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New York Times
2 days ago
- Health
- New York Times
Donor Organs Are Too Rare. We Need a New Definition of Death.
People die in many ways, but in medicine there are only two reasons a person can be declared dead: Either the heart has stopped or the brain has ceased to function, even if the heart is still beating. A person may serve as an organ donor only after being declared dead. (Until then, transplant surgeons are not allowed even to interact with a dying patient.) This common-sensical rule underpins organ donation in the United States and many other countries. Most donor organs today are obtained after brain death, defined by most state laws as a condition of permanent unconsciousness with no spontaneous breathing, no response to pain and no primitive reflexes — in other words, devastation of the whole brain. Organs obtained this way are often relatively healthy, because brain-dead patients can continue to circulate blood and oxygen. Brain death is rare, though. In New York State, with a population of 20 million, there are on average fewer than 500 cases suitable for organ procurement and transplantation each year. Far more often, people die because their heart has permanently stopped beating, which is known as circulatory death. However, precisely because the blood has stopped circulating, organs from people who die this way are often damaged and unsuited for transplantation. The need for donor organs is urgent. An estimated 15 people die in this country every day waiting for a transplant. We need to figure out how to obtain more healthy organs from donors while maintaining strict ethical standards. New technologies can help. But the best solution, we believe, is legal: We need to broaden the definition of death. Consider how things currently work. In the procedure known as donation after circulatory death, a typical donor is in an irreversible coma from, say, a drug overdose or a massive cerebral hemorrhage, and the heart is beating only because of life support. The donor is still not legally brain-dead; he or she might have, say, a gag reflex or other primitive functions. In such cases, with the blessing of the family, a donor is brought into an operating room and life support is carefully withdrawn. If, as is expected, the removal of life support results in stoppage of the heart, surgeons will wait long enough to determine that the stoppage is permanent — to be confident of death — but not so long that vital organs get damaged. This period is typically about five minutes. Then the surgeons remove the organs. But even a few minutes of a stopped heart often results in damage to the organs. This deprives potential recipients of healthy organs and thwarts the wishes of donors to have their organs used to help others. Fortunately, there is a relatively new method that can improve the efficacy of donation after circulatory death. In this procedure, which is called normothermic regional perfusion, doctors take an irreversibly comatose donor off life support long enough to determine that the heart has stopped beating permanently — but then the donor is placed on a machine that circulates oxygen-rich blood through the body to preserve organ function. Donor organs obtained through this procedure, which is used widely in Europe and increasingly in the United States, tend to be much healthier. But by artificially circulating blood and oxygen, the procedure can reanimate a lifeless heart. Some doctors and ethicists find the procedure objectionable because, in reversing the stoppage of the heart, it seems to nullify the reason the donor was declared dead in the first place. Is the donor no longer dead, they wonder? Proponents of the procedure reply that the resumption of the heartbeat should not be considered resuscitation; the donor still has no independent functioning, nor is there any hope of it. They say that it is not the donor but rather regions of the body that have been revived. How to resolve this debate? The solution, we believe, is to broaden the definition of brain death to include irreversibly comatose patients on life support. Using this definition, these patients would be legally dead regardless of whether a machine restored the beating of their heart. So long as the patient had given informed consent for organ donation, removal would proceed without delay. The ethical debate about normothermic regional perfusion would be moot. And we would have more organs available for transplantation. Apart from increased organ availability, there is also a philosophical reason for wanting to broaden the definition of brain death. The brain functions that matter most to life are those such as consciousness, memory, intention and desire. Once those higher brain functions are irreversibly gone, is it not fair to say that a person (as opposed to a body) has ceased to exist? Understandably, some will worry that doctors will prematurely pronounce a patient irreversibly comatose when in fact the patient is not or there is genuine hope for recovery. This is rare, but it can happen (as recently documented by The Times), and when it does, it is a catastrophe. That sort of concern, however, is about practicalities such as whether doctors are following protocol properly and whether external pressures are creating perverse incentives for doctors and other medical workers to be careless. These are critical issues, to be sure. But it remains possible (and common) to responsibly determine whether someone is irreversibly comatose, and in such cases a judgment of brain death is merited, as the law should be revised to reflect. In 1968, a committee of doctors and ethicists at Harvard came up with a definition of brain death — the same basic definition most states use today. In its initial report the committee noted that 'there is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.' This frank assessment was edited out of the final report because of a reviewer's objection. But it is one that should guide death and organ policy today. Sandeep Jauhar (@sjauhar) is the author of 'Heart: A History' and a cardiologist at Northwell Health, where Snehal Patel and Deane Smith are the directors of the Center for Heart Failure, Transplant and Mechanical Circulatory Support. The Times is committed to publishing a diversity of letters to the editor. We'd like to hear what you think about this or any of our articles. Here are some tips. And here's our email: letters@ Follow the New York Times Opinion section on Facebook, Instagram, TikTok, Bluesky, WhatsApp and Threads.
Yahoo
5 days ago
- Health
- Yahoo
Are BBQ sides bad for your health? From pasta salad to potato salad, you may want to watch for sodium and fat at your next cookout
These side dishes are tasty additions to summer meals, and you don't always have to skip out on them to meet your healthy eating goals. When warm weather beckons at-home chefs to take dinner outside, lighting up the grill is a no-brainer: From hot dogs and hamburgers to steaks and corn, barbecued food is one of summer's simplest pleasures. The head-scratcher? Choosing a pairing to serve alongside all that charred-and-smoky deliciousness — doubly so if you're trying to stick to your healthy eating goals. As ever, moderation is the key to health, happiness and making the most of a meal without neglecting the needs of your body or feeding into any food neurosis. Below, we recap the nutritional profile of a host of classic BBQ side dishes, helping you get the lowdown on what's really happening on your plate. This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle. Pasta salad The cool and creamy counterpoint to the sizzling heat of freshly-barbecued mains, pasta salad can look a number of different ways: It can be macaroni swimming on its back in a pool of mayo, rotini cuddled up to baby mozzarella and olives in a blanket of vinegary sauce, or a concoction that's equal parts diced veggies and cold pasta. No matter what your platonic idea of pasta salad looks like, there's a reason why it's a classic cookout accompaniment: It's filling, crowd-pleasing and often affordable. And while the recycled Atkins ethos of the moment might make you think twice before adding a scoop of pasta salad to your dinner, Lauren Toyota, a vegan cookbook author and creator of the site Hot For Food, told Yahoo Canada in a recent interview that 'regular pasta is a pretty healthy food, actually: It's fortified with iron and whatnot. I think the cheaper foods sometimes get demonized by the food industry.' Good ol' pasta is also a food featuring fibre, a nutrient that, according to a 2015 study from the American Journal of Clinical Nutrition, less than 25 per cent of Canadians age 19 and older get enough of. That being said, veggie-flecked pasta salads will obviously offer more nutrients than varieties that are just noodles. Moreover, creamy sauces will likely contain more fat and calories than their vinegar-based brethren. Sodium is also something to eyeball here: Health Canada states 72 per cent of children, 90 per cent of men and half of women are eating more sodium than recommended daily. Cheese, cold cuts and commercial salad dressings — all items that could find their way into pasta salad — are high-sodium foods to be enjoyed sparingly. It's worth mentioning here, too, that oftentimes burgers and hot dogs — and the buns they're served on — also contain significant amounts of sodium, contributing to a higher total amount of sodium in your meal if eaten alongside pasta salad. The takeaway: Throw more vegetables into your pasta salad for a boost of nutrients, and cut down on the cheese, deli meats and commercial salad dressings. Caesar salad Bringing crunchy, creamy, punchy addictiveness to every plate it graces, caesar salad is That Girl. But how does it stack up nutritionally? Caesar dressing is high in fat and sodium, sometimes almost as much as 444 mg of the stuff. Again, keeping in mind that burgers and hot dogs can also skew sodium-heavy means that adding caesar salad to your meal could make for a salt-laden meal. Caesar salads featuring kale and croutons made of chickpeas or whole-grain bread will make the dish more nutrient-dense. However, it's worth noting that vegan caesar salad dressings don't always seem to save much sodium compared to their traditional counterparts: A search of popular vegan caesar salad recipes saw many clocking in between 400 and 500 mg of sodium per serving. That being said, this briny beauty is a classic for a reason, offering taste nirvana in every bite. And, the mountain of romaine it's made from — plus the cheese flecked throughout — means it's not an insignificant source of calcium and protein. The takeaway: Watch for sodium in caesar dressings. Try making your own at home instead, while also swapping some ingredients for healthier options like kale and chickpea-based croutons. Potato salad Another legendary BBQ side dish enters the chat. No matter if you're team cubed-and-creamy or if your tastes skew towards smaller potatoes more lightly dressed (sometimes called German-style potato salad), this is a side dish that is so beloved it could steal the show. Fat-free and carrying moderate amounts of fibre and protein (about a gram and change of each per 2/3 of a cup cooked), potatoes are not exactly a nutritional powerhouse. But they also aren't totally devoid of nutritional value, being stocked with potassium and B vitamins. As with creamy versions of pasta salad, potato salad with lots of mayonnaise will carry higher fat, calorie and sodium counts. Vinegar-based dressings will likely clock in lighter on all those fronts, though it's worth noting some German potato salads are dressed in vinegar and bacon grease, adding these factors back into the equation. However, since potato salad carries an important cultural value in various global cuisines, now feels like a good time to remember that nutrition facts alone aren't the only factor that goes into choosing what we eat: Identity and taste are also equally important considerations. The takeaway: Go lighter on the mayonnaise for potato salads, and avoid adding toppings like bacon or the drippings that come out the meat when cooking it. Watermelon salad Nothing is more refreshing on a hot summer's day than cold, grainy watermelon. Whether you're serving a blend of melon dusted in Tajin seasoning (a Mexican blend of lime, chili peppers and salt) or mixing it with feta, it adds a hydrating hit to warm-weather dining. Watermelon itself is a bit of a superfood: It's hydrating since it's 92 per cent water, according to the Mayo Clinic, and also rife with vitamins A, B6 and C. This melon also has the highest amount of antioxidant lycopene found in any fresh fruit or vegetable. Combining it with feta or salty seasonings could, of course, increase the sodium levels of your meal: One cup of crumbled feta can be 100 mg more than the recommended daily intake of sodium. Combined with salt-heavy processed meat like hot dogs and this could create a very high-sodium meal. The takeaway: Avoid overdoing added salt when crafting watermelon salad, and think about the other high-sodium meals you'll likely be eating at your barbecue. Which side is the healthiest? The bottom line Strictly sticking to nutritional facts, it's safe to say a classic garden salad with vinaigrette will likely be the lowest-sodium option on the buffet table. It'll also offer a host of vitamins and minerals from the vegetables therein, as well as some much-needed fibre, making a case for it as the healthiest choice. But it's worth remembering you can honour your cravings and find joy in food, too. Perhaps this looks like a smaller scoop of potato salad alongside some garden salad. Or, maybe it looks like pasta salad today and a more vegetable-rich meal tomorrow. Whatever you decide, here's to making the most of summer fun while it lasts.
Health Line
11-07-2025
- Health
- Health Line
The History of Heart Disease
Heart disease today is considered the top preventable disease in the United States. However, heart disease has been described and studied by people…
