Today, in part 1 of Organ Donations, we talk about the history and the rules behind giving someone your organs. It does get a little gross when we learn that lungs come apart into 'lobes' but it's probably still a good thing to know!
Today, in part 1 of Organ Donations, we talk about the history and the rules behind giving someone your organs. It does get a little gross when we learn that lungs come apart into 'lobes' but it's probably still a good thing to know!
Hi Friends! Our transcripts aren't perfect, but I wanted to make sure you had something - if you'd like an edited transcript, I'd be happy to prioritize one for you - please email doomedtofailpod@gmail.com - Thanks! - Taylor
Taylor: 19 crazy things happened over the weekend on Doomed to Fail
>> Taylor: In the matter of the people of State of California vs. Orenthal James Simpson, case number BA097.
>> Farz: And so, my fellow Americans, ask not what your country can do for you.
>> Taylor: Ask what you can do for your country.
>> Farz: Meetings. Hello, Taylor.
>> Taylor: Hello.
>> Farz: How you doing today?
>> Taylor: Good, how are you?
>> Farz: Good. Did you have a fun active weekend?
>> Taylor: My God, like 19 crazy things happened. I've been waiting to tell you.
>> Farz: Can we hear them all?
>> Taylor: Yeah. First, hello. Welcome to Doomed to Fail. I'm Taylor. Joined by fars, we bring your history's most notorious disasters and epic failures twice a week. And I had a crazy freaking weekend. You were just talking about how I should move to Texas. And I was like, I love California. I'm not moving. But also. So I'm in Joshua Tree between palm springs and 29 palms. This dude yesterday bombed a fertility clinic in, in Palm Springs and then like had another bomb in 29 palms. Like I think maybe went off. There's like a blast zone. I don't know what happened. I think the guy's dead. But he was like, his manifesto was like, he was pro mortalist, which means that life should be ended as soon as possible because it only results in death, which is why he bombed a fertility clinic. And he said having children is unethical because it only exposes more people to future suffering and death.
>> Farz: It's weird. It's almost like a nihilist perspective. But yeah, done extremely badly.
>> Taylor: Yeah. And so that happened. And then today I was at a birthday party at a park, like a public park. That's nice. But you know, I know that like some kind of. There's some shady characters that hang out there or whatever. A dude died in the bathroom during the birthday party today.
>> Farz: I would say that's not that weird. When I was living in la, the Starbucks that I would frequent also had a dead body in the bathroom from an od. So.
>> Taylor: Yeah, and like the, the people, the parents that were there, they actually work in recovery. And so they had an arcan in their cars, you know, they were like as the closest they could have gotten, but they didn't get there in time. And I had to like talk to the kids and be like, hey kids, let's stay over here, you know.
>> Farz: God, it's awful.
>> Taylor: It's awful.
>> Farz: Yikes. Okay, well, you had a lot that went on wild.
>> Taylor: Yeah.
I started getting super interested in organ transplantations and the whole process
>> Farz: Okay, so I think it is me going first this time.
>> Taylor: Yep, it's your turn.
>> Farz: So I didn't mean to do this, but I am going to end up doing a two parter. I think because this ended up getting pretty long and super juicy. So I, and this is entirely by accident. I just learned like, like an hour ago that Sanjay Gupta is going to be having a whole special on this topic on cnn. I just, it is airing tonight. I literally only learned it like an hour ago. So I promise I'm not getting inspiration from other people. This is straight from my dome. I started getting super interested in organ transplantations and the whole process in the multiple different variations of people getting organ transplants, the history of it and all that good stuff. So I'm going to get into a bit of the first half of the story in terms of organ transplantation history, the process, the donation system within the United States, the country that does it the most, which is not well on per capita basis. It's not the most. It's on the United States. But I'll talk about that later. I'll tell some fun, interesting stories around the topic as well. But the juicy, juicy bit is part two, which is the duress.
Voluntary donations or the worst, which is involuntary donations
Voluntary donations or the worst, which is involuntary donations.
>> Taylor: Is that like being like taken to a hotel room and put into a bathtub?
>> Farz: Exactly. Precisely that.
>> Taylor: There was something I just saw yesterday on the Internet that was like, science has enough bodies. I'm gonna donate my body to English lit and see what they do with it. So that was really funny.
>> Farz: And they're just gonna make a book out of your skin. It'll be cooler. It'll be more metal for sure.
>> Taylor: So much more metal. I like it. Yeah.
>> Farz: So I went through the history of organ donations and organ transplantations in general, and there's a really, really stupid story about this Chinese doctor who did it in like 300 B.C. where he swapped the heart of two men, one who was strong willed but strong in spirit or some. It was one of those deals, like it was obviously not real. And it just sounded like this guy was basically collecting corpses. The first actual organ donation that we can really call a modern organ donation happened in Boston in 1954. And that was a kidney transplant.
>> Taylor: Wow.
>> Farz: The history of organ transplant surgeries was such an insane leap of faith. It goes back to what I told you before, which is like, I feel like back in the old days, life just didn't matter. Like your life didn't matter. People didn't care about their lives.
>> Taylor: I don't think that it's that necessarily. I think like we're talking about the other day with like the death industry, it just was more common.
>> Farz: Maybe because you saw it more. Maybe for the death industry was more Part of what you did or you saw you experienced before.
>> Taylor: Yeah, before. Before it became what we have now. You experienced it a lot. You know, it's true. I think, and I think that that makes, makes it a couple of things. It makes it like easier to deal with if you are them. And also it makes it less scary and more scary if you're us because you don't see it a lot.
>> Farz: Know which I think I'm. After doing all this, I'm solely coming to your side, which is we should probably be more closely tied to it. You know what's funny? The other day I was thinking about my dog dying. I got really upset and was like, like I, I literally worked myself up, like, totally. I was really depressed about it and I was like, well, that's going to happen. Like, like, you know, I'm gonna die. Everybody's. So just get past it. But so, yeah, you're right. Like, maybe if I didn't have stuff off distance relationship with it, it wouldn't have been so emotionally traumatic for me to think about.
>> Taylor: Yeah. I mean, when I had my, when I had my daughter, I had to be like, in my head I was like, listen, enjoy every freaking second of time with her. Like, that's all you can do, you know, Otherwise I'm going to lose my mind just taking care of this person that I love so much.
>> Farz: Yeah.
>> Taylor: Like, try to figure out how to survive, you know, it's crazy.
>> Farz: Endure it all endured. Enjoy it.
Chris Washowski: There's a long history of unsuccessful organ transplants
Well, with the history of organ transplant surgeries, there was so many stories, such a long history of what's called unsuccessful transplants, which is literally just people dying on the operating table or shortly thereafter.
>> Taylor: I also. I'm so sorry to interrupt you. We've been interviewing you a lot. Okay. I have a lot of thoughts. I have no idea where things are in my body. I very, very recently understood for the first time that your fallopian tubes aren't like this. Like, they're not in a T, they're like in a blob. In your body. No, they're a blob. They put them in the T so you can see what they are. But in your body it's like uterus floating tubes on the side of them. It's like a big blob together. And I'm like, I didn't know that. Like, why did I, Why did I not know that? That's so weird. Like, I just think that's like, I don't know where anything is.
>> Farz: You know what's funny? In the middle of this When I. When I get towards, like, probably, like, the 30% part of this is when I had a similar experience where I'm going to go into lungs, and I'm like, wait, that's how they're shaped like it is.
>> Taylor: Oh, yeah. I can't wait to hear Chris.
>> Farz: It is so much different than what I thought it was.
>> Taylor: Yeah.
>> Farz: But. Yeah, basically, like, with the original pre1950s and even the 1950s experience of organ transplants, it was a lot of doctors shuffling organs around between different animals, see what works and how it works, and then kind of trying some of that in. In humans and seeing what takes and what doesn't take. My favorite story is a guy named. Not favorite in a good way, but it was a guy named Boyd Rush, who was the person who received the first heart transplant in January 1964. This goes back to, like, an old Bill Burr bit where he was, like, talking about hair transplant surgeries, and he's like, never be the first one to.
>> Taylor: Do anything for real. As exactly what I was just thinking. I was like, oh, God, do not be the first guy to get your freaking heart transplanted. I mean, I guess it's your choice. You're like, I'm gonna die anyway. But.
>> Farz: So he didn't really make the decision in this case. He was suffering from acute heart failure, and by the time he was taken back to initiate the transplant surgery, he'd gone into shock, and his heart had stopped already. He was already dead, basically. It wasn't, like, a voluntary thing. Well, he knew he was gonna do. They knew that this was gonna happen, that he might wake up, but he also knew he was gonna die no matter what. So.
>> Taylor: Right.
>> Farz: So the doctors did the next obvious thing. When he died in 1954 in Boston, what do you think the next obvious thing was here?
>> Taylor: Taylor try to put his heart in somewhere else's body.
>> Farz: So you know what I wrote? That's right. They stuffed a chimpanzee heart into Boyd. So you got it wrong, and the outline isn't going to correct the record that you got that wrong.
>> Taylor: I don't know. I don't think I would have guessed that. So the.
>> Farz: The story goes that it was, like, these surgeons who had been, like, tinkering with chimp hearts, and they had. Somehow. They had four chimpanzees in the hospital, and they went like.
>> Taylor: That was more common because they were doing. They were doing a ton of, like, testing on it. Right.
>> Farz: I would feel weird if I went to, like, a. A. A hospital. And they were also Running like a part time zoo in it. But yeah, I guess back then, Back.
>> Taylor: Then like animal torture chamber I think is the right word.
>> Farz: Yes, yes, yes. To, to their credit, to their credit, this guy's heart, sorry, the chimpanzee guy's heart did beat for about an hour and a half and he did come back to life for an hour and a half before the chimp heart failed on him.
>> Taylor: He was unconscious, right?
>> Farz: He was unconscious, yeah. The first normal heart transplant, quote unquote was performed in South Africa in 1967. This one was a guy named Washkowski who survived for 18 days without any other medical intervention before dying of pneumonia, presumably due to the anti rejection medication that he had to take to suppress his immune system. And that was part of the. After this like because nobody had done this. You're just like tinkering. It's like baking a cake. Like okay, so if I add like, like the eggs are the heart and then the immune suppression is like the flower and like how long you.
What do you think the most complicated transplant surgery is
The surgery also.
>> Taylor: So many veins.
>> Farz: So many veins.
>> Taylor: Like insane amount of veins together.
>> Farz: I'm going to ask you this. What do you think the most complicated transplant surgery is?
>> Taylor: Okay, so you're saying like face.
>> Farz: I did not do any research on face surgeries because that is kind of a new invention.
>> Taylor: My dad always says he wants to only donate his face.
>> Farz: That is a funny. That is funny.
>> Taylor: I don't know.
>> Farz: All right, we're going to get to it. We're going to get to it. I was curious if you would have any assumptions here. You know what, we're going to get to it right now because I forgot that the next part of the outline is this piece.
Some lung transplants require a living donor versus others require a dead donor
The lungs.
>> Taylor: Oh, okay. You just mentioned that.
>> Farz: Are a particular challenge compared to all the other organs that have to be transplanted. So it took until the 1980s to really perfect this one. The lungs are the least likely to have long term success and the reasons for it are they are the only parts of your body that touches. Sorry. It's the only part of your organs that touch the outside world. You're breathing in air, you're breathing in pathogens, you're bringing in different things. And the other factor is things like who can donate a lung, who can receive a lung for example. The recipient can have any infections or cancers or hepatitis. They can't be overweight, they can't be underweight, they can't have a history of alcohol. They can. This is fascinating. They can't have a history, a long term history of smoking, which. Who do you Think needs the lungs, right? But if you smoke forever, you damage your lungs. You donate them. Well, you can't donate them, but you can't be the. Sorry, the recipient, the person getting the lungs cannot be. Can't be a smoker. And those are the ones that most likely to require it. The trick shot tends to be with these folks, they have to be basically healthy. And it's a little bit hard to come by a relatively healthy person. I think of our former friend who got needed a lung transplant, but he needed it because he had to get cancer treatment that scarred his lungs. It wasn't because he was a lifelong smoker, but most people need lung transplants, need them because of smoking.
>> Taylor: Do they usually keep smoking?
>> Farz: You can't. So like part of. Part of the cessation process. No part of the cessation process. And this is also goes into like that income disparity and lack of equality when it comes to this kind of stuff is that you have to have had a prolonged period of secession, not just of smoking, but of any nicotine or whatever. And also counseling and psychological evaluations. Like you had to have gone through a very expensive and protracted process once you qualify to even qualify to be added to the list for a lung transplant. Because they don't want to give these organs to just anybody. Yeah, makes sense. So I think this should be obvious, but some donations require a living donor versus others that require a dead donor. You have, let's say for example, a full lung. A living person that can obviously not donate a. A lung except in certain rare conditions in Japan and in the United States where a living donor can donate what are called lung lobes, which I did not know. So when you look at the picture of the lungs and there's these like deep creases in them, you know, I.
>> Taylor: Look up lungs, I'm going to regret it.
>> Farz: Those are the lobes, those deep cuts that look like they're like chopped in there with like a cleaver. Those are lobes. So apparently you need two donors to create one full lung on the left side and three to create a full lung on the right side. But otherwise you can only obtain lungs from a dead donor. Because you can't. It's hard to convince two or three living people to undergo this surgery.
>> Taylor: So the creases are different sections?
>> Farz: Yes.
>> Taylor: So it's not like one full lung.
>> Farz: They're lobes. I'm going to throw up their lobes. You're filled your chock full of lobes, Taylor.
>> Taylor: Should I click on the ones that have like the blurred image I think I will.
>> Farz: Got to be so gross.
>> Taylor: I've seen like as a child of the 90s, do children still see pictures of black lungs?
>> Farz: I don't know. Do they?
>> Taylor: There's also a very. Do you ever watch Hannibal, the TV show?
>> Farz: No. I should, I should probably watch it.
>> Taylor: I need to rest. I need to start over. I think it was. I like watched a couple seasons, I forgot where I was. But obviously he's a cannibal. But he does this like. He is like also a like brilliant chef, you know, in this one. And so they have like really long scenes of him like making this beautiful dish out of lungs. And then I like read an interview with like the set designer and she had to like make them out of other things, you know, obviously like make them as look as much like lungs. I. You should watch it. But also you should not eat when you do.
>> Farz: Yeah, it's gross. It's all gross. I. I can't do those meats. I can't do. I can't do lung. I have not. Jesus. Lung. I, I can't do liver. Like, I've tried liver before and I just cannot. I. Apparently those meats are the best for you though. They're the most.
>> Taylor: I know, I was going to say that if you are in a down price situation, pull out the liver and eat it. That's going to help you the most.
>> Farz: If you're in a what situation?
>> Taylor: A diner party situation.
>> Farz: Party situation. Okay, it's fair.
About 91,000 people are waiting for a new kidney and there's
So I'm assuming, can you guess the most in demand organ possible for transplantation?
>> Taylor: Heart.
>> Farz: Kidney. Kidney is the most. So in the US about 91,000 people are waiting for a new kidney and there's a hundred thousand people total on the overall organ donation list. So. So it's a huge chunk of what people need. There are a lot of differences in supplying someone with a kidney versus anything else. For example, if someone receives a complete healthy lung, their survival rate tends to barely be about half. Like it's about 50 to 53% for five years. If you get a healthy lung from someone by 10 years, a lung transplant person is about 28% chance of survival. The person that we're thinking about, he lasted 11 years if I remember correctly. But I think he also had double lung transplant, didn't he?
>> Taylor: He did. I think so. He had two different ones.
>> Farz: Yeah.
>> Taylor: Oh my God. Lungs are so gross.
>> Farz: Hey, love the ones you got.
>> Taylor: I. Yeah. For real. Stop smoking. I know it's great, but stop it. You don't want to deal with this.
>> Farz: Do fail. Brought to you by Marlboro.
>> Taylor: Oh God. Remember when the cigarette people would like come into the bars and give you free lighters and stuff?
>> Farz: I don't recall that.
>> Taylor: In New York all the time there were cigarette people and they would come and they would be like, hey, try these Marlboros. Here's a Marlboro thing. You can get your points and like get a jacket, you know, you get like Marlboro points.
>> Farz: Oh yeah, of course, yeah.
>> Taylor: But then there's all these people that were like, there's job was to get you to do it.
>> Farz: Yeah, of course. It's good business. The heart is slightly better on. The survivability rate after five years is 69% for women and 73% for men. So go men. Although it's interesting because if a man receives a woman's heart, John Hopkins has determined that they their survivability rate after five years decreases by 15%. And this tends to be because men need larger hearts and there's a different cardiac output output based on the size. So that's part of the reason. Also, I didn't know this, but apparently women have way better immune systems and that's really good for like normal stuff. But apparently women are also, what is it, four times more likely to develop autoimmune diseases than men because like their body will attack because their immune system works that well that it can attack itself. and also a lot of this stuff you're, like I said, you're kind of tinkering like with how much rejection to take and how much not to take and all that stuff. And so having two different gender organs together can mix. Mix the whole thing up.
>> Taylor: Yeah, I never thought about that.
>> Farz: Yeah, I don't think about it either. Makes sense though, I guess.
>> Taylor: Do you have to have a hard. Someone that doesn't seem like size as you.
>> Farz: I don't think you need to have the same size. I think they just do the calculus based on your eligibility for it, your compatibility with it and then hey, like you might have gotten one and you're off the list. And this is going to last you probably five years and the next guy might get 10. We don't know.
>> Taylor: Right. You just kind of hope for a good one.
>> Farz: Yeah, we're going to go into the details of that allocation piece because that is incredible. So I share all that. To say that organ transplant in general are like kind of non obvious and mostly not totally quantifiable in terms of what'll work, how long it'll work, who it'll work for all that stuff, like the human body is kind of complicated. There's a lot going on in there.
>> Taylor: Yeah.
>> Farz: So by comparison to the hearts and lungs, kidney transplants, after five years, you have about 80 to 87% chance of survival. So it's pretty high.
>> Taylor: Yeah.
>> Farz: With living donors, their quality of life isn't severely impacted. So the donor giving the kidney isn't severely impacted. The remaining kidney apparently will grow to compensate for the missing one in a lot of cases. And typically they go back to normal life within four to six weeks, which kind of.
>> Taylor: That's incredible.
>> Farz: Yeah. The only obvious risk or challenge I could find was being a donor. Other. Sorry. With being a donor, other than the few weeks of discomfort was slightly higher risk of complications during pregnancy and apparently difficulty in getting life insurance. Or in some states, you get higher health insurance premiums. That's it. Yeah. So that's a little bit of the demand side.
Spain has the highest rate of transplant surgeries per capita
Let's get to the supply side real quick because this is where it gets super juicy juice. E. There are two ways to obtain organs voluntarily and voluntarily. Let's get to the easiest one first, which is voluntarily, with no duress, no coercion, and you're talking to an organ donor. So Spain apparently has the highest rate of transplant surgeries on a per capita basis. And it's interesting because it's because they have. Well, part of the reason is because they have an opt out system. Can you guess what that means?
>> Taylor: That you cannot. Oh, but it's not opt in, it's opt out.
>> Farz: Yeah, yeah, yeah. Every citizen is by default an organ donor unless they explicitly state that their wish is not to be an organ donor. They also accept more donor types than other countries do. For example, they will accept organs from elderly people, which most countries don't. They won't like. There's a certain cutoff here. And also an interesting thing that we don't do here in the US Is that they consider the organ donation and organ harvesting process to be part and parcel with the end of life support for somebody.
>> Taylor: That makes sense.
>> Farz: When you're in the room doing like palliative care like those people are there with. Well, not probably breathing over you like the grim reaper, but still, you know what I'm saying?
>> Taylor: With, like a cooler.
>> Farz: I know. Hey, we're ready to go. Choppers, choppers fueled up. Let's get this show on the road, guys.
Spain includes organ donation as part of end of life treatment
The US Is the highest in terms of absolute organ transplant surgeries, but we use an opt in system. So let's look at the donors, starting with the legal framework for deciding who is a organ donor for the sake of being dead, to harvest their organs, you are legally dead. If there has been irreversible cessation of circulatory and respiratory function or irreversible cessation of all brain activity. One is obviously better than the other. It's the brain one.
>> Taylor: Yeah.
>> Farz: So these two factors are determined by physicians who have nothing to do with the patient's care, the one who's dying being the donor or the recipient's care whatsoever. Basically it has to be a total random under uninterested doctor who assesses whether you are dead for the purpose of organ donation. Once that's determined, then organ donation, the process can be started with the appropriate consents before death or through family consent. So what I was saying earlier that this, this in Spain, this is part of the end of life. You are dead, then the process begins. So like you're losing time here. Like the window of time is, is.
>> Taylor: Gradually your body is decaying immediately.
>> Farz: That's why I said one is better because it doesn't decay immediately if it's brain death. So condition is somebody being brain dead because the heart doesn't depend on the brain to pump, so it just keeps on going, meaning the heart keeps oxygenating the organs that you might eventually want to transplant. Then there's donation after circulatory death or dcd. This happens when the person has severe head trauma but the brain isn't dead yet. These are more time sensitive situations where life support is withdrawn. A two to five minute window of time is observed to ensure death is not reversing itself. Which should have been in the Final Destination movie I just saw yesterday. But.
>> Taylor: Oh, how was it?
>> Farz: Fun.
>> Taylor: Oh my God, I cannot wait. We know that, we know the producer. He's someone that wanted to know from film school. So we're even more excited.
>> Farz: Tell him he did great.
>> Taylor: Oh, I can't wait.
>> Farz: And Tony Todd was incredible. I'm so glad. That was like, well, I'm sad that he's dead, but like if that was the last movie for him, that's the one for him.
>> Taylor: So exciting.
>> Farz: I felt like, I almost felt like it was like too good having him in there. Like he was in it.
>> Taylor: That's awesome.
>> Farz: He added a gravitas to the movie that was like, whoa. Like that. You just like kicked it up like several notches and I was expecting this to be like it was a popcorn flick.
>> Taylor: Wow.
>> Farz: So anyways, you had a two to five minute window of time, then you make sure death isn't reversing itself and then the body's rushing to surgery to retrieve the organs. I mentioned earlier that Spain includes organ donation as part of end of life treatment. Like I said, this does not occur in the U.S. mostly because I think the U.S. has more of a conspiracy mindset when it comes to this stuff. Like, I'm sure you've also heard people talking about how doctors will not save you because they want your precious.
>> Taylor: Yeah, yeah, yeah.
>> Farz: I don't know why, like we ended up with that mentality here. I understand why for one demographic we're going to touch on later. I don't totally get why that's the case here. That's why it is totally separate. It's all deliberate.
>> Taylor: Yeah.
>> Farz: So nine states plus Washington, D.C. have individual decided physician assisted suicide laws. Meaning that you on your own can just show up to a place and say, I want to die. Yeah. California is one of them.
>> Taylor: Cool.
>> Farz: Montana has court approved physician assisted suicide. In none of those cases can the organs of those people under any circumstance, consent or not, be donated. Again, there's no physician, no organs from somebody who passes from physician assisted suicide can ever be donated under any circumstance.
>> Taylor: Interesting. Oh, is that okay, tell me why.
>> Farz: Well, the why of it gets into the moral and ethical kerfuffle that we're going to definitely go super deep into and part two of this topic. But it's the moral aspect of it. It's like, it's like you, you don't want people to. I would assume that part of the logic around this is that you don't want to create incentive structures for people to do things that society might deem not helpful on an individual basis. So somebody who is. If somebody's suffering from like something horrible, like a horrible, horrible cancer and they are never going to recover and they want to get a physician assisted suicide, hey, they weren't going to be a candidate anyways. Right. Because in that situation your organs are not transferable to another healthy human. So you're, you're basically cutting out every demographic that could potentially be a donor, except for the ones who are obviously severely mentally ill. And those people make decisions that are not reasonable and rational. And you don't want people who fall into that line of thinking to have incentive structures around, oh, I'm doing something good, I should kill myself, it's going to help these other people. Like, Right. I think that's the theory behind it.
>> Taylor: I get that. I mean, obviously like the whole bunch of reasons someone might choose that. But like, that definitely makes sense for. And also like, you could easily become an organ harvester.
>> Farz: You can imagine how many people are manipulated into like, being only fans people or whatever. Like, you could. You could find. You could obviously see a universe where people are like, yeah, you should do this, and your family will get a $50,000 where we're going to super deep into this because the moral aspect of donating is like, really touchy for people, I think, going back to this. So once the person is declared dead, that's when the organ donation process starts. The hospital will contact what is called the Organ ProCure organization, the OPO, which is a nonprofit that is funded entirely by the government. It's a. It's its own separate entity, but it's all run of the auspice of the government. So it's basically the government outsource all this. The federal government, I meant outsource all this to this one nonprofit. And it's their job to recover the organs. The OPO then checks donor registrations and contacts the family. If the consent is received, then the body is placed on ventilators and fluids to preserve the organs. And then the organs are recovered, matching happens, and the organs are sent to the recipient's hospital. There's one thing I learned about this which, like, was incredible. Look up heart in a Box on Google. And I know that we imagine people just running around with organs and like Coleman's little fridge, things like actually a.
>> Taylor: Picture of that, but.
This contraption keeps the heart active before transplantation
Oh, cool. That's cool.
>> Farz: You know, you say that's cool, but if you watch a video of it after this, you're gonna be like, what, Frankenstein?
>> Taylor: They're keeping it alive, are they?
>> Farz: They're keeping it. So basically what this contraption does is it keeps it active. So if you actually watch a video of it, if you see a picture of it, you're not gonna be able to tell, obviously, but if you saw a video of it, it is a literal human beating heart completely removed from the body and just floating in this box. It is dystopian. As dystopian, I hate it. But it's a way to keep the heart live, and it's a way to keep it from getting like, freezer burn before transplantation. So that's the incentive structure for that.
>> Taylor: I know you don't remember this brand, One Tree Hill, when they dropped the. The cooler with the heart in it and the dog ate it in the hospital.
>> Farz: You know what's funny, Taylor? You said that, and I kind of do remember that, actually, out of all the things you've ever asked me.
US passed Hope act in 2013 allowing HIV positive people to donate organs
So we Discussed the class, the class of people that are not one class of person that is not able to donate organs. And that's the medically assisted suicide people. There's a pretty extensive list. So this is interesting. So typically people with HIV can't donate, but in the US in 2013, they passed the Hope act, which allows people with controlled viral loads of the disease to donate to others who also have it. So that's good. The, the thing I didn't know is like, even, even when they decided to do this. It's also super rare that we actually do do this in the US because apparently there's a thing called HIV super infection. Have you heard of this?
>> Taylor: No. That sounds bad.
>> Farz: It's when an HIV positive person gets infected with another distinct genetic variant of the same virus. Mm. So they like have to find new ways to treat it because there's now multiples of it. It's like right. Apparently so. So because of, because of this and multiple different reasons, even under the HOPE act, this is super, super tightly controlled. Like I said earlier, cancer patients, they can't donate because of the risk the cancer cell could spread to other people. Anyone with a prion disease is absolutely restricted from donating. Zero exceptions. So mad cow disease, that is full stop Amazon. Yeah. Also this one's interesting. So if someone dies, like under mysterious circumstances, like their cause of death isn't like obvious. They are also excluded. Or people who are living like a riskier lifestyle, like prostitutes or intravenous drug users. They're also excluded. People who have been. Say again.
>> Taylor: I mean, that makes sense.
>> Farz: Yeah. And people who have been incarcerated or died during incarceration are also excluded. Death row inmates can never voluntarily donate their organs. Like that is a. No. No. And again, that goes back to like the moral and ethical aspects of this was like, yeah, what are we going to do? We're going to start telling people to get rich people to have these organs. Like that's. That's all that. Also what's really interesting is people who die outside of a hospital and they're far enough away from a hospital they never get to donate their organs even if they consented because they're too far for their organ retrieval, so.
>> Taylor: Oh, that's too bad.
>> Farz: Yeah. So all the people like on. In car accidents or plane crash. In plane crash. I guess the organs swore up anyways, but still.
>> Taylor: Yeah.
So let's break down the key demographic data of donor versus donor recipients
>> Farz: So let's break down the key demographic data of donor versus donor recipients. So the age, age wise, donors are typically between 35 and 49 years old. And no shocker the recipients are older adults in the 50 plus age range which we are rapidly approaching, which is like super weird that it's called an older adult. Gender wise, women are disproportionately represented as 64% of living donors are women. And the reason generally seems to be that, like, it's for family members. It's like they're more, you know, that aspect of it. The recipients are men. They're disproportional recipients of organs. About 60 to 70% of all organ recipients are men.
Racially, black Americans are disproportionately represented on wait lists for transplantation
Racially, black Americans are disproportionately represented on wait lists for transplantation. They make up about 14, just under 14 of the overall population, but make up 30% of the transplant list. And some of this has to do with the fact that there's a apparently three to five times higher rate of end stage renal disease and kidney failure amongst black Americans and white Americans. This part kind of gets a little bit. We're going to dive into this into more detail, but it gets into the socioeconomic disparities around things like donation and transplantation in overall kind of health outcomes, because this kind of plays a big deal in it. There has been called out in several research papers about the Tuskegee Airman study and how things like that built a deep distrust within black Americans of, like, the medical community and why, like some of the guidance being offered there isn't. Isn't necessarily adhered to. Also, like I said, like, if you are not close to a hospital to get the donation when the call comes, or you, there's reasons why you wouldn't be able to accept the donation even if you were allocated one. And a lot of them are due to your socioeconomic status. So that's the fact for all this. And the biggest one tends to be wealthy, which is like shocking to no one.
>> Taylor: I mean, we know the person that we know that had the lung transplant who has since passed away, but they definitely had someone who has a lot of money talk to people and say, do this.
>> Farz: Yeah, I think it was like three billionaires.
>> Taylor: Yeah.
>> Farz: Yeah.
>> Taylor: So we were like, cool. And then a lot of us were like, that f****** sucks.
The organ allocation program is designed to be impartial with no consideration given to wealth
>> Farz: Well, I want to actually get your opinion on this and we can actually dabble in it. Before we get into the second piece of this, I am curious to hear your perspective on and kind of debate this a little bit. Getting to the wealth piece. So on paper, the organ allocation program is designed to be impartial and neutral with no consideration given to wealth. So that is like, that's how it's supposed to work and it actually does do that because the algorithm running the checks on availability versus need, it said the United Network for Organ Sharing or unos. It's not able to be gamed like the algorithm is an algorithm. You can't gain it based on your wealth.
>> Taylor: Right.
>> Farz: The thing that it looks at is that it looks at medical urgency. So the sickest people go to the top of the list. Then the next step is it looks at the time of the people that are on the wait list and then it goes through the compatibility aspect of organ compatibility, Geographic territory, regions, all that stuff.
>> Taylor: So it tries its best to get people who need it the most first.
>> Farz: Exactly, exactly. It's not actually in its nature. It's not designed to be gamable. It is though, so.
>> Taylor: Sorry, sorry, that was funny. You're like.
>> Farz: It is though in, in various ways. So you can't be evaluated at all to join the transplantation list unless you undergo extensive medical evaluations. You have to consent and do consistent healthcare follow ups on ongoing basis. You have to show proof that you can handle the post transplant care, including the immunosuppressant drugs. And those can run somewhere between 10 to 20 thousand dollars per year.
>> Taylor: Wow.
>> Farz: So it is a. It is a. It is an inherently very expensive thing to do. And there are people who were in need of organs that were denied access to the list because they could not fulfill all the requirements of being on the list. Yeah, that's where money comes into play. In part. There's other parts where it comes into play because the people who are super, super duper wealthy, they can afford consistent travel, they can afford homes in multiple locations. They don't have to be confined to a specific geographic territory where the donation could occur.
Steve Jobs got listed in Tennessee on wait list for liver transplant in 2009
So, so let's talk real quick about Steve Jobs. Have you heard the name?
>> Taylor: I have, yes.
>> Farz: Great. So in 2009, the wait list in California for a liver transplant could take up to five years just due to the need there. By comparison to that time, Tennessee only had a few month waiting list. In 2009, while still living in California, Steve Jobs got listed in Tennessee on their wait list for a liver.
>> Taylor: Wow. I don't know that.
>> Farz: Which wasn't a problem because when the liver became available, he and his team of caretakers, his doctors, just boarded his private jet and then scooted over the facility. They got there in enough time as somebody who's poor in rural Tennessee would have had to drive all the way there.
>> Taylor: Right.
>> Farz: So you get access to this broad pool. And he got his operation, he got his Liver transplant. And I mean he ended up dying anyways. I mean you would. Because it's a. Well, the lung was a hard one. So like he ended up dying. But yeah, regardless, he had access to do that. He only waited a few months when a lot of people would have waited half a decade, if not longer.
>> Taylor: Wow.
>> Farz: So According to a 2022 audit of UNOS, there were hundreds of missed transplant operations that could have happened every year but didn't because of lack of communication delays or patient availability. People who have missed an organ transplant surgery did so because they might have missed a call, their cell phone was dead, the battery was dead, or there was bad weather making transportation super difficult. Or because they arrived at the hospital, additional testing found something new that precluded the operation. Which are all things that you would have known if you were rich and were surrounded by a team of doctors. There is a disparity in potential outcomes here.
Next segue has to do with the coerced, legal and the illegal organ
All that to say I'm going to go ahead and stop this here because the next segue after this has to do with the supply side on the coerced, legal and the illegal organ side of things and the worst of the worst, which is the involuntary organ. I don't even know if you call donation side of things, but I will.
>> Taylor: Say, but yeah, donation. I don't think. Well, I don't know, whatever.
>> Farz: When I was, when, when our friend was going through what they were going through, I do remember thinking that if somebody wants to be paid to give away their organ and is like exorbitant comp, like life changing money, they should be allowed to do it.
>> Taylor: Yeah, like one of them, like a kidney, not like your heart.
>> Farz: Yeah, of course, yeah. Yes, yes.
>> Taylor: You can only do it once.
>> Farz: You only do it once.
>> Taylor: But I'm sure you can find someone.
>> Farz: Yeah, like so part of the thing we're getting into next week is that places like the Philippines, the outskirts of Russia, like Thailand, places like that, people are getting paid like 1600 to like $2000 to sell their kidney. And when you hear the other side of it, somebody is paying 120 to 150000 to get a kidney.
>> Taylor: Right. So that person, the middleman's making all the money.
>> Farz: That's where I have like a huge moral issue with it is like how screwed over like that person should be paid a ton for what they're doing. They're not. And that is bad. And so anyway, I think that's where I land on this. I will say that the World Health Organization was offered a pilot program for federally paid for organ compensation and they refused it. And the reason they refused it was around how there's a coercive effect potentially of paying people for organs. And that's probably also true. So I don't, I think I get both sides of the equation. It's just. I don't know. I don't, I don't know how I feel about it yet.
>> Taylor: Yeah, it's gross. Weird.
>> Farz: You have an opinion on it?
>> Taylor: No. I don't know. I feel like you should. I don't know if it was like you get like a ton of money but people will be like lining up to do it once. I don't know.
>> Farz: But. But then what happens when that one kidney starts failing?
>> Taylor: Right.
>> Farz: Then you just create a machine that just self perpetuates. Right?
>> Taylor: Yeah. You know what, and that's not good for you to continue to go through like that over and over again.
>> Farz: No, I read, I read that the dial dialysis process is typically three times per week with it being five to eight hours per session.
>> Taylor: Yeah, it's awful.
>> Farz: It is like, it is debilitating time. But again, if you're wealthy, you can afford one that's in house so they can run while you're asleep and it's still uncomfortable and it's still awful. But like, you know, again the wealth thing comes into play here. So. Yeah, but we'll, we'll talk about that in more detail.
Canada is the only country in the world that legally sells organs
Also, one country came up which is the only country in the world that allows for legally selling organs, which just blew my mind. We. Do you want to guess which one?
>> Taylor: Canada?
>> Farz: No, no, I'm not going to tell you because I'm gonna, I want to ruin this. But it will be shocking when you hear it. But anyways, so that is the story. A brief story.
This topic is so complicated and so fascinating. If anybody has any stories about this, I would love to hear them
This topic is so complicated and so fascinating. If anybody has any stories about this, I would love to hear them because it sounds, it sounds almost like the medical science, this is still kind of in its infancy. There's some talks of them being able to grow organs and through from stem cells or using fetal pig organs.
>> Taylor: Right. We were talking about that for like 30 years.
>> Farz: But that's, it's so complicated. Like it's so hard. Like our bodies are crazy complicated. And like, I mean just the fact like even between same age adult, same race and everything, people who are of the, of a different sex, it doesn't work. Like, it is super nuanced and complicated.
>> Taylor: We obviously have to also have like the same blood type, right?
>> Farz: Yes. Yeah, that's the, that's the easiest that on the checklist. That's the easiest box to typically check, unless you're one of the rare blood types. But, like, for the most part, that is the easiest one to check. The hardest thing, it sounds like is just going through in the US Is just going through the process of not intermingling life saving with organ donation because it creates this complete and utter firewall between the two and that kills time. And time is the enemy of getting organs that are healthy into another person. And so really interesting stuff. But, yeah, I realized that I'm not qualified to be a doctor in this.
>> Taylor: Process, so I think it's too late.
>> Farz: Yeah, probably. Thank you.
>> Taylor: I think it's also a big part of it also. I just looked it up. D*** Cheney's still alive because he doesn't have a pulse. Right. If you hear that. So does he have, like, the only robot heart in existence?
>> Farz: He might. He might. He did. So I think he got one heart transplant, but he has, like, he's had, like. He had a. I think his first heart attack was, like, at 30 years old. He was, like, crazy young when he got his first heart attack. But also he. He was super fat. Or Christian Bale played him super fat.
>> Taylor: Didn't watch that. I don't know. I have very controversial thing to say.
>> Farz: Let's. Let's hear it. We can edit out if we have to.
>> Taylor: He looks kind of cute in his Wikipedia picture.
>> Farz: Oh, my God. Oh. Just as punishment. I'm not going to edit that out.
>> Taylor: He's like, kind of like, winking at you a little bit.
>> Farz: Like, are you looking at Christian Bale or.
>> Taylor: No, I'm looking at D*** Cheney. I don't feel good about this. I'm just sharing it.
>> Farz: Yeah, he is. He is a very, very. Let's call him a unique and complicated.
>> Taylor: Person somehow still alive despite having a robot heart.
>> Farz: Dude, they all went through this. Like, did I think, like, Clinton have, like, four bypassers?
>> Taylor: He did, yeah.
>> Farz: Like, all these guys like that do these, like, crazy high pressure jobs. Except Bush. Bush seems chill. I think it's because he smoked so much weed when he was younger.
>> Taylor: Good for him. Good for him. Yeah. No, cool. Super interesting.
>> Farz: Lots of factors go into it, but yeah, we'll leave it there. I think next week's gonna be super interesting.
Next week is where we get into the gritty drama of the transplant trade
I kind of left the boring stuff for this episode because next week is, like, where it gets in, like, the gritty, like, human drama of the transplant trade and what. What goes on there.
>> Taylor: Oh, he's. Okay. I'm sorry. I'm on. He smoked three packs of cigarettes a day for 20 years. He had his first of five heart attacks in 1978 at age 37.
>> Farz: So I will. I will say this, and I know that this is going to get me probably flamed. He is winking.
>> Taylor: He is winking.
>> Farz: No, I will. I will say this. Like, the more I'm reading about, like, the complications of the human body and everything that it entails, the less into the body positivity thing I'm into. Because it is conclusively, scientifically, unequivocally proven that a healthy body weight is necessary.
>> Taylor: Yeah. But for everyone.
>> Farz: And that also goes for the guy. Like, there's all these bodybuilders who are dead at, like, 30 years old.
>> Taylor: Absolutely. Because. Absolutely destroys their heart.
>> Farz: Yeah. This is not like a don't eat pancakes for breakfast conversation. This is like a do the right thing. Yeah. Don't do extremes on any equation. Like, all those guys. Like, your body's only meant to handle so much. Like, designed a certain way. And, like, if you operate outside those boundaries, it affects everything.
>> Taylor: So cigarettes a day is constantly smoking cigarettes.
>> Farz: You said three packs a day?
>> Taylor: Yeah.
>> Farz: For how long?
>> Taylor: 20 years.
>> Farz: I mean, good for him.
>> Taylor: I can't believe he's still alive.
>> Farz: Good for him. See, like, you don't want his. You don't want his lungs in you. No, his lungs are charred.
>> Taylor: Or maybe if you get part one of his organs, you can. You too, can live forever from whatever deal he made.
>> Farz: There was something about how they're able if you're a. There's something about live organ donations for children that I'm struggling to remember right now. But it was something along the lines of, you can do a liver transplant from a live donor to a live recipient if it's a child, because what they can do is snip a piece of it off, graft it, and then it'll grow. The recipient grows back, and the new one gets the full one when it grows up.
>> Taylor: Gross. Can you look up if it's true that dentists practice on real human heads?
>> Farz: Chatgpt to the rescue.
>> Taylor: I mean, I have to look it up right now. I mean, for next episode, I could show. Also from the computer, my mom told me that she saw human heads in the thing in. In a conference room at work one time.
>> Farz: Yeah, yeah, they have.
>> Taylor: I specifically put in my will that I don't want my head to go to dentists.
>> Farz: All right, well, hopefully that doesn't get lost in the melee of your cremation or whatever's happening.
>> Taylor: I hope it helps it too because I don't want those guys out of my heads. My head.
This topic all came up, Taylor, because Rachel was telling me about the bodies exhibit
>> Farz: This topic all came up, Taylor, because Rachel was telling me about the bodies exhibit.
>> Taylor: Oh yeah, I've never seen that.
>> Farz: I never seen either. She said it was really incredible. She was also like, did you know that it was like Chinese dissidents and.
>> Taylor: Like there's definitely someone who's like, I think my son's in it. And they won't tell her if it's him.
>> Farz: So. So that is in the outline. I'm going to cover that at the very end under miscellaneous. The outline's already done.
>> Taylor: Good for you being a week ahead.
>> Farz: This I love when I find a topic I'm super interested in because it's not like working. I'm just like super interested. I want to keep it anyways. Hopefully you guys found that interesting. This episode dragged on a little bit. Apologies for that. Taylor, do you have anything to read us off with?
>> Taylor: No, but thank you everyone for listening. I had some fun conversations with folks on Instagram this week and if you have any ideas for us, let us know. We're@ doomtofellpodmail.com we have a Patreon where you can can opt in to ad free episodes forever. I'm on TikTok a bunch and yeah minus there dude fail pod all things.
>> Farz: Thank you all. Thanks Taylor.