need to.
| matthewmacleod wrote:
| Honestly that whole system is nice idea on the surface
| that rapidly becomes a nightmare - in my view doing
| little except encouraging health inequality.
|
| One of the big problems is that "choice" is much more
| expensive for some people than others; this means that
| while I might be able to take a day off an visit a
| hospital a couple of hours away, it's much harder for
| someone who does't have access to transport, healthcare,
| funds or whatever else is required. So that system ends
| up offering choice only to people who can afford it, and
| you end up shuffling the poor people off to the less
| effective local healthcare facilities and your postcode
| lottery is back.
| aksss wrote:
| Are there countries/cities you would point to that have
| gotten this right? (i.e. proximity of everyone to better
| quality care regardless of neighborhood?). I mean, some
| of it is just a function of where doctors prefer to live
| when they are successful enough to have a say in the
| matter. Those with a say, like all of us, probably prefer
| nicer neighborhoods/offices.
| ljf wrote:
| The NHS is free at the point of delivery. https://en.m.wiki
| pedia.org/wiki/National_Health_Service_(Eng...
|
| It is not free like a free buffet.
|
| But if you have a need, and a doctor/nurse agrees, then you
| get the treatment at no cost/free.
| InfiniteRand wrote:
| The UK study seems to be the pioneer but it is worth noting that
| this procedure is also being tested out in the US now
| https://www.statnews.com/2020/01/16/heart-transplant-donatio...
|
| It's a good sign that the procedure is spreading
| emteycz wrote:
| From their page it seems like it's from the US...?
|
| https://www.transmedics.com/ocs-hcp-heart/
|
| https://www.transmedics.com/our-company/
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(page generated 2021-02-21 23:02 UTC)