[00:00:00] Speaker A: Foreign.
[00:00:22] Speaker B: Welcome, friends, to Faith in Healthcare with where we continue to explore the issues that matter most to Christian healthcare professionals. Whether you're actually in healthcare, married or otherwise connected to someone who is, or you're just simply interested in how God is working through Christ followers in patient care and beyond, we're glad that you're here.
In this episode, we're bringing you a special crossover program with CMDA's Voice of Advocacy podcast, hosted by my colleague and friend, Dr. Brick Lance. He's CMDA's Vice President of Advocacy and Bioethics.
In this conversation, Brick's joined by Dr. Gary Ott, who's a renowned cardiac transplant surgeon at Oregon Health and Science University.
They're going to walk us through some of healthcare's most profound and pressing questions, like how do we define death in the era of ventilators and ICUs?
Or what's the ethical difference between brain death and donation after circulatory death, Abbreviated dcd Where do new technologies like portable perfusion, heart in a box systems and normothermic regional perfusion or NRP help patients? And where might they cross ethical lines?
With decades of transplant experience and a deep Christian conviction about the image of God, Dr. Ott helps us think clearly about organ procurement.
The pressures on OPOs and transplant teams and the temptation toward utilitarian ends justify the means reasoning.
He also lifts our eyes to the gospel image at the heart of transplantation.
One life is given so that another may live and the hope that we carry into end of life care.
So let's dive in.
[00:02:27] Speaker A: In 1954, the first kidney transplant took place. It was actually after that that hemodialysis was developed. And then 1967, the first heart transplant in South Africa.
And our guests can talk about that a little bit.
But it was in the 1960s that modern technology with ventilators and ICU technology created more ethical dilemmas because it actually created more difficulty in actually defining death. In fact, 1968, the New England Journal of Medicine published the Harvard definition of brain death. And so we have a physician who is in the transplant world and can give us some information on that.
So Today more than 100,000 people in the United States are on the national transplant waiting list.
The Department of Health and Human Services just this year has stated, we need reform for the transplant business, if you will.
So we have probably 13 to 15. That's the estimate. People die each day that are on the wait list. The Organ Procurement and Transplant Network oversees it. And there's dozens, dozens Organ procurement Procurement Procurement organizations come as A sidelight. When I was moonlighting in residency, I harvested, and it actually paid quite well, but you had to be on call with a pager.
So just recently, the New York Times has published several articles this summer about our situation in America, in the United States, about transplantation.
And they say they're trying to create, obviously, some public concern because the Health Resource and Service administration exam in 351 cases, of which there was a good handful that may have started the process before they were actually dead according to current criteria.
So I want to introduce our guest today. This is Dr. Gary Ott, heart transplant doctor from OHSU, that's Oregon Health Science University.
And so he joined the heart transplant team in 1991, which started a few years before that. So he has decades of experience as far as education, medical school, internship, residency, all at University Hospital and Thomas Jefferson Medical College, and then went on to his fellowship in Columbia, New York.
He served on many transplant committees. And most importantly, Dr. Ott loves the Lord. Welcome, Gary.
[00:04:54] Speaker C: Thank you. Thanks for having me today, Brick.
[00:04:56] Speaker A: Yeah, this is going to be fun. Hey, Gary, just. Let's open up. Tell me a little bit about your faith story and then along with that faith story, why you chose this career path.
[00:05:05] Speaker C: Well, that's a great question.
I would say my faith story is the story of faithfulness through the generations. I'm a Chinese American immigrant. My grandparents immigrated for economic reasons at the beginning of the century, came here with my grandfather, came with nothing, and lived in the Chinese ghetto here with no contact with the larger community.
And the reason I mention it is as my parents and my wife's parents grew up together in a Chinese ghetto in a large city. They didn't speak English and had no contact with the larger community. And some largely untrained but loving Christians offered to teach these young kids English if their parents, that is, my grandparents, would let them have Sunday school.
And the entire block, the entire community came to the Lord, largely, and the Pittsburgh Chinese Church was started. And I came out of that faith tradition and have benefited from their faithfulness to this day.
[00:06:07] Speaker A: And so you were interested in medicine, and then obviously your career path took on to being a cardiovascular surgeon.
[00:06:14] Speaker C: Heart surgeon, yes.
[00:06:15] Speaker A: So how did that get directed?
[00:06:16] Speaker C: As some of you are familiar with Asian culture, education is a good thing.
And so just picking a path, God opened the door one door at a time. I did the accelerated program. I was accepted to medical school from high school and graduated early. So that allowed me to pursue a longer residency like cardiothoracic surgery and transplant without too Much of a penalty in life years, if you will. But God opened the door one at a time, each step. Surgical residency, research, fellowship, training in cardiothoracic surgery, where I felt that I couldn't measure up to what the other guys were doing. But God opened a door and gave patients ability. And as you know, there's no substitute for hard work. And so I've been the beneficiary of those things.
[00:07:01] Speaker A: So I'm going to reflect back on the past, Gary, and just. I remember in my internship, I had to be MOD and sod at the VA hospital. So surgeon on duty, medical officer on duty, and of course, responding to codes and finally calling the code and declaring the patient dead. It seems like with new technology, the definition of death has changed, and it's still in debate in certain circles, particularly the ethical community. So why is death so difficult to define?
[00:07:28] Speaker C: You know, that's interesting, because the Uniform Determination of Death act in 1980, still not accepted by all the states. And the two criteria that are set out verbatim is irretrievable cessation of circulatory and respiratory function. That's one definition. The alternative definition is irreversible cessation of all functions of the entire brain, including the brainstem. So these are two separate independent criteria, either one of which will fulfill the letter of the law for death.
But that line is increasingly blurred as technology allows us to do that. And if I could interject as a believer, someone who understands that life is a gift and that God animates us in a spiritual way, even as we discuss what it means to be human, that God breathes into us the breath of life and to take it to its metaphysical level. We understand that, that there is a difference between life and death. But it is difficult to define. Defining life is hard, too. There's an animating process, and when it leaves, you're back to just the chemicals. But the chemicals interact too. So where's life between the two? We see this as separation of the soul from the physical body.
[00:08:48] Speaker A: Now, I know you're the one actually, you know, taking the heart transplant to another patient, but there's other doctors in the ICU that are, you know, declaring death, if you will. And then in my studies, no different issues or topics or ways to define death have helped along the way to some, like, determine the ADH level, because that can. Any diuretic hormone coming from your pituitary.
[00:09:09] Speaker C: Yes.
[00:09:09] Speaker A: Whether that is functioning or not. And if that is reasonable. And then we used to have these apnea tests. We'd Actually stop the ventilator and check for CO2 levels in the arterial blood and such.
Are some of those still used or not?
[00:09:23] Speaker C: Yes, it's a good point. And let's just talk about brain death for a moment. We'll narrow down on that. Because until very recently, as far as use of organs for human donation, it mostly was done with brain dead donors. So our definition of brain death has been codified over time, and it's very strict. There can be no reflexes, there can be no cellular function in the brain. A brain scan can be done to show no flow. That's one definition, and that's good enough.
Next is absent reflexes, including corneal and tracheal reflexes. And most importantly, the apnea test is still used. And the apnea test is a very strict criterion where spontaneous respiration is allowed.
And you have to reach a PCO2 of 70.
Anyone who has any brainstem function is going to initiate a breath once when their PCO2 gets that high and the PH gets that low. And that's a very basic primeval life versus death criterion. Incidentally, as we look at brain death, we have to be careful too, because there are caveats such as, is the patient warm?
Have you reversed every type of electrolyte imbalance that can cause these types of problems? And so all those are very important for us to make sure that the brain has an opportunity to flow.
So those are caveats to that. But the brain death criteria is held as a gold standard still, and saying, no, this patient is actually dead. And organ donation is ethical and appropriate after that point.
[00:11:04] Speaker A: So, okay, you're in the operating theater and you have the donor and you're going to harvest that heart.
Now fill my knowledge gap on this situation. You want no blood flow to the brain. Now, there are some heart surgeons that would clamp the arteries to the brain versus what I would call the five minute wait rule, if I said that correctly. Can you go over those?
Are there situations where. The second part of the question is, are there situations where unethical medicine is practiced?
[00:11:35] Speaker C: Yes. Okay, let's break down the first thing. Let's talk a little bit about the mechanisms that occur when you procure a heart for donation. The majority 70% plus of hearts are still taken with a standard brain death definition. The brain death definition means that this patient is declared dead by a group of physicians. That is not the transplant team. That's very important. The transplant team. Myself, as a transplant surgeon who have people waiting in my home hospital, I practice at Providence Heart and Vascular Institute in Portland. And there is no crossover between myself and the donor team in terms of declaration of death. So there's no cross purposes or mixed motivations with looking at brain death. So I have nothing to do with the declaration of brain death. But it is incumbent upon me when I arrive at the donor site to ascertain legally on paper, on record, that the apnea test has been done, that the brain death declaration has been made by the appropriate credentialed authorities, usually a neurosurgeon or a critical care doctor, and that the brain death certificate, death certificates are signed and done.
So that I'm filling my responsibility to be sure that this is a brain dead donor and we are free to get the organs. Now, what does it mean to be brain dead in this instance? It means that there is no function of, of the brain or the brain stem by the criteria I said, but the heart is still beating.
Definition of brain death is you have no respiration, you make no effort to breathe. So these donors are all on respirators. They require continuous exchange of oxygen and CO2 with a machine. But the heart autonomously beats without neural input from the brain. And its heart rate is determined mainly by circulating catecholamines.
It can remain in that state, the heart can remain in that state for several days. And while it does that after brain death, that's when people like myself, the donor teams are assembled and the unit, the organs are allocated and the procurement can take place. That's what happens with the brain death donor. The procedure is that the heart is still beating.
And so when the heart is procured, we use standard techniques to remove the heart and give it a preservative solution that, that makes the heart stop to decrease its oxygen requirements. And it can be stored for a period of four to five hours, even in a cold storage. And we can expect it to be transported back to the home hospital, placed into a new different patient, a recipient receiving the new heart and have it work so it can live in the bucket cold, not beating for four to five hours. And that heart was taken out from it was beating until we make it stop with the special solution.
So that's the brain death donor. What you were bringing up a second ago, if I may, has to do with a different type of donor, which is called a dcd. It's called Donation after cardiac death or circulatory death Donation after Circulatory death dcd. And that's being increasingly popular. When I was training and when you were training Brick, back in those days, there Was no such thing because this criteria for donation was not widely accepted. Secondly, by definition, the heart stops before donation. We didn't want to take a heart that had already stopped because it could be ischemic and have tissue damage, acidosis and breakdown of metabolic functions that would render it not a good graft. But experimental evidence led to interest in expanding the donor pool to DCD donors. There are far more patients who die and are young, age and could donate organs, who don't die of brain death, but die of circulatory death, which by definition is irreversible. And here's where the problem is, because with dcd, if I could, I'll just describe the dcd.
[00:15:37] Speaker A: Yeah, please do.
[00:15:38] Speaker C: Okay, so this is a completely different set of donors. They may have neurologic injury or other types of injury that make long term survival or short term survival unlikely. In fact, if you were to take them off the ventilator or breathing machine, it would be maybe a matter of hours before they would die is our best guess. But they do not fit the criteria for brain death.
They attempt spontaneous respiration. They may have reflexes, they may even move to certain stimuli, but they're so weak that they can't maintain their own respiration for a long period of time.
[00:16:12] Speaker A: Time.
[00:16:13] Speaker C: And so they are placed into that gray zone, that twilight zone of patients that cannot survive for long, but are young, but also have healthy organs such as kidney, liver, pancreas, heart, lungs that can be used by someone else. So what do you do with these patients? They're entered into something called the DC depot, the donation after circulatory death.
And the definition of circulatory death that is used commonly and it does, does vary from region to region and hospital to hospital.
In general, it requires five minutes of documented cessation of circulatory activity.
That will allow for some electrical activity on the ekg, but there can be no pulse or circulatory activity. And that is documented, usually by an arterial line. So the way it works is this.
The DCD candidate donor that has consent from the family or from the individual before they were ill is considered for DCD donation and the patient is evaluated by unos, the United Network for Organ Sharing, which is the private organization which is contracted to the government to identify, allocate and distribute organs throughout the country.
You can only get a heart transplant or organ transplant through unos. They are the official organization that allocates organs. So UNOS identifies this person, and I will come up on a list because I'll have a Patient waiting who's the same blood type, heart and weight and appropriate for possibly use for transplant. And so I'll be notified. The DCD donor is given a time agreed to by the family, the hospital, the OR and so forth. So all the teams arrive at the donor hospital.
The donor is brought from the ICU to a waiting room or a recovery room or a separate OR from the procurement or and it's taken off the ventilator. Taken off the ventilator and let natural processes occur. But they are carefully monitored and not by any donor team, not by any team that wants the organs, but by the primary doctors that have been taking care of that patient. They will watch that patient in that room with the arterial line and invasive monitoring to determine the exact moment that circulatory function stops.
[00:18:46] Speaker A: And that can be quite variable.
[00:18:47] Speaker C: I would assume very very it may never happen 40, 50, 60% of the time depending on the region of the country. The the donor teams go home empty handed because the person, the donor doesn't stop breathing and the heart doesn't stop after 90 minutes. We go home because we consider by then the patient will have been hypotensive for a long period of time and those organs probably won't be good because of that low profusion. But we usually give it an hour to 90 minutes and so you're waiting for that moment when circulatory function stops. No more forward blood flow. That starts a stopwatch, five minute stopwatch and nothing is done for five minutes. We watch, the teams are alerted.
Five minutes have started.
At the end of five minutes, the patient is wheeled rapidly into the organ recovery room, the operating room where we're going to recover the organs and it varies from region to region. I'm giving you what we do or the generic case.
There's a rapid prep and then the abdomen and the chest are opened simultaneously very quickly by teams that are skilled at doing this.
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[00:22:24] Speaker C: The first thing is done is the patient, having previously been heparinized, is a cannula that's placed in the right atrium and two liters of blood is removed very quickly. It just takes a few seconds with a siphon and we take blood out. The heart is not beating, it's just still.
[00:22:43] Speaker A: It's been still for five minutes.
[00:22:44] Speaker C: For five minutes we take out two liters of blood because that's necessary to prime the reanimation machines that are necessary.
After that is done, the aorta is cross clamped and we give a special solution to the heart to try to preserve it even though it's already not beating. To cool it and keep it from having more acidosis.
The heart is taken out with standard techniques and then placed onto a special device that is basically a portable extracorporeal membrane oxygenator machine.
[00:23:17] Speaker A: Now this is it's out of the body.
[00:23:19] Speaker C: Now it's out of the body and it's hooked onto a special machine that uses the blood you just took from the donor and circulates it through that heart, oxygenating it, getting rid of the CO2 just like we would with a conventional heart lung machine and we attempt to reanimate that heart and we watch it for 3040 minutes to make sure it gets function back.
If it does get good function back, then we call back to our home hospital and say okay, start the recipient operation. We're coming back with this heart. It's a good heart. And we will bring it back with the heart beating. This little machine is FAA compatible. We have transport ground and air.
And we bring it back to the home hospital and then we use that animated heart and put it into the new recipient.
[00:24:08] Speaker A: What's the farthest distance you've flown for transplant?
[00:24:12] Speaker C: Well, the. Okay, two different things. In the cold, the cold storage where it's on ice, there have been reported incidents of 7, 8 hours, even in extenuating circumstances. But it's never good. It's better to be short. The furthest we've gone. And this is. Well, since we're talking about Portland, Oregon is Cheyenne, Wyoming, Anchorage, Alaska is good because you get a tailwind from Alaska back to here. It takes longer to fly up to Anchorage than to come back Phoenix. It's about as far as we want to go. Flight time. Because don't forget, it's not just flight time that takes up the cold ischemia time. That is the time the heart sits in the box, but also the time transport from the hospital, donor hospital to the airport at this end, airport back to our home hospital. And you have to actually put it in the new recipient, which takes a little bit of time.
So even though we say four or five hours, the flight time is only part of that. Right. So that's as far as we can.
[00:25:10] Speaker A: So how long has this extracorporeal perfusion been used? That technology.
[00:25:13] Speaker C: The technology for extracorporeal perfusion for the heart has only taken off in the past couple of years.
[00:25:19] Speaker A: So pretty recent.
[00:25:20] Speaker C: Yes, but the technology for it or the idea for it has been out there for a while, even when I was in the lab. But it couldn't be made gentle enough and safe enough for a human trial. But now, two years ago, it was just a few hearts that were done with this technique. Last year it was. Depending on the region of the country, up to 30% now are done with this technique. That is the DCD with the extracorporeal circulation in the transportable box.
[00:25:50] Speaker A: Interesting. So let me ask as the.
Because this is. Some of this technology is way over my brain, my brain space. So as a orthopedic surgeon asking the question, there's got to be some ethics involved in this whole process where unethical situations can arise or ethics can be broken.
[00:26:11] Speaker C: Yes.
[00:26:12] Speaker A: So what can go wrong here?
[00:26:14] Speaker C: Okay, I'll mention on a broad scale, we'll go back to unos. UNOS is the United Network for Organ Sharing. It reports to the HHS Secretary One of its charges is to get the maximum number of organs.
UNOS has divided the country up into 11 separate geographic areas. Region 1, 2, 3, 4, up through 11. I happen to be in Region 6, which is Alaska, Washington, Oregon, Hawaii, part of Idaho, and eastern and western Montana. That's Region 6. So Region 6 has a lot of geographic area, but not that many people compared to the East Coast. So it's a big area.
And the situation is that Region 6 is divided up into different organizations that are self contained, called OPOs, Organ Procurement Organizations. They consist of the professionals who take the calls of potential to donors and coordinate the flight times, coordinate the different allocations of the organ within their geographic region.
They are under tremendous pressure by HHS and by the government to produce a certain number of organs per population.
And I can tell you in the past five years it's been ratcheted up, up, up, up.
So now you've got these professionals who are doing what they want to do. They want to help people. Everyone wants to get more organs to help people.
But if the pressure's on you to get more and more, there's naturally some pressure to cut corners.
And I can't. I know the recent cases, I looked at them before Congress and things.
This is another case where if you just will be compliant with the rules that are in place right now for brain death, you won't have those problems. Okay, So I don't think we need more rules concerning brain death, but you have to follow the ones we have.
But the pressure is on. And here's where the DCD is a problem.
You can see where there could be some subjectivity with the dcd. Yes, because sometimes there's still electrical activity and how little circulatory flow can there be? Maybe there's still some with the A line, but it gets flat enough that now they call it and you move ahead.
And that's an issue.
And it's coming to a sharp focus for heart transplant surgeons and programs with something called nrp, which is normothermic regional perfusion. And this is a subtype. It's a little complicated here. A subtype of dcd, the DCD I was describing to you has a donor who has stopped heart circulation. And we just take the organs out rapidly, basically, and assume that that five minutes of non circulation has produced an irreversible death.
But if you look in the fine print of the definition of irreversible death in the Uniform Determination of Death act, it says irreversible despite any medical therapies.
[00:29:21] Speaker A: Hmm.
[00:29:21] Speaker C: Now.
[00:29:22] Speaker A: So there are some therapies that could be done.
[00:29:24] Speaker C: Yes, and here's what happens with every NRP case, which is more and more common now for abdominal organs. Well, let's pick up the scenario for dcd. So this is a subset of DCD patient donors where the donor is taken to the waiting room, the heart stops, we wait our five minutes.
What's different is this.
We move those donors. And I personally don't participate in this and our program doesn't. But I'll describe what happens.
This donor, now five minutes without circulation, has moved into the OR very rapidly. Instead of taking the organs out quickly, we put in tubes, cannulas into the femoral artery and femoral vein and start them on extracorporeal circulation. Warm oxygenated blood at flows that are physiologic. It takes 30 seconds to do this.
Now you've restored circulation, what happens?
The heart starts beating, the liver starts metabolizing, the kidneys start making urine. Rick, you've been at many codes when you were a resident.
[00:30:34] Speaker A: Yes.
[00:30:34] Speaker C: And they've been in the bed for five minutes and no one's noticed. And then you start CPR and they come right back and they're fine. They wake up and say, why are you pressing on my chest? Right. Right. Well, this is happening to someone who's been down for five minutes, witnessed.
And now you're resuscitating them with a much more effective and powerful resuscitation than any CPR because they're getting warm oxygenated blood flow at physiologic levels in seconds after the five minutes. So what's the issue with that? What's the big deal with that? Well, now the heart's beating and now you don't have to use that fancy device to perfuse the heart to see if it works.
[00:31:18] Speaker A: Right?
[00:31:19] Speaker C: Because now it's working just like it would have if it was a brain dead donor. But here's the thing.
For abdominal organs, which this technique's been used for a while without much ethical concern, because when they use it, they put the cannulas in the femoral artery and femoral vein and they clamp the aorta in the abdomen. There's no blood flow to the thoracic organs or the chest because the blood's flowing the opposite direction from below. The brain never sees blood again. And the patient who is dead legally stays dead.
When you do NRP for the heart and thoracic organs, that is the lungs and heart, you perfuse the aortic arch backwards from the frontal vein. So, Brick, think about it. You've resuscitated many patients that have CPR for a while, more than five minutes, or have been down for five minutes. And five minutes is not long to.
[00:32:13] Speaker A: Be down, some over 30 minutes. Yes.
[00:32:14] Speaker C: Or. Or where you've just stopped and they've come back in five minutes. So what we're doing is we're taking those patients now, or donors, potential donors, and giving them blood.
But now I'm taking their heart out.
[00:32:28] Speaker A: This is fascinating. Let me ask. Let me switch gears here. Let's go to the philosophical question, because what we hear in the media today, and for the lay physician like me, is we have a shortage of organs in this country.
That has a lot of implication, that statement right there, that we have a shortage of organs.
[00:32:46] Speaker C: Right.
[00:32:46] Speaker A: So there's an impetus on doctors like you that we need more.
[00:32:50] Speaker C: Exactly. And just in the area of heart problem, for instance, there's about 3,500 heart transplants done last year in the U.S.
there's 4,000 some people on the waiting list. But there's estimated to be 50,000 patients in the US right now that could benefit from heart transplant. But we don't list them all because there's not realistic to list everyone who might need it. We only list the people who are ill enough to be in imminent risk of death to get a heart transplant.
So there are deaths on the waiting list, and we know that there's a shortage because clearly the best quality of life that we can give to patients with this degree of heart failure is heart transplant. There's no machine yet, no artificial heart that can equal the quality of life you get with a biological heart transplant. So that's still the gold standard.
There is tremendous pressure on us to do this. In addition to the pressure from a numerical standpoint. The way the system works is, for instance, in our hospital.
We have several patients waiting in the hospital right now who we know them very well, maybe we've been taking care of them for years. We know their families. They are trusting us. They are counting on us to get that heart.
And so if there's a marginal donor out there, we're going to look hard at it.
And the motivation is to try and do our best. That's why I think for many of the cases that we see here, we say, well, they're breaches of ethics when these things occur. I think it's not because there's some evil being put forward by some clinicians, but rather you think, oh, this donor is going to be dead anyways.
And I can help someone who clearly needs help, and you start making a calculus that's a little bit subjective, and that's where we can get into a bit of a problem.
[00:34:40] Speaker A: Yeah. It's going to creep some ethical milieu out there that may not even be solvable. So I don't. Gary, I don't mean to put you in the spot of being a prophet, but let's go back 50 years ago. The. The ventilator, new technology, it created an ethical dilemma because it created a more difficult definition of death.
[00:35:01] Speaker C: Yes.
[00:35:01] Speaker A: What do you foresee in the future? Is there anything coming down the road in the near future that's going to create more ethical?
[00:35:07] Speaker C: Yes, and I think we're seeing that already. And that's the. The overall trend in our culture to look beyond human life as a sacred thing and view it from a utilitarian standpoint. What are you able to do?
Because somehow lives become less valuable when you don't walk, when you don't mentate the way you used to, when you aren't as interactive. It's human nature for us to look at it that way. But for us as Christians, it's important for us to remember that life is a gift and we're created in the image of God. Our worth comes from who we are and who created us, not what we're able to do.
And so we see that already in our discussion, say in the icu, about persisting in certain things. One rule of thumb that some of us find useful is that when we see ventilators, pacemakers, ecmo, that is the extra corporeal circulation where we can simulate the work of the heart for a period of time, you have to ask yourself, am I prolonging the natural act of dying, or am I actually going to help them make a meaningful recovery? And that's subjective. I know that, but it can't be anything but. And so we're called upon to use our good judgment and our understanding of compassion and useful application of the technology.
So I don't like to use these things to unnaturally prolong a death that is unavoidable in any case.
[00:36:39] Speaker A: Well, it's reassuring to know that there's Christian men like you that are in this world that hopefully can give guidance to the rest of the transplant world about how to do this ethically.
[00:36:49] Speaker C: Can I make one comment about the NRP before we leave? And I know I didn't want to leave it for a professional who's heard what I just said. I didn't get to finish the last part, and that is, as we perfuse the brain with the DCD donors from the femoral artery and vein, we push the blood up backwards through the aorta up into the head. There is a provision for that. The people who are proponents of the nrp, the normothermic perfusion, say what you must immediately do when you open the patient is clamp the carotid blood vessels.
[00:37:26] Speaker A: So there's no blood flow to the brain.
[00:37:28] Speaker C: Yes, but the manner, the actual manner in which it's done is not as surgically precise as you think because the time frame is so compressed secondarily. Anyone who does vascular surgery knows the carotid are not the only blood supply.
[00:37:46] Speaker A: Vertebral arteries.
[00:37:47] Speaker C: Absolutely. And those are not affected by any clamping you can do in the neck.
[00:37:51] Speaker A: Interesting.
[00:37:52] Speaker C: So those brains are getting perfused with this with a five minute downtime and you're taking the heart out, organs out, without any other.
[00:38:04] Speaker A: More dilemmas.
[00:38:05] Speaker C: Yes. And so some of us may that you were asking about the different moral dilemmas that for me has made me not want to have us participate in that particular thing right now until it's sorted out. You know, I.
This is a personal feeling. This is what I see. So far it's a minority position because the NRP is becoming more and more widely used, especially in big centers.
And so it's something we have to keep our eye on.
[00:38:34] Speaker A: Well, there's a couple of hospitals now in academic centers that are doing genetic research about organoids. Develop some kind of quasi, I don't even know how to describe it, quasi humanoid. With taking the genetic material and growing organs.
[00:38:46] Speaker C: Yes.
[00:38:46] Speaker A: Do you ever think that's going to come to fruition?
[00:38:48] Speaker C: Well, they are doing it already with, with organs that don't have discrete structure, mainly pancreas.
If you can grow the appropriate cells from a stem cell background and implant them, say in muscle tissue and just perfuse it, you can get endocrine function. And I think there's no problem with that. Those are autologous cells. And if they want to do that and are able to do it, that's fine. We all know the risks of that.
Primarily tumors and unforeseeable genetic changes that occurred because we don't really control it as well as we think we do. The place for, I think believers, and I hope that many will agree with me that the very best cells for this happen to be embryo cells. And I would object to that.
The use of fetal tissue. It turns out that fetal tissue is very useful for pluripotential cells, they grow great organs, they are more potent, and our ability to get them to mature in what we want them to be.
But I think from an ethical position, that's more difficult.
[00:39:56] Speaker A: Oh, boy. That's gonna open a can of worms. Hey, let's close with this. Gary, you're an outstanding surgeon, well respected. Tell me some of the greatest joys or just a story? One of the greatest joys and maybe one of the greatest trials in your career.
[00:40:09] Speaker C: Oh, that. That's. That's a lot. But we, in my business, I have the great privilege of taking patients who are moribund and have them walk out of the hospital in the same hospital stay.
And with every transplant that we get to do, someone has died to give someone life.
And in that story, we see a picture of our Savior.
And in our hospital, I take the opportunity to point this out to people who are willing to hear. And we've had patients come to the Lord around the time of their heart transplant because of the reality of the sacrifice given for them and the worth of life that only God can give.
And that is why we do this. That's why I love to do this.
[00:40:59] Speaker A: That's awesome.
Gary, thank you so much for being on the Voice of Advocacy. Appreciate it.
[00:41:05] Speaker C: My pleasure. Thank you, Brick.
[00:41:07] Speaker B: Many thanks to Dr. Brick Lance for hosting and Dr. Gary Ott for his knowledge and his wisdom. This conversation reminds us that technology, it moves so fast, friends.
But Christian ethics must remain rooted in the truth that every person bears the image of our God.
Whether you're navigating definitions of death or evaluating DCD and NRP cases, or you're caring for families in the icu, we are called to practice excellent healthcare with a formed conscience, protecting life at all times, speaking truth in love, and bearing witness to the hope that we have as healthcare professionals in Christ.
If this episode encouraged you, would you share it with a colleague or a friend? Be sure to follow our podcast on socials and stay connected and up to date. To learn more about how CMDA equips healthcare professionals to live out their faith with wisdom and courage, you can just visit CMDA.org to learn more.
CMDA exists to equip and encourage healthcare professionals and to live out our faith with both courage and compassion. If you're not yet part of this community, we sure would love to welcome you. Just go to CMDA.org join to become part of a movement of passionate Christ followers in healthcare in both the US and abroad.
Next week, I'll have the privilege of Joining orthopedic surgeon Dr. Scott Southard he is founder of the In Jesus Name Medical Ministry which is a growing network of free church based clinics that bring health care and the hope of Christ directly into local communities.
What began as one doctor's prayer in Reno, Nevada has become a model that is empowering church congregations as well as clinicians to serve the poor, to pray with patients and partner with hospitals for care. For the least of these, Dr. Southard shares powerful stories of lives that have been changed from a child walking after surgery to a deaf grandmother regaining her ability to do sign language again, illustrating how meeting physical needs In Jesus Name opens doors for spiritual healing and renewed purpose in healthcare. You don't want to miss it.
Thanks for listening to Faith in Healthcare, the weekly podcast from CMDA where our mission remains the same. We are bringing the hope and healing of Christ to the world through committed Christ followers in healthcare. Like some of you listening, that's what matters to cmda. May you recognize this week that our Lord Jesus is with you and that he is for you to do his good work. Thanks for listening and we'll see you next time, Lord willing, on Faith in Health Care.
