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The Official MacNN COVID-19 Thread (Page 32)
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ghporter
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Apr 24, 2022, 12:10 PM
 
I was on the “third line,” as an inpatient rehab therapist. Early on, the folks I got who had survived long enough to make it from ER to acute hospital to us had anything from “mild shortness of breath” and poor endurance to near total debility.

Last year, we had far more people in for rehab after something else, but “oh look, you’re positive for COVID…” often days after they were admitted - and thus they were spewing virus all over everyone for that long. Lovely stuff.

All the while, the corporate folks were pushing to cut costs (which resulted in less and less patient care and poorer outcomes). Pressure at ED levels was NOT what I signed up for. If I hadn’t hurt myself last spring and wound up leaving there, I don’t know how long it would have lasted there.

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bstone
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Apr 24, 2022, 02:10 PM
 
Originally Posted by ghporter View Post
I was on the “third line,” as an inpatient rehab therapist. Early on, the folks I got who had survived long enough to make it from ER to acute hospital to us had anything from “mild shortness of breath” and poor endurance to near total debility.

Last year, we had far more people in for rehab after something else, but “oh look, you’re positive for COVID…” often days after they were admitted - and thus they were spewing virus all over everyone for that long. Lovely stuff.

All the while, the corporate folks were pushing to cut costs (which resulted in less and less patient care and poorer outcomes). Pressure at ED levels was NOT what I signed up for. If I hadn’t hurt myself last spring and wound up leaving there, I don’t know how long it would have lasted there.
Omicron variant spreads like wildfire. Maybe faster? There was a time in the ED where so many patients were covid positive it felt like one of those daytime talk shows where the host goes "and you have covid, and you have covid, you all have covid!"

There were a number of patients with cardiac or GI symptoms who we only realized were due to covid when their screening test came back. Yeah, that sucked cause we all had exposures and this was months before a vaccine. That was when I went to wearing an N95 the entire shift and somehow managed to avoid getting covid.
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ghporter
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Apr 24, 2022, 05:18 PM
 
...yeah, fun times. [/sarcasm]

We first were told we could NOT wear even procedure masks - one of our therapists quit because of his underlying respiratory issues, and a young child at home. Then "wear procedure masks, and change them if they get wet." Then "wear the same mask all day", then ... You get the picture. This was part of the stress load - management didn't seem to care if we got sick, and some of us did.

In contrast, tearing a hamstring got me to my primary care doc, who tested my range of motion, which was awful. Xray the next day, MRI the next, and literally 366 days ago a shiny new left hip! The point is that in ALL of the health care facilities where I was a patient, the policies were clearly in place to protect everybody, they were all well supplied, and were all extremely professional about it. Not just hand washing, but really good "don't touch your face or your mask" discipline, and so on. That contrast was a substantial part of my not being too disappointed when I wound up not going back to my old job.

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OreoCookie
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Apr 25, 2022, 02:18 AM
 
Originally Posted by bstone View Post
Happy to answer questions about covid or what it has been like on the very front lines.
Can you tell us how the Omicron wave compares to the previous waves? It seems a lot of countries (currently I’m in France) have simply decided the Covid pandemic is over, period, and we just don’t want to bother with it any longer. Or you have countries that still seem to be in a state of unjustified panic (looking at my home of choice, Japan, and China).

Also, have there been any lasting changes to the medical system? While people have been clapping for medical workers a year, two years ago, at least as far as I can tell, working conditions and pay are still as shitty as they have been before.
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bstone
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Apr 28, 2022, 01:10 AM
 
Originally Posted by OreoCookie View Post
Can you tell us how the Omicron wave compares to the previous waves? It seems a lot of countries (currently I’m in France) have simply decided the Covid pandemic is over, period, and we just don’t want to bother with it any longer. Or you have countries that still seem to be in a state of unjustified panic (looking at my home of choice, Japan, and China).
As far as the patients, they are much more mildly sick especially if they are vaccinated. Most are complaining of cold-like symptoms and a sore throat. I am rarely seeing patients being as sick as they were with the original covid. Unvaccinated patients with preexisting conditions can still present seriously ill and some are still dying, but overall it's much better.

Also, have there been any lasting changes to the medical system? While people have been clapping for medical workers a year, two years ago, at least as far as I can tell, working conditions and pay are still as shitty as they have been before.
No change in pay at all unless you're a travel nurse. Medical insurance premiums went up but no raise so we're making less money this year than last year. No better working conditions. The people once cheered for us, now they curse us. They call us liars and demand we give them a horse deworming medication. They refuse to get vaccinated yet come to us when they fall ill and demand we do everything possible for them. They refuse to wear masks and make challenges in court on masking.
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Spheric Harlot
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Apr 28, 2022, 06:45 AM
 
Originally Posted by bstone View Post
The people once cheered for us, now they curse us. They call us liars and demand we give them a horse deworming medication. They refuse to get vaccinated yet come to us when they fall ill and demand we do everything possible for them. They refuse to wear masks and make challenges in court on masking.
I can't imagine how disheartening and frustrating that must feel.

I'm so sorry.

No wonder people here are quitting the nursing profession in droves.
     
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Apr 28, 2022, 11:09 AM
 
For a short time, we got a slight bonus, (essentially) “hazard pay” for working with “who knows if they have COVID or not” patients. It went away after the first surge and never came back…

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reader50
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Apr 28, 2022, 12:45 PM
 
Originally Posted by bstone View Post
They call us liars and demand we give them a horse deworming medication.
You could point out that worms will most likely come from the rear of the horse. Yes, worms could be anywhere. But popular imagination will associate them with the action end.

So, tell them they're asking for horse-butt medicine. Should go well with asshole patients. You'd think they'd tire of vomiting and diarrhea, and be happy to return to recommended treatments. Ones that actually work, with fewer side effects.
     
bstone
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Apr 28, 2022, 10:22 PM
 
Originally Posted by ghporter View Post
For a short time, we got a slight bonus, (essentially) “hazard pay” for working with “who knows if they have COVID or not” patients. It went away after the first surge and never came back…
I wish I ever got hazard pay but alas.
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Apr 28, 2022, 10:34 PM
 
Originally Posted by Spheric Harlot View Post
I can't imagine how disheartening and frustrating that must feel.

I'm so sorry.

No wonder people here are quitting the nursing profession in droves.
I can't speak about nurses, I am not a nurse. I am a PA. Most of the RNs in the ED are travel and they are making insane amounts of money per week, up to five times more than I do. It makes me wonder if all the years of schooling, bachelors and masters degrees, were worth it when someone with an associates degree is doing financially much better than I am. Money can't buy happiness but financial stability contributes significantly to happiness.
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OreoCookie
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May 3, 2022, 01:24 AM
 
Originally Posted by bstone View Post
As far as the patients, they are much more mildly sick especially if they are vaccinated. Most are complaining of cold-like symptoms and a sore throat. I am rarely seeing patients being as sick as they were with the original covid. Unvaccinated patients with preexisting conditions can still present seriously ill and some are still dying, but overall it's much better.
That’s good to hear. Although in some countries I have heard that there is still pressure on the medical system, it just has shifted from the stations for the super sick to regular stations. Is that true in your case as well or does your experience differ.
Originally Posted by bstone View Post
No change in pay at all unless you're a travel nurse. Medical insurance premiums went up but no raise so we're making less money this year than last year. No better working conditions. The people once cheered for us, now they curse us. They call us liars and demand we give them a horse deworming medication. They refuse to get vaccinated yet come to us when they fall ill and demand we do everything possible for them. They refuse to wear masks and make challenges in court on masking.
If I were in your shoes, that’d be very hard for me to square with my oath to treat everyone the same. I’d get angry at the refusal of seeing the truth, combining being super critical of the vaccine while being quick to embrace alternative “treatments”. Coupled to that that clapping is cheap and that people don’t want to put their money where their mouthes are.
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bstone
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May 4, 2022, 05:29 PM
 
Originally Posted by OreoCookie View Post
That’s good to hear. Although in some countries I have heard that there is still pressure on the medical system, it just has shifted from the stations for the super sick to regular stations. Is that true in your case as well or does your experience differ.
I am fortunate that of all the covid patients I've had in the past 8 weeks have all been discharged home in stable condition except for one who kept fainting due to dehydration but had an otherwise normal pulmonary exam. We have more options for treatment now including doing monoclonal antibodies and antivirals in the ER, also things like paxlovid are helping a lot.

If I were in your shoes, that’d be very hard for me to square with my oath to treat everyone the same. I’d get angry at the refusal of seeing the truth, combining being super critical of the vaccine while being quick to embrace alternative “treatments”. Coupled to that that clapping is cheap and that people don’t want to put their money where their mouthes are.
Every patient who comes to the ER gets the same level and depth of treatment base do on their clinical situation, but those who refuse vaccination and then come begging for covid help get a little bit less compassion. Those who are outright antivaxxers get very little compassion but still get every bit of medicine that their situation requires. Among the staff we privately criticize and chastise this category of patient.
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ghporter
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May 5, 2022, 10:56 PM
 
“Quality of care” and “friendliness” are not necessarily related. It is entirely feasible to provide top-notch care without going a millimeter farther than absolutely necessary, and without adding “warm fuzzy” stuff.

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OreoCookie
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May 8, 2022, 10:22 PM
 
Originally Posted by bstone View Post
I am fortunate that of all the covid patients I've had in the past 8 weeks have all been discharged home in stable condition except for one who kept fainting due to dehydration but had an otherwise normal pulmonary exam. We have more options for treatment now including doing monoclonal antibodies and antivirals in the ER, also things like paxlovid are helping a lot.
That's good to know. Although I reckon this will disincentivize some people from getting vaccinated.
Originally Posted by bstone View Post
Every patient who comes to the ER gets the same level and depth of treatment base do on their clinical situation, but those who refuse vaccination and then come begging for covid help get a little bit less compassion. Those who are outright antivaxxers get very little compassion but still get every bit of medicine that their situation requires. Among the staff we privately criticize and chastise this category of patient.
That's good to know, although I reckon how much these people might frustrate you and your colleagues.

I have one question for you that was discussed earlier in the thread: some clinics that do organ transplants require that the patient be vaccinated against Covid-19. What is your medical opinion on this? Should that requirement be dropped once the virus has gotten endemic? Or earlier? Or not at all?
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subego
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May 9, 2022, 04:02 AM
 
FWIW, that particular scenario was for an organ donated by a family member, so for all intents and purposes a “surplus” organ.

Non-surplus is a different matter.
     
MacNNFamous
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May 13, 2022, 01:15 PM
 
Interesting.

https://twitter.com/wsbgnl/status/1524929252465909762

Yesterday we had 161k postivie cases.... at this time last year, we had 35k cases. This is not even the real number, as most places have stopped testing, and most people who catch it don't bother reporting it. AND, vaccines are less effective on the new variants.

The red and blue teams have decided to just infect everyone; they don't give a shit about any of us.
     
reader50
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May 13, 2022, 01:44 PM
 
I've continued wearing a mask in indoor locations away from home (stores, gas station, etc). Had been debating reducing the mask use for the summer lull. I guess that's out the window now.

The red states would sweep all the bodies under the rug anyway. My guess is the Dems aren't doing unpopular things because they're already unpopular, with the midterm races begun. Clamp down on masks today, lose both houses of Congress tomorrow, no further court appointments. Followed by worse legislative gridlock, as Biden has to veto lots of dingbat bills. Plus necessary bills, that have poison pills attached.
     
subego
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May 13, 2022, 02:24 PM
 
Generally speaking, aren’t mask mandates a state thing?

I’m not wearing masks now, but am still avoiding crowded indoor areas.

Got invited to a movie premiere. Yeah… hard pass.
     
ghporter
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May 13, 2022, 02:43 PM
 
I’m wearing a mask whenever I’m indoors other than home. Grocery store, hardware store, etc. all are mask zones for me.

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May 15, 2022, 07:09 PM
 
Originally Posted by subego View Post
Generally speaking, aren’t mask mandates a state thing?

I’m not wearing masks now, but am still avoiding crowded indoor areas.

Got invited to a movie premiere. Yeah… hard pass.
They never were here in Wisco. Basketball stadiums, sold out, no masks. Summerfest, no masks, no distancing. Society has said they don't give a shit if they kill my girlfriend, so I no longer give a shit about society.

Work has told everyone to return to the office, I called HR and said yeah not happening, so far so good but meetings are being scheduled more often in person, and I worry about my career path with things like this. It fucking sucks.
     
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May 15, 2022, 08:49 PM
 
Originally Posted by ghporter View Post
I’m wearing a mask whenever I’m indoors other than home. Grocery store, hardware store, etc. all are mask zones for me.
In Japan masks are soft-mandated everywhere. With much of the population vaccinated, I hope society will relax in a bit when outdoors. But indoors, I'm perfectly fine wearing a mask. Not a hassle at all, not sure why people in other countries are whining so much about them. Perhaps I've been in Japan for too long … 
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bstone
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May 16, 2022, 04:33 AM
 
Originally Posted by OreoCookie View Post
I have one question for you that was discussed earlier in the thread: some clinics that do organ transplants require that the patient be vaccinated against Covid-19. What is your medical opinion on this? Should that requirement be dropped once the virus has gotten endemic? Or earlier? Or not at all?
Vaccination is absolutely required for receiving an organ. There is a severe lack of organs available for those who are in need and therefore those who are willing to do every single thing their doctors and PAs instruct them to do are the ones who are most likely to receive a donation. If COVID were to magically disappear forever then I imagine that would no longer be a requirement for the person receiving a transplant however until such a time comes then the requirement will remain.
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Spheric Harlot
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May 16, 2022, 05:18 AM
 
Originally Posted by OreoCookie View Post
In Japan masks are soft-mandated everywhere. With much of the population vaccinated, I hope society will relax in a bit when outdoors. But indoors, I'm perfectly fine wearing a mask. Not a hassle at all, not sure why people in other countries are whining so much about them. Perhaps I've been in Japan for too long … 
Yes. What is normal courtesy in Japan is a major infringement on personal freedoms in Germany. Especially if it's an appeal to "personal responsibility".

Covid has really brought out the best in people here.

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subego
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May 16, 2022, 01:33 PM
 
Originally Posted by bstone View Post
Vaccination is absolutely required for receiving an organ. There is a severe lack of organs available for those who are in need and therefore those who are willing to do every single thing their doctors and PAs instruct them to do are the ones who are most likely to receive a donation. If COVID were to magically disappear forever then I imagine that would no longer be a requirement for the person receiving a transplant however until such a time comes then the requirement will remain.
That’s what makes the “surplus organ” part of the question relevant.

There was at least one example of a transplant being denied, even though the organ was kidney coming from a family member. There was no question of a more deserving recipient, but the transplant was denied anyway.
     
OreoCookie
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May 16, 2022, 06:45 PM
 
Originally Posted by subego View Post
There was at least one example of a transplant being denied, even though the organ was kidney coming from a family member. There was no question of a more deserving recipient, but the transplant was denied anyway.
Does the concept of a “surplus organ” really exist in the US medical system? (@bstone, feel free to chime in.)
Originally Posted by Spheric Harlot View Post
Yes. What is normal courtesy in Japan is a major infringement on personal freedoms in Germany. Especially if it's an appeal to "personal responsibility".
I was recently in Europe and was able to sample the attitudes of three different countries, the Netherlands, France and Germany. According to my friends who live in the Netherlands, the attitude there was the most America-like, people wanted to get rid of masks asap, he was mandated to teach in person relatively soon and the mask mandate on campus was dropped before other mask mandates. Likewise, in France there was a sizable portion of the population who are, well, to use a German term, Querulanten. My sister’s bf does not want to get vaccinated, but is really afraid of catching Covid :facepalm: I don’t have a good read on what happened in Germany, because my family there all masked up (at the height of the pandemic, my mom was a cancer patient prior to broad availability of vaccines, so we all took that very seriously). Still, this April more people in Germany were wearing masks than in the Netherlands. But of course, nothing compared to Japan.

We were concerned catching Covid — not because we were afraid for our health, but because it’d disrupt our trip back to Japan. My wife was double-vaxxed at the time (due to availability of Pfizer/Biontech, she was vaccinated a few months after me), I was triple vaxxed, but our young children cannot be vaccinated yet.

What was your impression of the developments in Germany? I was living/experiencing my bubble, which is hardly representative of the population at large.
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subego
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May 16, 2022, 11:54 PM
 
Originally Posted by OreoCookie View Post
Does the concept of a “surplus organ” really exist in the US medical system? (@bstone, feel free to chime in.)
I’m using it to describe the situation where the organ is being donated by a family member. If that donor is unwilling to donate to someone else, it can be considered surplus.

At that point, the question isn’t the rarity of the organ, but the rarity of other resources (e.g., the availability of qualified surgeons, or space to quarantine the patient).
     
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May 17, 2022, 12:15 AM
 
@subego
I understand the point you were trying to make. That’s why I was asking whether there exists a legal distinction between “ordinary” (living) donors and what you called “surplus donors”. And in case the distinction exists, what consequences it has. I don’t know the answer to that.

PS There might be some other differences we aren’t thinking about. E. g. my mom donated bone marrow to her cousin when she suffered from leukemia. She had different rights than anonymous organ donors, because she (obviously) knew my cousin prior to giving bone marrow. For reasons I don’t quite understand, my mom didn’t want my cousin to know, though, she thought it might make things weird between them. So I don’t think the doctors told the patient that my mom was the donor. Anonymous donors do not know who they donate to, and they can only ask after a few years (don’t remember how many). Again, that’s all German laws and privacy regulations, so they do not apply here.
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subego
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May 17, 2022, 12:36 AM
 
Ah! Totally misunderstood. My bad!
     
bstone
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May 19, 2022, 01:45 AM
 
Originally Posted by OreoCookie View Post
Does the concept of a “surplus organ” really exist in the US medical system? (@bstone, feel free to chime in.)
I have never heard the term "surplus organ" before. At the major academic medical center where I work we do heart and kidney transplants very regularly. (For whatever reason do don't do liver transplants, but another hospital 1mi away does). In all of my discussions with the transplant teams, patients who have received transplants, and hours reading through medical charts I've never heard of read this term.
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OreoCookie
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May 19, 2022, 02:02 AM
 
Originally Posted by bstone View Post
I have never heard the term "surplus organ" before. At the major academic medical center where I work we do heart and kidney transplants very regularly. (For whatever reason do don't do liver transplants, but another hospital 1mi away does). In all of my discussions with the transplant teams, patients who have received transplants, and hours reading through medical charts I've never heard of read this term.
I think @subego coined this term by himself, and he means by that organs donated by someone for someone they know (as opposed to anonymous donations where you have to wait for a donor organ to become available). E. g. my mom donated bone marrow to her cousin, and I reckon he would consider that a “surplus organ donation”.

subego's argument as best as I understand it is that for such “surplus organs”, he finds it unfair that Covid-19 vaccine requirements are in place, because these organs are not available to others and thus, nobody more deserving would lose an organ. (@subego, I hope this is a cogent and accurate 1-sentence summary of your argument.)

So I was wondering whether donations where donor and recipient know each other are treated differently from anonymous donations? Do you (as a physician) think these two cases should be treated differently when it comes to vaccinations, and why? E. g. one of my arguments was that during an ongoing pandemic an unvaccinated organ recipient could introduce Covid-19 onto a floor full of immunosuppressed patients, putting everyone at risk. (When my mom was treated for cancer late-2020 till mid-2021, all cancer patients in the region were aggregated into a single hospital and highly stringent rules were put in place. E. g. nobody was allowed access unless they tested negative twice, once with an antibody, once with a PCR test. My dad was not allowed into the clinic, even on critical appointments. Instead, a cancer nurse was with her.)
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subego
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May 19, 2022, 11:05 AM
 
Originally Posted by OreoCookie View Post
I think @subego coined this term by himself, and he means by that organs donated by someone for someone they know (as opposed to anonymous donations where you have to wait for a donor organ to become available)
This is correct.

I don’t know what the official lingo is for when an organ is electively donated by a family member rather than unelectively donated by a motorcyclist.
     
bstone
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May 20, 2022, 11:32 AM
 
Originally Posted by OreoCookie View Post
I think @subego coined this term by himself, and he means by that organs donated by someone for someone they know (as opposed to anonymous donations where you have to wait for a donor organ to become available). E. g. my mom donated bone marrow to her cousin, and I reckon he would consider that a “surplus organ donation”.

subego's argument as best as I understand it is that for such “surplus organs”, he finds it unfair that Covid-19 vaccine requirements are in place, because these organs are not available to others and thus, nobody more deserving would lose an organ. (@subego, I hope this is a cogent and accurate 1-sentence summary of your argument.)

So I was wondering whether donations where donor and recipient know each other are treated differently from anonymous donations? Do you (as a physician) think these two cases should be treated differently when it comes to vaccinations, and why? E. g. one of my arguments was that during an ongoing pandemic an unvaccinated organ recipient could introduce Covid-19 onto a floor full of immunosuppressed patients, putting everyone at risk. (When my mom was treated for cancer late-2020 till mid-2021, all cancer patients in the region were aggregated into a single hospital and highly stringent rules were put in place. E. g. nobody was allowed access unless they tested negative twice, once with an antibody, once with a PCR test. My dad was not allowed into the clinic, even on critical appointments. Instead, a cancer nurse was with her.)
I cannot imagine a situation in which a transplant surgeon would agree to that sort of end-run. Transplantation is more than just the actual surgery but in addition the anti-rejection meds which seriously compromise the immune system and therefore every bit of protection must be adhered to.
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May 20, 2022, 12:58 PM
 
I think a better term than “surplus” would be “sourced outside of normal channels”.

There are still review boards involved in every transplant. I think the biggest difference with what subego’s talking about is shortening the wait for a “normal channel” organ to become available.

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May 23, 2022, 05:07 PM
 
May 20 2021: Daily average 27k new cases

May 20 2022: Daily average 108k new cases

Neat....
     
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May 23, 2022, 06:23 PM
 
Originally Posted by bstone View Post
I cannot imagine a situation in which a transplant surgeon would agree to that sort of end-run. Transplantation is more than just the actual surgery but in addition the anti-rejection meds which seriously compromise the immune system and therefore every bit of protection must be adhered to.
Thanks for your perspective. I thought as much, but it is good to hear the opinion of an expert.
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subego
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May 23, 2022, 08:07 PM
 
Originally Posted by bstone View Post
I cannot imagine a situation in which a transplant surgeon would agree to that sort of end-run. Transplantation is more than just the actual surgery but in addition the anti-rejection meds which seriously compromise the immune system and therefore every bit of protection must be adhered to.
This attitude makes perfect sense in the context of the rarity of organs as a resource, but I don’t see how it can be applied without modification when rarity isn’t a question.

If due to non-compliance the prognosis for carrying through on the transplant is worse than dying in the near term from kidney failure, okay, then deny the transplant. If not, on what grounds is it being denied?


Edit: from the previous discussion about this, the grounds to deny which resonated the most with me is it’s not fair to put the surgeon through that stress. However, as I also said at the time, the optics on that reason aren’t the greatest.
( Last edited by subego; May 23, 2022 at 10:22 PM. )
     
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May 23, 2022, 10:29 PM
 
subego, perhaps the surgical team does not wish to experience failure. Even with a voluntary donor, they're still performing surgery on two people. If one (or both) croak afterwards, their time was wasted. And they didn't take enough precautions. How would you feel, if you design a special effects shot, and someone dies during that shot? Wouldn't you demand all standard precautions be followed, even if the actors offered to sign waivers? The waivers might excuse legal liability, but you'd still be known as the designer who killed a few people, and got away with it.

Even if every other factor were voluntary, professionals will want to maximize the odds of success. It's literally life and death, and they want to have minimal deaths. I'm not seeing any motivation for professionals to skip standard rules. "Because it would make the patient happier before they die" isn't motivational. Hospitals are tracked on death statistics, and it wouldn't surprise me if doctors are too.
     
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May 23, 2022, 11:03 PM
 
I agree with all your points! This is what my edit was getting at.
     
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May 24, 2022, 12:04 AM
 
Originally Posted by reader50 View Post
subego, perhaps the surgical team does not wish to experience failure. Even with a voluntary donor, they're still performing surgery on two people. If one (or both) croak afterwards, their time was wasted.
I think that certain treatments require sufficient buy-in from the patient. E. g. at my mom's (orthopedic) hospital they would sometimes make a joint replacement contingent on weight loss. This wasn't doctors fat shaming patients, but the doctors knew from experience that if the patient is overweight, then there would be a substantial risk of, say, a knee replacement from breaking the bone, which would result in the patient spending the rest of their lives in a wheelchair.

@bstone can correct me here, but I think for at least some organ transplants there are strict requirements regarding alcohol consumption or smoking.
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May 24, 2022, 12:25 AM
 
Originally Posted by subego View Post
This attitude makes perfect sense in the context of the rarity of organs as a resource, but I don’t see how it can be applied without modification when rarity isn’t a question.

If due to non-compliance the prognosis for carrying through on the transplant is worse than dying in the near term from kidney failure, okay, then deny the transplant. If not, on what grounds is it being denied?


Edit: from the previous discussion about this, the grounds to deny which resonated the most with me is it’s not fair to put the surgeon through that stress. However, as I also said at the time, the optics on that reason aren’t the greatest.
Approval for organ transplantation is different from an organ being available. Approval requires the recipient to show they can be completely compliant with all medical instructions. Being able to supply your own organ doesn't allow for those instructions to be done away with. I know of no transplant team which would approve someone for transplant knowing they would not be compliant with basic medical advice such as vaccination.
( Last edited by bstone; May 25, 2022 at 01:08 PM. Reason: spelling)
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May 24, 2022, 12:06 PM
 
If it’s 100% compliance or nothing, then that’s what it is I guess.

Denying the 99% compliant seems extreme.
     
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May 24, 2022, 07:52 PM
 
Originally Posted by subego View Post
If it’s 100% compliance or nothing, then that’s what it is I guess.

Denying the 99% compliant seems extreme.
That’s not the right way to do the math here. This is not the same as a patient who was asked to lose 50 kg and they only lost 99 % of that, 49.5 kg. Suppressing the recipient’s immune system is an essential part of aftercare, so being fully vaccinated is a central piece of the defense — not just for the patient, but also to protect all other patients who they will cross paths with on their frequent trips to the hospital.
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May 24, 2022, 08:38 PM
 
Protecting other patients is a good point, but when it comes to the patient themselves, it’s only a valid concern (in my mind) when the prognosis for the transplant while unvaccinated is worse than terminal kidney failure.
     
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May 24, 2022, 09:13 PM
 
Originally Posted by subego View Post
Protecting other patients is a good point, but when it comes to the patient themselves, it’s only a valid concern (in my mind) when the prognosis for the transplant while unvaccinated is worse than terminal kidney failure.
Of course it is worse, because transplant patients are on immuno suppressants. Avoiding infections or mitigating the severity with vaccines is paramount — especially during a pandemic. Covid-19 is still not endemic. But even if it were, I’d defer to medical experts whether Covid-19 vaccinations should no longer be mandatory. I personally don’t see any logic in doing that since Covid-19 will likely be as prevalent as the flu, but again, I defer my judgement to the experts.
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May 25, 2022, 01:09 PM
 
Originally Posted by subego View Post
If it’s 100% compliance or nothing, then that’s what it is I guess.

Denying the 99% compliant seems extreme.
Organ transplantation and life-long immunosupression are extreme.
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May 25, 2022, 01:09 PM
 
Originally Posted by OreoCookie View Post
That’s not the right way to do the math here. This is not the same as a patient who was asked to lose 50 kg and they only lost 99 % of that, 49.5 kg. Suppressing the recipient’s immune system is an essential part of aftercare, so being fully vaccinated is a central piece of the defense — not just for the patient, but also to protect all other patients who they will cross paths with on their frequent trips to the hospital.
^this
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May 25, 2022, 01:16 PM
 
Originally Posted by bstone View Post
Organ transplantation and life-long immunosupression are extreme.
So is dying of kidney failure.
     
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May 25, 2022, 01:27 PM
 
Originally Posted by subego View Post
Protecting other patients is a good point, but when it comes to the patient themselves, it’s only a valid concern (in my mind) when the prognosis for the transplant while unvaccinated is worse than terminal kidney failure.
ESRD (end-stage kidney disease) sucks a lot. It requires a person to be on dialysis but it's important to know that millions of people go to dialysis centers three days a week every week and lead otherwise mostly normal lives. Transplantation if successful removes the need for dialysis (either hemo or peritoneal) but opens up a whole new can of worms in terms of rejection, immunosupression, etc.
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May 25, 2022, 01:29 PM
 
Originally Posted by subego View Post
So is dying of kidney failure.
Few people die from ESRD as they are on either HD or PD and lead otherwise normal lives. The only ones I've seen die from ESRD are those who want to die or those who have rare complications from dialysis.
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May 25, 2022, 01:33 PM
 
All good info!
     
 
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