The Power of Pacemaker Donations

The good news for developing nations is that many are beginning to get some of the infectious diseases that have long plagued their populations under control.  Unfortunately, the burden of disease is shifting to chronic diseases.  Of particular concern is cardiovascular disease.  From 1990 to 2020, it is expected to increase by 137%.  It is impacting people in developing countries at younger ages than here which affects their economic productivity and therefore the well being of their families.  

In the United States, when someone develops a heart condition, pacemakers and defibrillators (ICDs) provide fairly easy remedies.  In developing nations these devices are not an option when they cost upwards of $8,000 and the average wage is between $50 and $100 a month.  It is estimated that 1 to 2 million lives could be saved or enhanced with a pacemaker or defibrillator.  

“How can we get these people pacemakers?”  you may be asking yourself.  Well, there is something we can do to help.  People may opt to donate their pacemakers.  A study conducted by the University of Michigan Cardiovascular Center found that 90% of their participants would be willing to donate their device to be sent overseas, but few knew that the option existed or how to go about doing so.  If a person is receiving a device upgrade (i.e. from a pacemaker to a defibrillator) and the device has enough battery life left, a patient can request to have the device and donate it to charity.

More after the jump.
Just as people having wills and advanced directives, they can have living wills for pacemakers with directions on how to handle the device post-mortem.  These living wills are unofficial documents through which a person can designate what she wants done with her device after death, including donating it to charity.  Furthermore, it is not infrequent for funeral homes to have devices sitting around which they have removed prior to cremation since the device will explode when heated to high degrees and damage the crematorium.  Funeral home directors may also ask families if they would be willing to donate the pacemaker of a loved one to send overseas.  

There are a few options for people wishing to contribute to the cause.  Currently the Penn Bioethics Society is collaborating with Dr. James Kirkpatrick in collecting devices, analyzing their battery life and handing them to doctors who go overseas and will implant the devices directly.  Project My Heart Your Heart of the University of Michigan is also collecting devices in a project for the study of these devices overseas.

If you are individual who wishes to donate your pacemaker, be sure to include it in your living will and tell your family members your wishes.  If you are a Funeral Home interested in participating in the collection, we would be happy to send a representative to pick up the devices.  Please contact Chelsea Ott with any questions.  

Words Can Kill!

Hearts have their own natural biological pacemaker that allows them to beat on their own accord even when the brain dies.

— Robby Berman

People don’t like to talk about death. But I can’t help it. It’s my job. I encourage Jews to donate organs upon death to the general public. It is a difficult profession and journalists are constantly making my job even tougher. Recently a four-month-old Israeli baby boy died. Some Israeli media reported he died on Friday while others reported he died on Sunday. Why were they confused? Because his brain died on Friday and his heart died on Sunday.

More after the jump.

Hearts, yours and mine, have their own natural biological pacemaker that allows them to beat on their own accord even when the brain dies. (Go to YouTube and type in the words “dead frog beating heart” and see for yourself.) The heart is not connected to the brain in any meaningful way, and as long as it is artificially receiving oxygen from a ventilator it can take a licking and keep on ticking for a few more days before it, too, dies.

So which is it? Did the baby die on Friday, when his brain died, or did he die on Sunday, when his heart died? The Israeli Medical Association, Israeli legislation, the Ministry of Health, the Chief Rabbinate of Israel, the Medical Association of almost every country in the world all understand that when a person’s brain dies death has occurred. In other words the organism is dead but its organs can remain alive for a few more days.

Why? Because they are artificially — and incidentally — being given oxygen by a ventilator.

Well, if it is resoundingly clear that brain death is death then why did some Israeli media organs get it wrong? Why did IBA English TV News and The Jerusalem Post, among others, report the baby had died on Sunday when his heart stopped beating? Why didn’t they say he died on Friday when his brain died? The answer is not a good one. It is because it would have felt weird to say on Friday that a baby that is warm to the touch — whose heart is still beating — is dead, and it would have felt weird to say on Sunday that a dead baby had been lying in the hospital with a beating heart for two days.

Not only is describing the functional reality of brain death difficult to put into words, it’s hard to decide how to refer to the baby himself. What do you call him? If you accept brain death as death, should the baby be called a braindead patient? The word “patient” implies he is alive. Should he be called a brain-dead corpse? If he is a corpse, why is he being kept in a hospital bed attached to a ventilator? And if he is dead, why are we calling him brain dead? He should just be referred to as dead. He should be called the deceased, not the brain-dead deceased.

This is not simply an exercise in semantics. This is an important issue that all responsible citizens have to wrap their heads around.

The words chosen by family members, doctors and journalists can lead to life or death decisions.

Israel has one of the lowest organ donor registration rates in the world. So the words chosen by the chosen people will have an impact on how family members and the public perceive a brain-dead corpse (hear how weird this term sounds?).

Is he a living patient or is he a corpse whose heart doesn’t know enough to stop beating because it has an artificial supply of oxygen? Your answer will influence your decision whether or not to donate organs. If he is alive, then understandably you will not donate his organs. But if he is dead, you will consider it. And since one organ donor can save eight lives the stakes are high – especially if you are one of the 100 Israelis that will die this year waiting for an organ that will not be donated.

Another dangerously inaccurate and misleading term that is the darling of doctors and journalists is “life support.” Sometimes a living patient needs help to breathe and so he is put on a ventilator. His life is indeed being supported by the ventilator. But if a brain-dead corpse (whose heart is still beating) is on a vent, his life is not being supported because he is already dead. And to say he is “on life support” implies he is alive, again inhibiting donation of his organs.

If I am being asked to remove life support I am killing my loved one.

It would be just as inappropriate to use this term if I were to attach a football to a ventilator (which could easily be done) and see it reported in The Jerusalem Post that I put a football on a life-support machine. The ventilator simply vents air in and out of the thing it is attached to. A vent is a vent is a vent and nothing more. The word ventilator is accurate as it is neutral and should always be used.

Israeli medical and Israeli media professionals have an obligation to the public to use exact terms and to be consistent in their reporting. If a health reporter insists that the baby died on Sunday when his heart stopped beating then she should also, for the sake of consistency, report that doctors are murdering patients every time they remove organs from a brain-dead donor because the heart is still beating.

Consistency is the bedrock of clarity and currently Israeli medical reporting is rolling around on shifting sands. An Israeli journalist who reports that a brain-dead baby died upon cessation of heartbeat contradicts the understanding of the medical community in practically every country in the world, as well as contradicting the Chief Rabbinate of Israel, the Knesset of Israel and the Ministry of Health of Israel. A journalist who uses the term “life-support,” when she should have written ventilator, contributes to people’s decisions not to donate organs resulting in the needless deaths of more than 100 Israelis every year. Choosing our words carefully is good advice for conversation as well as for journalism.

The writer has an MPA from the Harvard Kennedy School of Government. He is a freelance writer and the founder and director of the Halachic Organ Donor Society.