Link Banana

As ever shouldering his responsibility to tackle moral gray areas, William Saletan offers an enlightening (if unsettling) look into the battle over our organs.

How can we get more organs? By redefining death. First we coined “brain death,” which let us take organs from people on ventilators. Then we proposed to allow organ retrieval even if nonconscious brain functions persisted. That goal has now been realized through “donation after cardiac death,” the rule applied in Denver, which permits harvesting based on heart, rather than brain, stoppage.

Stoppage is complicated. There’s no “moment” of death. Some transplant surgeons wait five minutes after the last heartbeat. Others wait two. The Denver team waited 75 seconds, reasoning that no heart is known to have self-restarted after 60 seconds.

This made me cry.

(I tried for five minutes to come up with a better title, I couldn’t.) Pamela Paul has an interesting article in tomorrow New York Times Magazine about the difficulty of fighting cancer — which seems to be made more likely by pregnancy — while still protecting the health of the fetus. The basic dilemma:

“She was afraid not to be treated for cancer, but she was afraid to expose her fetus to drugs,” Cardonick recalled when I spoke to her recently. It was perhaps the ultimate maternal conflict: choosing between the biological imperatives for self-preservation and procreation.

Ryan and Leo were born on the same day to the same parents. But one looks “black” while the other looks  “white.”

(via BuzzFeed)

Annie Murphy Paul’s story on the discipline of ministering to morbidly obese pregnant women drives home how overweight this country is.

The challenges of caring for these patients begin early. “We perform an anatomical survey of the fetus, but in an extremely obese woman, the ultrasound signal often can’t penetrate through all the tissue,” Chames says. He must use a vaginal probe instead. A thorough examination is especially important in obese women, Chames said, because they are at greater risk of having babies with neural-tube defects and other malformations.

Birth brings more difficulties. The fetuses of obese women are often too large to fit through the birth canal; their mothers are about twice as likely as normal-weight women to need a Caesarean section. Longer surgical instruments are required, as are extra-wide operating-room tables, reinforced to support hundreds of additional pounds.

Hymenoplasty — recreating a hymen for a woman whose has broken — is gaining in popularity, especially for Muslims. One quote justifying having it done:

“In my culture, not to be a virgin is to be dirt,” said the student, perched on a hospital bed as she awaited surgery on Thursday. “Right now, virginity is more important to me than life.”

And while Dave Pell thinks that’s depressing, William Saletan defends the procedure.

Darshak Sanghavi makes an interesting point:

The greatest medical advances depend mostly on small but consistent improvements in the use of old drugs.

Preliminary evidence suggest that autism isn’t actually more common today, just more commonly diagnosed:

But the rise in the number of recorded cases is real enough. In Britain, for example, the rate of diagnosis has risen from 50 per 100,000 in 1990 to 400 per 100,000 today. That must have a cause. And one popular hypothesis is that this cause, too, is fashion…

The result was that almost a third of her volunteers looked, from the modern point of view, misclassified. Eight fully met the modern criteria for autism. A further four fell into what is known as the autistic spectrum, evincing signs of autism short of the full-blown syndrome.

Thomas Goetz’s profile of PatientsLikeMe has gotten a fair amount of attention on the blogs today. It’s a pretty interesting profile of a rather interesting site.

One afternoon in late November when I visited the office, Jamie turned to a nearby whiteboard and traced out an x-y axis, slashing a descending line from left to right. “We have the ability to run a probability engine,” he said. “We can mathematically model each patient. We can tell them what’s going to happen in their life. We can tell you when you’ll need a wheelchair.” He made a mark along the line. “And we can even tell you the day you’ll die, with remarkable certainty.”