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Authors: M.D. Kevin Fong
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division that the face gains its blood supply. From this there are branches aplenty, enough that we as doctors in training employed a variety of mostly obscene mnemonics to help remember them.
Run the tip of your finger gently back along the line of your jaw until the point just before it turns up toward your ear. At this point you can feel the pulse of the facial artery as it runs just below the surface of the skin.
From here it breaks over the surface of the face, with smaller vessels running above and below the lips and branches that run alongside the nose and then up to the eyes. And this shower of arteries joins with other branches of the external carotid artery that also creep across the face. This arrangement supplies both the facial skin and well over a dozen muscles that are involved in eating and facial expression. Surgeons had feared that the complexity of the arterial blood supply might prove an insurmountable challenge when it came to attempts at full face transplants. But more recently doctors discovered that the blood vessel connections required to supply and drain the face might be fewer and simpler than previously thought. This realization took the full face transplant from a thing of science fiction into the realm of science fact.
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T HERE IS SUCH A THING as life after death. Itâs called transplant medicine. After death a patientâs heart, lungs, liver, and kidneys can be donated to give the gift of life. Many lives can be saved or improved by that single act of generosity. But death must come first.
In the United States more than one hundred thousand people are currently waiting for an organ transplant. The list is growing quickly; on average a new name is added every twelve minutes and demand outstrips supply. Each day in the United States eighteen people die waiting for an organ transplant. It is possible for patients to receive an organ, removed from a donor, after the heart has stopped beating. This is called non-heart-beating organ donation and it has greatly increased the numbers of organs available for lifesaving donations.
But waiting until the heart has stopped beating before beginning the transplant process means that the organs become deprived of a fresh supply of blood and oxygen. Once that has ceased, the organs begin the process of dying, and there is a greater risk that they will fail to function properly after transplantation.
Some organs are more resilient than others. Kidneys in particular can endure long periods of little or no blood supply and still be resuscitated. But organs with higher metabolic demands, such as the lungs and the heart, fare less well. It is because of this that a new definition of death was coined around the time of the first heart transplants, to give surgeons the best chance of obtaining a heart that might survive the transplant process and function well.
After severe head injuries, the brain can sometimes be so damaged that its higher functions are lost, leaving only the most essential reflexive processes intact. The intrinsic rhythms that drive your heart or the automated activity that drives your digestion, for example, can continue even if everything that is essentially you has ceased to be.
This is brain-stem death: the irreversible and permanent loss of consciousness and cognition. It is as final as the state that accompanies the standstill of a heart and the arrest of breathing. A heartbeat may remain, and breathing might be supported artificially, giving the outward appearance of life, but the elements that define a human being are no longer present. The organs continue to be supported by the beating heart that remains, even though death has already occurred. But it is from these tragic losses, usually from accidents or massive strokes, that the best hope of new life can come. Brain death allows organs to be given in the best possible condition.
The conversations that we have with the relatives and close friends of patients, in softly
Run the tip of your finger gently back along the line of your jaw until the point just before it turns up toward your ear. At this point you can feel the pulse of the facial artery as it runs just below the surface of the skin.
From here it breaks over the surface of the face, with smaller vessels running above and below the lips and branches that run alongside the nose and then up to the eyes. And this shower of arteries joins with other branches of the external carotid artery that also creep across the face. This arrangement supplies both the facial skin and well over a dozen muscles that are involved in eating and facial expression. Surgeons had feared that the complexity of the arterial blood supply might prove an insurmountable challenge when it came to attempts at full face transplants. But more recently doctors discovered that the blood vessel connections required to supply and drain the face might be fewer and simpler than previously thought. This realization took the full face transplant from a thing of science fiction into the realm of science fact.
â
T HERE IS SUCH A THING as life after death. Itâs called transplant medicine. After death a patientâs heart, lungs, liver, and kidneys can be donated to give the gift of life. Many lives can be saved or improved by that single act of generosity. But death must come first.
In the United States more than one hundred thousand people are currently waiting for an organ transplant. The list is growing quickly; on average a new name is added every twelve minutes and demand outstrips supply. Each day in the United States eighteen people die waiting for an organ transplant. It is possible for patients to receive an organ, removed from a donor, after the heart has stopped beating. This is called non-heart-beating organ donation and it has greatly increased the numbers of organs available for lifesaving donations.
But waiting until the heart has stopped beating before beginning the transplant process means that the organs become deprived of a fresh supply of blood and oxygen. Once that has ceased, the organs begin the process of dying, and there is a greater risk that they will fail to function properly after transplantation.
Some organs are more resilient than others. Kidneys in particular can endure long periods of little or no blood supply and still be resuscitated. But organs with higher metabolic demands, such as the lungs and the heart, fare less well. It is because of this that a new definition of death was coined around the time of the first heart transplants, to give surgeons the best chance of obtaining a heart that might survive the transplant process and function well.
After severe head injuries, the brain can sometimes be so damaged that its higher functions are lost, leaving only the most essential reflexive processes intact. The intrinsic rhythms that drive your heart or the automated activity that drives your digestion, for example, can continue even if everything that is essentially you has ceased to be.
This is brain-stem death: the irreversible and permanent loss of consciousness and cognition. It is as final as the state that accompanies the standstill of a heart and the arrest of breathing. A heartbeat may remain, and breathing might be supported artificially, giving the outward appearance of life, but the elements that define a human being are no longer present. The organs continue to be supported by the beating heart that remains, even though death has already occurred. But it is from these tragic losses, usually from accidents or massive strokes, that the best hope of new life can come. Brain death allows organs to be given in the best possible condition.
The conversations that we have with the relatives and close friends of patients, in softly
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