As They Lay Dying: Terminally Ill and Organ Donation

…W.B.’s life was turned upside down by the diagnosis. But once the initial shock passed, he began researching his condition intensively. He learned that he was unlikely to survive five years, and that in the meantime his quality of life would diminish dramatically. With limited options, many patients retreat. But, quite bravely, W.B. had other ideas. After much consideration, he decided that if he was going to die, he would like to try to save another person’s life in the process, even if that person was a stranger. And so last May he approached the University of Wisconsin’s transplant program, where we are surgeons, as a prospective organ donor.

…From the earliest days of transplantation, surgeons subscribed to an informal ethical norm known as the “dead-donor rule,” holding that organ procurement should not cause a donor’s death. In practice, this meant waiting until patients were by all measures completely dead—no heartbeat, no blood pressure, no respiration—to remove any vital organs. Unfortunately, few organs were still transplantable by this point, and those that were transplanted tended to have poor outcomes by today’s standards.

Source: As They Lay Dying

The medicine, the US in this article particularly, operates in a strange paradox – we uphold the right to patient autonomy in nearly every situation… Except when an otherwise (legally) competent individual chooses a care option that involves the outcome of death/disability by intervention. Physician-aid-in-dying and this particular case are examples of decisions made by terminally-ill people where we interfere with their right to self-determination.

I don’t stand on a political soapbox – everyone gets an opinion and a vote – but rather an ethical one.

If we can not cure, what are the boundaries of what we do to palliate? What if we are able to simultaneously palliate (psychologically or physically) one patient, while providing an invaluable service to another? Is it truly against the spirit of the Hippocratic oath to provide psychologically and spiritually meaningful interventions at the expense of the physical body?

I personally am of the mind that if the patient and physician enter into a trusting and respectful relationship, that these questions can only be answered/defined within the context of that particular relationship.


The Math of Organ Donation: Kidneys are an NP-hard Problem

We’re bilaterally symmetric organisms—we’ve got matching bits on our left and right side. But many critical organs are present in only a single copy (hello heart) or we need both to function optimally (see: lungs). The kidneys are rare exceptions, as your body gets by just fine with only a single one. That has enabled people to become living kidney donors, with both the donor and recipient continuing life with one kidney.

Often, in cases where someone needs a transplant, there is a relative willing to make this sacrifice, but unable to do so because they aren’t a close enough tissue match, which would lead to the organ’s rejection by its new host’s immune system. Separately, there are some rare individuals who are simply willing to donate a kidney to an unknown recipient. So the medical community has started doing “donation chains,” where a group of donor-recipient pairs are matched so that everyone who receives a kidney has a paired donor that gives one to someone else.

That, as it turns out, has created its own problem: given a large pool of donors and recipients, how do you pull a set of optimized donor chains out? It turns out that the optimization belongs to a set of mathematical problems that are called NP-hard, making them extremely difficult to calculate as the length of the chain goes up. But now, some researchers have developed algorithms that can solve the typical challenges faced by hospitals with the processing power of a desktop computer.

Source: The math of organ donation: kidneys are an NP-hard problem

This is an article for why you did that math in high school/post-secondary 😉