I am a cardiac surgeon, part of my job is to harvest hearts from living organ donors. AMA
i tried to do an AMA today but some people including mods were upset because i gave it a small twist and turned it into a short of guess who i am contest. i would like to give people a chance to ask direct questions now.
well, hope this goes better... AMA
EDIT: going to take a little break now, its 4 AM here but i will answer all your questions in like 4 hours. thanks for now, i just love this, be back soon, feel free to ask anything
EDIT 3: couldnt sleep so am back.
EDIT 4: wao frontpage!! by the way sorry for the grammar errors, english its not my first language. hope my answers are good enough to understand :/
EDIT 5: common question: there are no published reports of recovery of nuerologic function after the diagnosis of brain death using the criteria reviewed in the 1995 American academy of neurology practice parameter.
EDIT 6: i will spend today answering the remaining question that i haven't answered yet. P.S: i didnt mean to refer to the donors with "it" to objectify them, it just got lost in translation and i ve been corrected. another thing, i haven't heard about doctors making less of an effort to heal donors before, guess is an american thing or just an urban legend, don't see how a doctor could do that to a patient and the diagnostic criteria is really hard to meet with absolutly no false positive reported in the litarature yet. Give me some time and i will answer your questions, if i dont answer to you directly is because it was asked before you came in and i recomend you read all the comments, thanks for all the support and nice questions, this has been a great oportunity to talk to patients and nice people, thanks.
EDIT 6: am kind of surprised that some people are judging my surgical skills based on my command of the english language, you are going like"ok, he just told how to perform a repair of a transposition of the great vessels in 2 min, but am calling bullshit because he spelled putrid wrong, come on guys! Am also on an iphone...
EDIT 7: a lot of comments about zolpidem's new found ability to improve patients with brain injuries, i doubt this would work in organ donors that are brain dead, if you dont get blood to your brain you couldn't get a drug to your brain either. its intresting but there still evidence to be obtained and it needs to be peer-rewieved before we find out if it really works. also now days everybody is a especialist and decissions are made by a multidiciplinary team, the surgeon can't know everything and make every decission, thats what the rest of the team are for, and i am sure that when and if zolpidem's ability is well stablished the neurophysiologist in my team would be aware of it as i am aware of new surgical techniques they don't know about yet.
EDIT 8: hey everybody...nods are actually knots
EDIT 9: no longer relevant things
EDIT 10: thanks for being here, hope i could make some people aware that donors are needed, become a donor if you wish something good to come from something bad, try to make a difference in someone elses life. You have a big problem in USA and most countries in E.U were people don't want to become donors and patients have to be implanted with machines for long periods of time and poor quality of life and high risk of complications. This two AMAs have been an intent to bring closer to the people this problem and the people involved in it and humanize the surgeons and other personal involved, know that we feel about you but are glad an happy that together we can help many people out there that really need help. Thanks for asking questions and good bye.
EDIT 11: for last i want to adress the title of the AMA since i have gotten well deserved comments claiming that the title is missleading since braindead patients are considered dead in medical terms even if their organs keep working with life support and drugs. First i apologize if this confussed you or made you feel bad in anyway. but thinking about it i think someone would allways have a problem with this AMA no matter what its name was. WHY? you ask, lets see, if a called it "i collect or harvest or procure organs from dead donors" (that would be the pragmatic medical definition), when people found out they were brain dead, some people would eventually comment they still have some life in them, no matter what the correct definition of brain death is, and they wouldn't be completly wrong. if it was called "i harvest hearts from brain dead patients" it would have been probably be the more suitable name, but similar debates would have happen. i picked the title that i taught best described what i wanted to get across the room and that is that this patients hearts are beating and they still have vital signs, and their organs are working in their majority. I also wanted to get across that this is the only case in witch you can legally do something to a patient that would directly end all vital signs and advancing or precipitating the patients death, i just don't take them off life support and wait for the inevitable to happen on its own, we in an active manner stop this people's hearts and end the activity of all remaining organs and make the patients unable to live even on lifesupport like they did before. maybe i could have chosen a more suitable title? probably yes, but what i could'nt have done was picking a title that wouldn't cause commotion or controversy. i suggest if you are intrested you read the whole AMA because all remaing questions are answerd and clarified inside. you can keep posting questions if you are not satisfied, i will continue to answer them as long as reddit allows me to keep posting here. thanks and bye
depends from where you are looking, some people have told me it requires having no heart
some people think we are stonehearted and insane.
What was the strangest experience you've had during a surgery? Complications, fellow surgeons, anything.
a patient waking up and trying to move with her chest opened, cardiac surgery patients are at the highest risk of waking up during surgery because of the use of the artificial heart-lung machine, their drug distribution volume get really big so they need much more drugs to remain sleep. and of course ive had other intresting moments but its really impresive to see a person with no heart trying to move. of course she didnt remember anything after the surgery.
EDIT: was being a douchebag
Some people have the misfortune of remembering those experiences.
Presumably, this is why anesthesiology is one of the more highly paid medical professions.
they administer midazolam that causes amnesia so the patient doesnt remember this traumatic expirience
I woke up during surgery once, I remember everything.
tell us about it...
Not her, but I woke up at the very end of my tonsil surgery. The breathing tube was still in and the nurse yanked it out like it was a rip-cord after freaking out that I was awake. I didn't remember right away, which actually was more traumatic because I remembered while I was half-asleep through a nightmare.
they were waking you up after surgery, nothing wrong
Do you feel comfortable with the legal definition of "dead"?
hard question, but i have to say yes. of course definition can change along with science, so who knows if in the future we are able to bring back some people that now we consider to be dead
Interestingly, you worded your title as a harvester from "living" organ donors. But I know what you mean.
Do you ever wonder if someone on your table might be "locked-in" (but had been tested while "sleeping") as opposed to actually dead?
a donor has to have a absolutly no brain activity in two electroencephalograms performed without any sedatives and with no electrolite alterations and has to be evaluated by a lot of experts in order to confirm its brain dead.
Thanks for doing this AMA. It's interesting.
thanks to you for joining
Are the brain-dead
patients donors given sleeping pills to make sure they are really dead with no chance of ever regaining conscience consciousness?
actually the sleeping pills are withdrawn in order to confirm they are braindead, as far as your link goes, i had never heard about something like that. i guess the neurophisiologist that make the call have and dont think of it as relevant i guess. if this gets confirmed it would be great news. it also seems they were talking about comatose patients, that doent mean brain-dead. all braindead patients are comatous: yes, all comatous are braindead:no.
didnt see it then, i will defenetly check it out, try to get another source or something
Zolpidem may provide short-lasting but effective improvement in symptoms of aphasia present in some survivors of stroke. The mechanism for improvement in these cases remains unexplained and is the focus of current research by several groups, to explain how a drug which acts as a hypnotic-sedative in people with normal brain function, can paradoxically increase speech ability in people recovering from severe brain injury. Use of zolpidem for this application remains experimental at this time, and is not officially approved by any pharmaceutical manufacturers of zolpidem or medical regulatory agencies worldwide. Zolpidem is being studied to determine if zolpidem is associated with improved responsiveness or regional cerebral perfusion in patients with persistent vegetative states(coma).
Hope that helps.
still doesnt sound like it could help brain-dead patients but it seems to iprove the life of less severe brain damage
thanks, saved me a lot of work.
they are alive, but their brain has no blood flow. they would die eventually probably from an infection they got from the ventilator, neumonia more likely, or eventually their kidneys would fail.
My father was given an extra 4 years because a quadruple bypass. Your line of work is very hard and I am sure it's very stressful. Thank you for saving lives. You are a hero.
What is the 5 year survival of someone after you put a new heart in them?
When removing a heart from a donor, at what point is the patient deceased, in your opinion? (Before you start, because they are brain dead? Once you clamp certain vessels? Once you lift the heart out of the chest cavity?)
Does the heart stop after you remove it, but before you put it into the next person? If so, how long does it take to stop?
- 5 year survival is more than 90%, 10 year 83%
- they are brain dead, but they are dead dead after i clamp the aorta (the main artery of the body)
- we stop it with a high potasium serum before we remove it, this reduces its metabolism and oxygen consumption by 90%, making it last longer in the ice, giving better chances for the recipient
Thanks for your response, doctor. Question to follow up on 2:
With regard to clamping the aorta, is this a tricky thing to do?
You're dealing with a vessel that's pumping (IIRC) ~ 5 liters per minute.
Is the aorta in most people so incredibly strong that you can just clamp it off without getting an aneurysm?
Where does the blood go now that it can't go through the aorta? Does five liters of blood just stop moving all at once?
Do you ever get an aneursym when doing this (and consequently end up having to scrub the ceiling)?
And an additional question:
Do you ever have concern that some of the donors you clamp are actually (or were actually) suffering from locked-in syndrome rather than brain death? Do you insist on personally reviewing the data in order to confirm for yourself that the brain is gone? Has there anyone you've refused to do on suspicion of their not being brain dead?
its not easy to do and if the patient has a high blood presure it can shurely break, aneurisms dont form that fast, but it can break. what happens to the blood? at the same time the aorta is clamped wit perfuse the coronary arteries with a high potasium serum that stops the heart in seconds and we make 2 small stab wounds, one in the inferior vena cava and one in either a pulmonary vein or the left atrial apendage to decompress both ventricles, the blood poors into the mediastinum and pleural cavities and its disposed with the suckers.
Thanks again, doctor!
you dont have to call me doctor in reddit
Everyone should call everyone in reddit doctor, doctor.
i concur doctor
I love all of the technical terms until the "disposed with the suckers", made me laugh.
it makes me gigle too
I just read your title for your other IAMA (the one that got deleted).
Here's my question: are all surgeons as creepy as you are?
well, we are not "normal" if thats what you mean... it just was a cool twist i did, i never implied i did anything illegal or that i was a murderer
Well, reading the questions from the IAMA, you never directly implied you weren't.
....That is pretty creepy! =P
was having fun until they got me. i have them all the information they asked for except how and why i did those things. couldnt say from the beginning hey this is legal am not going to jail cause it leaves to few options of what i could be
Hey! I've already had part of my aorta replaced because of Marfan's syndrome, and I'm slated to have somemore of it and my bicuspid valve replaced at the end of the month (at MGH). It was some scary shit, but my cardiac surgeons made it very clear that they're fucking superhumans and that it was child's play. I don't have a question, I'd just like to thank you and others like your for existing. Getting to live past 30 rules.
thanks, hope you can valve repaird insteed of replace, ask if the David surgery is possible in your case, hope everything goes well.
Are you an Organ Donor yourself?
How do I convince my SO that if you are an organ donor, doctors will still do everything to save you and not "half-ass it" so they can give your organs to others?
doesnt work like that, dont say its impossible but really unlikely that would happen, for me its a win for my patients, but for the doctors that were taking care of the donor is a big fail and they dont get paid more or anything like that for giving us a donor.
I was born with a Transposition of the Great Vessels 20 years ago. It got corrected thanks to awesome people like you! If you have ever done one (maybe you have, maybe you haven't) would you be able to give me an idea of what goes on during the actual procedure? If not, no worries! just curious! :D
EDIT: oh oh and how the hell do you guys pry open infant rib cages to work on the actual heart?
EDIT 2: I created a thread for scars although I'm hoping to get a lot of pics of TGA scars, so if you have it please post! :D
EDIT 3: this is a throw away account so I promise I'm not karma whoring!
its a very complicated procedure, ive never done it my self but i have help my mentor many times. i probably will never perform one until my mentor retires (because everyone knows he is the best in southdern europe at it) but i can tell you what they probably did... you had the aorta comming out your rigth ventricle and the pulmonary artery arising from the left ventricle, its supossed to be the other way around. you were kept alive by different shunts inside and outside your heart that helped the two circulations mixed so your body could get oxigen from your lungs to the rest of the body... oyherwise you would be dead. they had to place you in a artificial heart-lung machine and stoped your heart with potasium. after that the had to separate this two main arteries from the ventricles, to reattach them too the correspondind anatomical ventricle. now here is the tricky part... your coronary arteries were also comming from the pulmonary artery and had to be removed from there to be reattached to the neoaorta, this leaves two big holes in your pulmonary artery that have to be repaird with a piece from your own pericardium. also after the repair we have to close the shunts tha were keeping you alive till then. do you remember what was the disposition of your arteries (side by side ot one in front of the other and in you had a normal coronary anatomy or you also had coronary anomalies?
The parts before "the tricky part" also sound very tricky.
i know what i mean.
Wow! that sounds very complicated haha! That's kind of cool/interesting that they use potassium to stop the heart. I don't remember what the disposition of the arteries were and as far as I know I had a normal coronary anatomy. Oh oh one more question. So I have the main scar that goes right down my sternum, however there are also 3 other smaller scars on my chest as well - two under each nipple and then one like 2 inches above my belly button. Any idea why those scars would be there? I never really asked my cardiologist about those ones lol
if they are really small, they are probably from the dreins left there for a few days in case you were bleeding
ah I see. Well thanks a lot sir! This was a very interesting/informative read!
allways glad to talk to patients, so i am asking questions now hahaha, how do you feel with the overall result, do you life a normal life? or you still have any problem?
I live a completely normal life. I've never had any problems or anything like that. I go to the cardiologist once every year and they do an ultrasound on it and a few other tests. I also had an MRI about 2 years ago for the sake of having an actual picture of my heart. That was pretty interesting! I also have a heart murmur but I was told that is pretty normal for people who had the switch done.
good to hear from a patient that he is ok.
About how much do you get paid?
depends on the month, anywere from 3,000 euros to 10,000 for people older than me, am still kind of new at this.
Let me get this straight, you're a heart surgeon in spain and you make around 36,000 Euros per year?
health here is public, people dont pay anything to get surgery, its all free.
i will try to move to germany after i learn the languaje but its how it is in spain, being a free public health system as it is, we make a basic salary, dont charge based on the procedures during the morning, in the afternoon we get paid extra but its like 100 euros the hour.
yes i hope i can go there at least for a couple of years. they are also pretty good on ventricular assist devices because there are not many donors in germany, patients wait for a heart for 3 years, here in spain they wait for 2-3 weeks so we have a lot of experience on transplants but not as much in VADs
Do people die of more accidents in Spain? Why are there so much more availability?
couse it became a fad to be a donor since 40 years ago, everybody is a donor and i have never seen a family refuse to donate their loved ones organs after we tell them there is notting else we can do
Do you know why there's such a huge difference in the number of donors?
couse its cool to be a donor in spain, its what hipsters do, spanish people donated organs before it was cool
I hereby formally invite you to Canada. You've got the English down already, come onnnnn!
might take you up on that, send me a PM
yes its not like in the US but for spanish standards it well
Where do you keep the hearts after they are removed?
we keep them in a little frige
Next to the root beer?
no the root beer is provided by the plane personal
Is it weird/difficult to pry open someone's ribs? It's always been the weirdest part of heart surgery to me. I just think of my ribs being pulled apart and shudder.
what we actually break its the sternum, the hard flat bone in the middle of your chest and its actually not that hurtfull because there are not many nerves there, it hurts less than a small incision between your ribs.
Sounds interesting yet nasty.
its really narly indeed, we use an electric saw that makes the most awful sound you can hear coming at you, but we are experts and dont damage anything important
Can you just.. unfold the ribs after breaking the sternum, or do you have to break the individual ribs as well?
they unfold, some patients with artrosis scoliosis only gives to one side making the surgery more difficult but you can still do it ok.
How many times have you drugged someone and stolen their organs to sell?
never done that, first an anesthesiologist drugs people, and 2nd organ donors dont need much sedation because they are brain dead, they need muscle relaxants so they are flacid during surgery.
Do you get sad thinking about that the people that are now brain dead?
its sad they are brain dead, but i dont feel bad for taking away the life they have left to help others.
Have you ever held a still-beating heart in your bare hands?
yes i have, the recipients heart doesn have to be stoped before taking it out so its beating and fibrilating while you do it. and in a less drastic manner, when you operate on a normal patient that you dont have to take out his heart you grab it a lot while its beating, you have to know how to do it in order not to kill him
To what use do you put the recipients' removed hearts?
they are disected by the residents to learn and then it is taken to patology and saved for a few days in case we need to run some test later on.
First off: by far the most interesting AMA I have ever read in all my years on Reddit. Thanks for doing this! And I'm jealous at your amazing job!
Question 1 : Of all the braindead people on your table, what causes of death are most prominent do you think? Are motorcycle riders more "well represented" than others?
Question 2: So you put a donor heart inside someone's chest cavity, connect the arteries and... then what? Aren't there nerves to connect? How does the heart start beating again, through physical massage or a steroid injection?
Thanks in advance :)
- mostly bike riders, that's why i don't get of the beautiful montsers
2.the nerves cant be reatached, its stays denerved. its starts up again when we restablish the blood flow. as soon as electrolytes start comming in it starts beating (hopefuly) the heart has automatism, this means it will beat when the conditions are ok, has its own little nervous system inside.
Have you ever had someone die during a procedure? If so, how did you cope with it?
first time was really bad for me, couldnt sleep for about two days. but it was a very complicated patient with very low chances, after 10 hours of surgery we just had to give up, nothing else to do. lucky we have a low mortality rate in my hospital, less than two percent. but its allways hard. you just have to keep going and as long as you did everything in your power you should be fine, i have seen people that cant take so i think you have to make you heart like stone sometimes to keep at it.
I'm a premed student hoping to become a cardiothoracic surgeon... any advice?
are you crazy, havent you been reading?? just kiding, you will have a great time. study hard
3 things, love the heart, love surgery, hate working with cancer patients.
Why do you hate working with cancer patients?
because its really sad when they go on chemotherapy, and most of cancers have so low survival that i feel i am not doing enough. so heart cancer its really rare it was one of the possitive points for me to pick it. dont get me wrong i hate cancer, not cancer patients, i hope they allways have someone taking care of them and doing research to improve outcomes, but when i see people losing bodyparts and still not cured it gets to sad for me.
Thank you for answering :) I think a lot of people underestimate the emotional impact that medical staff can often be placed under. It is a very brave career to be in
thank you you are very kind
Hey, someone like you did this to my little brother's body recently, and gave someone else another chance at life. Thank you for doing this.
nice to know families feel that way
Do you need a bit of a twisted mind to cut open people (and take their heart from their body)?
I've always seen surgeons as cold people....
what affects most people doesnt get to me. i find the inside of a chest beautiful, some people more than others. when you see that heart beating its like indescribable if you dont like it or find it gross. its beautiful machine billions of years in the making, ou am getting dizzy here, better move to another question.
hahahaha, dont mean to creep you out but you asked for it.
Do Jr. Mints really stave off infection if placed in the human body itself? I have it on good authority that they do.
yes, but not every infection
do you ever get nervous while operating?
its to be in alert mode, but nervous is bad, cant get too nervous
ok, i will look thru my cellphone to find more.
No question - I just wanted to say I found your answers fascinating. Thanks for your time!
If you live in San Diego, can I shadow you?
i live in spain, if you ever come here sent me a PM
You got any tips on how to become a surgeon? I am to start at med school in January and even though Surgery is far in the future in the 6th semester or so, do you have any tips for someone who wishes to specialize maybe as a cardiac or neurosurgeon...?
study hard, and practice nods and stiching at home with everything you get your hands on, chichen breasts, pig hearts, sponges, anything, practice nods while you watch TV, used to sit for hours just makind knots, used to make really long string of knots over many hours. and last but not least... dont faint the first time you see blood
Well i dont think ill have a problem with blood. I am/was a biology student and was thrown into a competition where i had to dissect a shark after never having dissected anything. Turned out this shark was pregnant and stuff with small mini sharks inside it. The girl next to me had to excuse herself but it didn't touch me. I also underwent surgery in the foot and was sitting up watching the whole affair as it unfolded - was quite weird to see my toe all cut open and down to the bone.
you are in the right track to say the least
I had an AVR 5 years ago with an On-X valve, and this was the first surgery that the hospital had done with that specific brand. The company had sent me some information, including a packet to give to the surgeon. When I had my pre-surgery interview with the surgeon, I offered him the packet and he shrugged it off and said something to the effect of 'If I needed that to perform the surgery, I don't think I should be doing them anymore.' Is that type of bravado typical among cardiac surgeons?
BTW, everything went fine, and I am doing well today! My surgeon was kind and attentive at every other interaction.
probably an old surgeon, am i wrong. cardiac surgeon were like gods 30 years ago. one of my bosses replyed to the wife of a patient he had just performed surgery on that was asking him somethings she read on the internet, that he just uses the internet to search for boobs, he is 70 yo
I have a bicuspid aortic valve (28 yo female here). So far little stenosis and regurgitation, but everyone says ill have to have a valve replacement someday. Do you see better outcomes with mechanical or pig valves?
some bicusoid valves dont have to be treathed. the best you can have is the David surgery that keeps your native valves. if you cant the choice of valve depends on many factors, like age (biological valves are better on old people) if you are younger than 65 you should get mechanical, if you dont have kids and want to have, you should get biological, but you would have to get surgery again in 10 years or so.
How old are you? I'm a pre-med student who's applying to medical schools this year and I was just wondering if you remember the process of applying to schools and whether it'd be relevant still.
How hard is surgery? I really want to do surgery and cardiac and neuro is up there. I heard that with neuro, you pretty much have no life outside of med. Is that true for cardiac?
How did you come to choose cardiac surgery?
And did you make the right choice? Is this all that you've dreamed it would be and that you're living a very happy and successful life?
am 30 yo. dont know about your process because i didnt study in USA everything in surgery is hard, but practice makes master neuro its pretty demanding and the results are not as good as cardiac surgery, many neurologic disorders cant be cured and you end up treathing tumors and accidents, some of which will endup getting their hearts cut out by someone like me after you cant save their brain. cardiac its demanding too. cause i love the heart and hate cancer i totally made the right choice for me and i am very happy
What use are the hearts after you harvest them?
to transplant other people, when the heart is suitable for transplant. but if the heart is damaged we also go harvest it for a stem cell research trial.
I had the pleasure of watching some coronary catheterizations in the US, they said Europe is a little more advanced than the US.
Do you do any cath/STEMI procedures? Are you doing valve replacements through catheterization, without the need for open heart surgery?
yes we do valve operations via catheterization, Its called TAVI, transcatheter aortic valvular implant. coronary catheterization is done by cardiologist, not surgeons, but we surgeons are learning that and reclaiming those patient for us, but for that you need a hibrid OR, we dont have that in my city, i am currently trying to get a rotacion in a hospital that does so i can learn to place stents too
Did you always want to be a cardiac surgeon? Was there some other kind of surgical field you wanted to go into, or may of had interest in? Finally you mentioned that part of your job is harvesting hearts what are some other parts?
my father was a doctor so i wanted to be one since i can remember, ever since i studied the heart for the first time i wanted to work with it, its just amazing and one of few moving organs. other part of my job are performing surgery on patients other than transplant patients, clinic hours and working on our intensive care unit.
Have you ever went to take a heart and have it not be usable, as in there was something wrong with it? Also, is the family notified about what organs could be donated, and if they can't be is the family told which ones were donated?
yes, do to arritmias, and they get all that information you asked about.
What decides that an organ is compatible for the receiver?
well, the thing we compare is age, weight, BSA, and ABO compatibility. after the organ its implanted some other inmunologic tests are made to see if the white blood cells are compatible. because this test last about a week we are not able to do it before we perform the transplant
Would you say your job requires a lot of heart?
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