August 12, 2025 • 29 mins
Dr. Sandeep Rao brings the borderland the latest information in healthcare, medicine and technology. He considers himself a hacker in the positive sense, using his intimate knowledge of the medical system to break down some of the barriers to accessing new medical technologies and information.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Good afternoon. It's another weekend here in the heart of
the dusty Chuahen Desert in West Texas, and you're listening
to the Medical Hackers. However, you may be tuned in
this week and I'm your host, doctor San Deep Growl.
I'm here to bring the Borderland the latest information in healthcare, medicine,
and technology on the show. I consider mysef a hacker,
(00:25):
a hacker in the positive sense, a hacker using my
intimate knowledge of the medical system to breaking down some
of the bears access to new medical technologies and current
health care information. So today's just me in the studio here.
I also have Amber, my producer. She's also a backer.
She can always she's always a bit of a sounding board.
I'm always lurking exactly so Amber. One of the things
(00:50):
I wanted to get into is the concept or the
overall idea of organ donation. And one of the interesting
that that's happened a study in the area of heart
organ donation. But I'm gonna kind of get into it
slowly because you might be wondering why would I myself.
(01:10):
I'm a vascin eventionalist. I'm also a radiologist. How am
I involved in this entire aspect of organ donations. Yeah.
So as a radiologist, one of the ways that I
am involved is I frequently get studies to interpret to
determine brain death. So whenever you are at the end
(01:32):
of the rope, when you know you're the light exactly,
there's really two ways, too, legal ways we can determine death.
One is brain death and the other one is cardiac death. Now,
brain death is a lot more difficult for a lot
of people to understand. Let's first get into cardiac death.
(01:53):
Cardiac death is basically very very simple. Your heart stops
your circulatory system, there's no blood flowing. Subsequently, your breathing
will top and you are at that point you are
you expire, right, So it's a very easy concept for
folks to understand because the heart is very frequently linked
(02:15):
to life. Nowadays they say unlived exactly. I've seen that.
I've seen that. Now. Another way in which this is
where I tend to be involved is the concept of
brain death, or what we call it determining someone has
expired by neurologic criteria. That means that if you have
(02:39):
complete and irreversible loss of brain and your brain stem,
which is just the little area below your brain function.
Then we can say that patient is death dead by
brain brain death. And so that's where radiology imaging comes
into place. Now, cardiac death is actually pretty easy to determine.
I've had to actually determine it myself. I've had patients
(03:01):
or maybe you have somebody. You just feel their pulse.
You can tell that they no longer have a pulse.
You check their breathing, you can listen to their heart
and lungs. Very easy to do from observation, from a
physical exam of determining that. But where when brain death
is in play, it's a little bit more complex. So
sometimes what we do is we do a scan called
(03:22):
a nuclear medicine scan. It's called a brain flow scan.
We inject a little isotope, a little radio active particle
in the ivy and we let that little particle circulate
through your system. So maybe your heart is still working
at that point, so you're not cardiac death. But we
may suspect, you know what, this patient's sitting in the
(03:43):
ICU and they may be braided. How do we know
if this patient who's in a coma, How do we
know if this patient who is lying there in a
static state. That sure, their heart may be working, but
do we know if their brain is actually working a
being supported because maybe they're on a ventilator and a
(04:04):
machine is doing all their work for them. How do
we know they're actually going to be functional from a
brain standpoint. That's where this nuclear medicine scan comes in.
That's where I have to frequently make this diagnosis. So
we inject this little particle through the bloodstream and then
we take some images. It's a nuclear medicine scan. That
means what happens is any of these little radioactive particles
(04:25):
as it travels up into your brain, it lights up
on binuclear medicine because it is radioactive by definition, and
so I can see as these particles as they go up,
they'll go up the carotid blood vessel. So if your
heart's to a pump and I can see it go
up into your brain. But then I want to see
it as it traverses, as it goes through your brain.
I want to see it go in and then ideally,
(04:47):
if you're truly alive, then the particles will go throughout
your brain and you can tell your entire brain is
well perfused. Now when you don't have brain activity. We
have something the light bulb side. So what that means is,
imagine a light bulb where you don't see anything there
is in the center. So imagine a scan in which
(05:09):
I just see the bottom part of the light bulb,
like that's like your exactly the blood's going in, but
that entire light bulb, the actual bulb is just empty
because your brain's not functioning. So I know some people
like that doctor don't know if you need a medical
diagnosis exactly, but but in this case, yeah, So the
reason why docs get me involved is they may be
(05:31):
at the point where they go, you know what, we
want to determine if this patient is indeed brain death,
at which point maybe a family can make a decision
do they want to still continue supportive care because they
may realize, you know what, this patient really not has
no hope of getting, you know, to any salvageable state,
or maybe we want to this patient may actually have organs,
(05:51):
maybe they are an actual organ donor they want to have.
They have a functional liver, they have a functional kidney
that maybe somebody else can be fit from. So we
always have to determine this in order to be able
to proceed with that now, so that, as I said,
it's sometimes it's very difficult for the public to understand
(06:11):
the concept of brain death because it's very difficult because
a patient can still appear alive even though you're brain dead,
because you may still have maybe that that ventilator is
breathing for you. And so that's that's one of the
things I wanted to kind of get into, but I
want to go into it in a little bit, a
little bit more depth because I was interested in the
(06:32):
concept of heart transplants and there's a very new concept
involving heart transplants. Okay, so obviously, you know, if you're
not everybody is going to need a heart transplant. You know,
I want my partners, actually want of good partners that
I work with. He's actually a electrophysiology doctor, so that
(06:55):
means he studies the sort of how the heart functions,
whether they're whether it's pumping properly, whether it's a arrhythmias,
and he gets a lot of patients who are may
need eventual heart transplantation because maybe the heart's not beating well,
maybe it has underlying structural defects, maybe there's valvular defects
(07:17):
now because of the fact that a lot of patients
cannot procure a heart. There's not just a bunch of
hearts out there, right, We're all exactly, that's true, that's true, right,
you know. I sometimes say, you know, there maybe a
lot of people who are ten men, so to speak.
Are you familiar with the tin men from the Wizard
(07:37):
of Oz Oh? Yeah, yes, yes, classically he had no heart, right,
so so you know, so the tin Man, you know,
he would ideally want a heart transplant. But unfortunately, exactly,
but you know, unfortunately there aren't many hearts going around
because one a lot of people may not be aware
of it. Some people don't want to contribute that organ,
(07:59):
and increasingly there's some ethics involved about heart transplantation, which
I want to get into.
Speaker 2 (08:07):
So can you choose which organs you want to donate?
Speaker 1 (08:10):
I'll be honest with you, I am not involved in
that aspect of it. I myself, you know, I'm on
my when I apply for my driver's license, as I'm
sure you did, there's a box you can check for
organ donation, and so for me, I'm totally willing to
contribute anything. So I just checked that box. I don't
know if you can say I want everything donated, but
I don't want my heart. Don't touch my heart right.
(08:32):
I don't know if that's that's possible, you know, because
because once it comes to the time to make that decision,
I don't know how much of a.
Speaker 2 (08:39):
Say yeah, I don't think you're going to care exactly exactly.
Speaker 1 (08:42):
So I'm going to take a quick break here on
the Hackers, and I want to get into a few
more details of one, who qualifies for a heart transplant?
And two what is this new thing that's out there
in which we could possibly really increase the number of
hearts that can be harvested.
Speaker 3 (09:03):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Raw, call nine one five five hundred four three
seven zero or by emailing Rao at medical hackers dot com.
Speaker 1 (09:31):
Back here on the Hackers, I'm doctor here, doctor row here,
Doctor Raw.
Speaker 2 (09:35):
I had a question, so you talked earlier about cardiac
death and brain death. Is it safe to assume that
if they have cardiac death, they cannot donate their heart,
but if they have brain death, then they can still
donate their heart.
Speaker 1 (09:47):
That's true. Yes, So obviously, if your heart's no longer functioning, yeah,
I don't know how many people would want to get
your non functioning heart, but if there might be some
weirdos out there, that's true. That's true. But if you
are brain death, if you have brain death, your brain
is not functional, you can still donate your heart, especially
(10:09):
if it is still pumping. That's certainly something they could obtain.
They could procure now, so the question is who might
need a heart transplant. So there's a lot of different areas,
but basically there's a lot of patients who eventually go
to heart failure. So that could be due to multiple things.
Some people have conditions like cardiomyopathy, which just means it's
(10:29):
a condition that's weakening your heart and enlargening your heart.
And so at that point, once your heart starts essentially
blowing up like a balloon, it's not going to have
that same contractile function that a younger, more normal heart
would have, and so it's difficult to pump blood. So
that's a very common thing, of course, especially right I've
(10:49):
heard sure exactly, So there are people. There are a
lot of different things that can lead to cardio myopathy.
There's lots of there's I've also heard of infections that
can lead to it. There's lots of different things, but
really your cardiologist tool essentially, they'll have to do an
array of tests to determine that. Another one is just
blockages in your cornery arteries. That's the most classic thing
(11:11):
that we see out there, blockages in the blood vessels
leading to your heart. So, as you know, I myself,
I'm a vascular interventionalist. I do a lot of peripheral
art chial disease, but a lot of patients also have
what we call cornery art disease, which is plaque build
up in your vessels, so that can lead to heart
attacks and damage the underlying heart muscle. Another thing is
(11:33):
a lot of children, especially have heart defects, underlying heart
defects that they just grew up with. Maybe there may
be a whole present, they may just have issues with
their heart that can lead to heart failure. Another thing
that we see with older patients is valvular disease. So
there are these little vows that separate the little chambers
(11:53):
of your heart. So your heart has four chambers, okay,
so it needs to the blood has to go from
each these chambers, from each of these little rooms to
the other room or chamber, and a valve that door
separates them. Now, over time, that door can get really
you know, to use an analogy, can get really creaky.
Maybe you can build up you know, it could stop
(12:14):
opening as well, and it could develop valvular disease. So
that could be little calcifications that develop, little hardening of
that valve, and so that can impede that transportation of
the blood, impede blood flow and lead to eventually to
heart failure. Another thing, and my partner that I work
with as a that electrophysiology dog, deals with a lot
(12:36):
of arrhythmias, meaning your heart's just not does not have
the proper beating that we normally observe. A lot of
variety can a lot of variety of things that can
lead to premature heart failure. But I don't really want
to get into that. I want to get into the
decisions that influence a transplant decision. So most of the
(12:57):
times they try to deal with this with medications. Sometimes
what they may also try to do is they may
try to do surgeries. You might also try to have
a device like a pacemaker placed. These are all less
invasive mechanisms to support your heart beating because, as I said,
there aren't too many hearts that are just lying around exactly,
(13:19):
not on the shelves there. So one thing that folks
often do is called a left ventricular assist device. Okay,
that's something that's frequently placed, and it's often done for
two reasons. One is, let's say you need a heart
transplant and you've qualified for heart transplant. You're just waiting
for the heart transplant, but you need something to get
(13:42):
you through that interval. Maybe you have to wait several
months for that now. The other thing is maybe you
just decided you don't want to go. You are too
sick to undergo a big operation like a heart transplant,
and you just want to be able to get through
the rest of your days with your hearts till pumping.
So ventricular syst device is something that is you could
(14:03):
use as a mechanical pump that's actually implanted in your
chest and they attach it to the left ventricle, so
the left ventricle is as I said, there's two atria
and two ventricles, the four chambers of your heart, and
the left ventricle is really key in contracting and pushing
that blood through to the rest of your body. So
(14:24):
they put a little additional little pump, a mechanical pump
attached to that left ventricle, and what that does is
it's able to help it. It carries the blood to
the aorta and really helps push all that blood to
your organs, helps them be well perfused and functioning. Yeah,
(14:44):
so it can increasingly be used for long term treatments,
although it was really indicated initially for patients who want
to get a heart transplant. So this is where we
come to the key part of this discussion, which is
what I wanted to get into, which is about harvesting
hearts individuals.
Speaker 2 (15:01):
So there has to be a better word for harvesting exactly.
Speaker 1 (15:06):
That's true. That's true, right, Yeah, sure, for sure. So
when you want to get a heart from a patient
who has been declared dead, you know what they typically
do is they use the aorta. Okay, the order is
the main blood vessel that's sort of extending from your
heart and they inject fluid, okay, and that fluid it
(15:27):
runs through a machine and it oxygenates that blood. So
if your heart's not working, they oxygenate that blood and
then what they do is they put that blood back
in and so that way, your heart is still pumping
like oxygenated blood because it can't really just pump regular
fluid because remember, your heart also needs oxygenated blood right
(15:48):
your cornery arteries, the blood vessels that feed your heart
need oxygen. You can't just be putting saline. You can't
just be putting blood that has no oxygen in it,
because the heart needs oxygen. So this thing that they
do is it's something called I don't want to get
into it too much JAP, is called normalthermic regional profusion.
So let's say a patient has been declared dead. They
(16:10):
now put them on a little bypass to send oxygenated
blood to the heart so it still keeps beating because
they don't want it to die off. That's a classic
way of obtaining or for lack of a better word,
harvesting that organ.
Speaker 2 (16:31):
To sustain it and to expose into a new body exactly.
Speaker 1 (16:34):
Now, So the problem is that there are certain countries.
There are certain hospitals that prefer not to do that
because there are some ethical concerns with doing that. And
the reason for that is there's this thing that we
have called the dead donor rule. Okay, so what that
dead donor rule basically states, it's just sort of an
ethical principle guiding transplant, is that organ retrieval must not
(16:57):
begin until your donor is legally dead. Right, So, unfortunately,
I don't know if there's anybody who's woken up in
an ice bag.
Speaker 2 (17:05):
I mean, we're right next to Mexico.
Speaker 1 (17:06):
I wouldn't be surprised, that's true. Right, So you know,
ideally you should be legally dead before you can harvest
an organ, although there are people who are willfully given
up a kidney. Yeah, right, So you don't have to
be dead to give up a kidney. Everyone's got two
of them. And if you want to get contributed to somebody,
you could certainly be willing to do that without being
without having expired. But we need to procure these organs
(17:31):
without where we know that the patient has already died.
So the reason why people have problems with that is
that they feel that this concept of artificially keeping the
heart pumping and alive violates that principle, and so that's
why they don't want to. They have now decided there's
(17:53):
a very interesting new thing that's come out where they
can actually let a patient expire, be declared dead, and
wait a short period of time between two to five minutes,
and don't even touch that heart, okay, And then after
two to five minutes they decide, you know what, that
heart's not pumping on someone for two to five minutes.
And then what they do is they then put some
(18:15):
oxygenated fluid through the heart and see if the heart
still pumps. And so what they have done is they
actually have done and this is what the study showed,
this new and journal medicine study which prompted this entire
discussion for the show. They found that this other mechanism
of getting a organ actually worked just fine. The heart
(18:35):
just worked perfectly if you just let it sit there
for two to five minutes. And they checked how this
heart worked in a patient one month, three months, six
months afterward, and the heart actually worked just as well
as if you did it the old method of artificially
keeping it pumping. So I think that's really interesting and
that's really good news because I think this will open
the door for more people to contribute organs even if
(18:58):
you have ethical concerns about about your the viability of
your heart, and also says a little bit more about
you know, the reversibility of death of cellular death. So
even though you have circulatory death, meaning your heart is
not pumping blood in your body, essentially we can essentially
(19:18):
revive the heart to a certain degree. And that's what
this study is shown. So now it wasn't a very
big study. They just did about three adult hearts. They
did one pediatric heart, so not a big number about
four patients. But what they found is by using this
new method of just letting heart sit there then letting
it function, it works just fine. So I think that's
great news and hopefully there'll be a lot more hearts
(19:41):
out there. Yeah, so I'm gonna take a quick break
here on the Hackers and go in a little bit
different direction.
Speaker 3 (19:47):
You're listening to the Medical Hackers with doctor Sandy Brow,
Board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news Radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Raw call nine one five five hundred four to
three seven zero, or by emailing rawat medical hackers dot com.
Speaker 1 (20:14):
Back here on the Hackers doctor Row here, and I
just finished a little discussion on transplantation. But I know, Amber,
I think you had some questions.
Speaker 2 (20:23):
Yeah, I have the question I had. You talked about
waiting two to five minutes, and that would be better
quote unquote better ethically. Why do we wait the two
to five minutes's what's the point of that?
Speaker 1 (20:34):
So really the reason why they're waiting two to five
minutes is that it's easy for people to wrap their
heads around the fact that a patient or a heart
that's not that we have just sat on the side
for two to five minutes. And I don't know why
they came up with two to five or versus I
guess you could also wait ten to fifteen minutes, right,
(20:55):
but then there're probably a little lower likelihood of that
cellular recovery. Maybe someone has to investigate that. But it's
just the idea of we're kind of letting this this
sat the state, this patient who's in this state, we've
left them alone. Right, they are not going to just
within two to five minutes unless they magically just jump
up and.
Speaker 2 (21:15):
They're not kind of dead, they're dead.
Speaker 1 (21:16):
Dead, yeah, exactly, difference exactly. So we've given them two
to five minutes to not wake up on their own, exactly.
And that's the reason why. So two to five is
pretty a random number, but I think it's if you
waited half an hour, then you might actually lose that
heart as well. Who knows. I don't know if you
(21:36):
would be able to recover a heart after say, thirty minutes.
Speaker 2 (21:40):
And so that's where the more ethical ways of getting
harvesting this heart come in, is just making double making
sure that they're un alive.
Speaker 1 (21:48):
Okay, exactly, that makes sense. Now, I know you had
some question about who gets these organs? Is there a priority?
Speaker 2 (21:57):
So yes, I'm an organ donor, right and I know,
you know, if my heart was to be donated, and
this might sound a little harsh, but if it's gonna
go to someone who's say ninety versus a ten year old,
you know, I know that I can't say who it
goes to, but that just brought up into my head
the question, Yeah, who gets priority when it comes to
(22:18):
getting these hearts? Since they aren't flying off the shelves.
Speaker 1 (22:21):
Sure. So as so far as your question goes specifically
relate to heart transplants, I have to tell you I
don't deal much with heart transplants specifically, so I don't
know if there's a priority list, although I'm sure there
might be based on my experience with liver organ donation.
So my experience has been a lot more with liver
(22:41):
organ donation since I deal with a lot more liver
cancer patients and a lot of the concept of brain
death actually deals with people are trying to obtain livers,
and so I can tell you when it comes to
liver donation or people who are eligible for livers, there's
definitely a hierarchy. The hierarchy is based on a lot
(23:03):
of different things. It's based not just on the severity
of your disease, but on whether you have underlying do
you have an alcohol use disorder, things like that, so
exactly a lot. So so what they'll do is they
will they will do it based on that. But I
have to tell you I don't really I'm not on
(23:24):
the side of obtaining these organs, harvesting these organs, so
to speak. But I think that's a great question and
It's definitely something that is worth looking into because you know,
definitely people would like to think that, you know, the
organ that I have given up is going to my
(23:44):
preferred patient, my preferred person that I want too I
think will benefit I don't want a serial killer, right, Yeah,
you want You wanted to benefit somebody, and I totally
understand that, because you probably wanted to benefit somebody who's
probably going to be like if it's a ten year old,
someone who's going to be on this earth much longer
than somebody who's probably just has maybe five more years
(24:05):
to live, right, And.
Speaker 2 (24:06):
Because you brought this topic up, do you see like
is do you see it being a really big issue
getting heart donations? I mean, I just know what I've
seen in the movies and from what we've talked about today,
And is that why you wanted to talk about it?
Speaker 1 (24:18):
So in general, I think it's just very good to
know we need to be aware of organ donation because
there's a lot of people who have stigmas about organ donation. Yeah,
some people think that it's a part of your body
that's you know, they think, oh I lost my heart,
now maybe my soul somehow will not exactly right. So
there are certain people who feel that they don't want
(24:41):
to give an organ because they feel that a part
of their body, a part of their their essential being,
is being taken away from them. And I honestly want
to just get rid of that entire stigma, and I
want people know there are people who need organs, and
there are a lot of folks who are obviously dying for
a variety of different things. It's always worthwhile paying it
for and being able to provide somebody with something at
(25:04):
that time. So I'll kind of want to I actually
wanted to talk about something else on this.
Speaker 2 (25:09):
Sorry, those are pressing questions.
Speaker 1 (25:11):
In my head, oh for sure, because we don't talk
about transplant enough. One of the things I wanted to
get into is the concept of opioid use disorder. I
don't think of too much time, but I want to
get into it very very briefly because people often ask
me why am I involved as a vascular interventionalists, someone
who does procedures, Why do I treat patients who have
opioid disorders? And the reason why this came up is
(25:33):
there was a study in the General of American Medical
Association which found that they're basically about six million people
in the US with opioid use disorders, but there are
less than two thousand doctors in the US who are
trained in addiction medication. So that's a very small amount
of doctors for a large number of patients. And we
(25:56):
also know that about eight hundred thousand people in the
US have died from opioid overdoses over a three year
period of time. Okay, And so the reason why I
say that is it's very important because now a lot
of different docs have to be involved with drug management.
So I don't know if you know this, but as
part of our continuing medical education, a lot of these
(26:18):
states have also said, you know what, as doctors, we
need to now start reading up. Even if you're not
an addiction medication doc, even if you're not a doc
who deals with opioids, you need to know about opioids
because one patients might ask for them after a procedure.
But also it's good to identify and know if you
have a patient with this problem when you might need
to send a referral or honestly, you could probably even
(26:42):
try to manage it yourself. And that's what they're trying
to do. They're trying to actually get more primary care
doctors to manage opioid use disorders. Now, sometimes it's difficult
to do that because one is from an educational standpoint.
But you might wonder, how do I, as a vascular
inventionalist deal with opioid dis Now we're running very short
on times. I'm gonna give you the quick thirty second answer,
(27:05):
which is, I deal with a lot of pain procedures, right,
and a lot of patients who are on opioids. Unless
you've done it because of some addiction, A lot of
patients might have gotten addicted because of chronic pain. And so,
as somebody who deals with chronic pain, I do a
lot of procedures for chronic back pain or failed back surgeries,
patients who have severe pain in their legs, and so
(27:26):
I do a lot of procedures where I can interrupt
the nerve signals to prevent the patient from recognizing that
pain signal in their brain. So I can actually and
I'll discuss it much more depth on a different top
on a different show. But I put tiny little wires,
tiny little leads near the back, near the nerves that
(27:46):
travel up the spinal canal into your brain and it's
really designed to help patients, and I've seen significant umber
of patients who've been able to get off their opioids
or at least decrease them significantly. And so that's the
little part that I'm trying to play when it comes
to opoid use disorders. But obviously when it comes to
(28:08):
this overall thing we're trying to do in society, there's
you know, there's three main drugs bupron, orphan now trek Zonne,
and methodone that are three drugs that are identified for
opioid use disorder management that I think a lot of
docs primary care docks especially unfortunately, you have to now
be more and more familiar with because there aren't enough
(28:28):
addiction management special so out there. Unfortunately, our time this
Saturday's up. If you're interested in any more information on
any of the mentioned treatments, you can always call to
get more information at nine one five five hundred forty
three seventy that's five zero zero four three seven zero.
You can also reach me by email at row at
(28:50):
medical hackers dot com. That's r Ao at medical hackers
dot com. I hope these healthcare hacks have helped you
navigate our complex medical system. If you've been tuned into
this whole time, bless your heart and your health. I'm
doctor sandeep Row, and you've been listening to the metaquackers
Good afternoon. It's another weekend here in the heart of
the dusty Chuahen Desert in West Texas, and you're listening
to the Medical Hackers. However, you may be tuned in
this week and I'm your host, doctor San Deep Growl.
I'm here to bring the Borderland the latest information in healthcare, medicine,
and technology on the show. I consider mysef a hacker,
(00:25):
a hacker in the positive sense, a hacker using my
intimate knowledge of the medical system to breaking down some
of the bears access to new medical technologies and current
health care information. So today's just me in the studio here.
I also have Amber, my producer. She's also a backer.
She can always she's always a bit of a sounding board.
I'm always lurking exactly so Amber. One of the things
(00:50):
I wanted to get into is the concept or the
overall idea of organ donation. And one of the interesting
that that's happened a study in the area of heart
organ donation. But I'm gonna kind of get into it
slowly because you might be wondering why would I myself.
(01:10):
I'm a vascin eventionalist. I'm also a radiologist. How am
I involved in this entire aspect of organ donations. Yeah.
So as a radiologist, one of the ways that I
am involved is I frequently get studies to interpret to
determine brain death. So whenever you are at the end
(01:32):
of the rope, when you know you're the light exactly,
there's really two ways, too, legal ways we can determine death.
One is brain death and the other one is cardiac death. Now,
brain death is a lot more difficult for a lot
of people to understand. Let's first get into cardiac death.
(01:53):
Cardiac death is basically very very simple. Your heart stops
your circulatory system, there's no blood flowing. Subsequently, your breathing
will top and you are at that point you are
you expire, right, So it's a very easy concept for
folks to understand because the heart is very frequently linked
(02:15):
to life. Nowadays they say unlived exactly. I've seen that.
I've seen that. Now. Another way in which this is
where I tend to be involved is the concept of
brain death, or what we call it determining someone has
expired by neurologic criteria. That means that if you have
(02:39):
complete and irreversible loss of brain and your brain stem,
which is just the little area below your brain function.
Then we can say that patient is death dead by
brain brain death. And so that's where radiology imaging comes
into place. Now, cardiac death is actually pretty easy to determine.
I've had to actually determine it myself. I've had patients
(03:01):
or maybe you have somebody. You just feel their pulse.
You can tell that they no longer have a pulse.
You check their breathing, you can listen to their heart
and lungs. Very easy to do from observation, from a
physical exam of determining that. But where when brain death
is in play, it's a little bit more complex. So
sometimes what we do is we do a scan called
(03:22):
a nuclear medicine scan. It's called a brain flow scan.
We inject a little isotope, a little radio active particle
in the ivy and we let that little particle circulate
through your system. So maybe your heart is still working
at that point, so you're not cardiac death. But we
may suspect, you know what, this patient's sitting in the
(03:43):
ICU and they may be braided. How do we know
if this patient who's in a coma, How do we
know if this patient who is lying there in a
static state. That sure, their heart may be working, but
do we know if their brain is actually working a
being supported because maybe they're on a ventilator and a
(04:04):
machine is doing all their work for them. How do
we know they're actually going to be functional from a
brain standpoint. That's where this nuclear medicine scan comes in.
That's where I have to frequently make this diagnosis. So
we inject this little particle through the bloodstream and then
we take some images. It's a nuclear medicine scan. That
means what happens is any of these little radioactive particles
(04:25):
as it travels up into your brain, it lights up
on binuclear medicine because it is radioactive by definition, and
so I can see as these particles as they go up,
they'll go up the carotid blood vessel. So if your
heart's to a pump and I can see it go
up into your brain. But then I want to see
it as it traverses, as it goes through your brain.
I want to see it go in and then ideally,
(04:47):
if you're truly alive, then the particles will go throughout
your brain and you can tell your entire brain is
well perfused. Now when you don't have brain activity. We
have something the light bulb side. So what that means is,
imagine a light bulb where you don't see anything there
is in the center. So imagine a scan in which
(05:09):
I just see the bottom part of the light bulb,
like that's like your exactly the blood's going in, but
that entire light bulb, the actual bulb is just empty
because your brain's not functioning. So I know some people
like that doctor don't know if you need a medical
diagnosis exactly, but but in this case, yeah, So the
reason why docs get me involved is they may be
(05:31):
at the point where they go, you know what, we
want to determine if this patient is indeed brain death,
at which point maybe a family can make a decision
do they want to still continue supportive care because they
may realize, you know what, this patient really not has
no hope of getting, you know, to any salvageable state,
or maybe we want to this patient may actually have organs,
(05:51):
maybe they are an actual organ donor they want to have.
They have a functional liver, they have a functional kidney
that maybe somebody else can be fit from. So we
always have to determine this in order to be able
to proceed with that now, so that, as I said,
it's sometimes it's very difficult for the public to understand
(06:11):
the concept of brain death because it's very difficult because
a patient can still appear alive even though you're brain dead,
because you may still have maybe that that ventilator is
breathing for you. And so that's that's one of the
things I wanted to kind of get into, but I
want to go into it in a little bit, a
little bit more depth because I was interested in the
(06:32):
concept of heart transplants and there's a very new concept
involving heart transplants. Okay, so obviously, you know, if you're
not everybody is going to need a heart transplant. You know,
I want my partners, actually want of good partners that
I work with. He's actually a electrophysiology doctor, so that
(06:55):
means he studies the sort of how the heart functions,
whether they're whether it's pumping properly, whether it's a arrhythmias,
and he gets a lot of patients who are may
need eventual heart transplantation because maybe the heart's not beating well,
maybe it has underlying structural defects, maybe there's valvular defects
(07:17):
now because of the fact that a lot of patients
cannot procure a heart. There's not just a bunch of
hearts out there, right, We're all exactly, that's true, that's true, right,
you know. I sometimes say, you know, there maybe a
lot of people who are ten men, so to speak.
Are you familiar with the tin men from the Wizard
(07:37):
of Oz Oh? Yeah, yes, yes, classically he had no heart, right,
so so you know, so the tin Man, you know,
he would ideally want a heart transplant. But unfortunately, exactly,
but you know, unfortunately there aren't many hearts going around
because one a lot of people may not be aware
of it. Some people don't want to contribute that organ,
(07:59):
and increasingly there's some ethics involved about heart transplantation, which
I want to get into.
Speaker 2 (08:07):
So can you choose which organs you want to donate?
Speaker 1 (08:10):
I'll be honest with you, I am not involved in
that aspect of it. I myself, you know, I'm on
my when I apply for my driver's license, as I'm
sure you did, there's a box you can check for
organ donation, and so for me, I'm totally willing to
contribute anything. So I just checked that box. I don't
know if you can say I want everything donated, but
I don't want my heart. Don't touch my heart right.
(08:32):
I don't know if that's that's possible, you know, because
because once it comes to the time to make that decision,
I don't know how much of a.
Speaker 2 (08:39):
Say yeah, I don't think you're going to care exactly exactly.
Speaker 1 (08:42):
So I'm going to take a quick break here on
the Hackers, and I want to get into a few
more details of one, who qualifies for a heart transplant?
And two what is this new thing that's out there
in which we could possibly really increase the number of
hearts that can be harvested.
Speaker 3 (09:03):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Raw, call nine one five five hundred four three
seven zero or by emailing Rao at medical hackers dot com.
Speaker 1 (09:31):
Back here on the Hackers, I'm doctor here, doctor row here,
Doctor Raw.
Speaker 2 (09:35):
I had a question, so you talked earlier about cardiac
death and brain death. Is it safe to assume that
if they have cardiac death, they cannot donate their heart,
but if they have brain death, then they can still
donate their heart.
Speaker 1 (09:47):
That's true. Yes, So obviously, if your heart's no longer functioning, yeah,
I don't know how many people would want to get
your non functioning heart, but if there might be some
weirdos out there, that's true. That's true. But if you
are brain death, if you have brain death, your brain
is not functional, you can still donate your heart, especially
(10:09):
if it is still pumping. That's certainly something they could obtain.
They could procure now, so the question is who might
need a heart transplant. So there's a lot of different areas,
but basically there's a lot of patients who eventually go
to heart failure. So that could be due to multiple things.
Some people have conditions like cardiomyopathy, which just means it's
(10:29):
a condition that's weakening your heart and enlargening your heart.
And so at that point, once your heart starts essentially
blowing up like a balloon, it's not going to have
that same contractile function that a younger, more normal heart
would have, and so it's difficult to pump blood. So
that's a very common thing, of course, especially right I've
(10:49):
heard sure exactly, So there are people. There are a
lot of different things that can lead to cardio myopathy.
There's lots of there's I've also heard of infections that
can lead to it. There's lots of different things, but
really your cardiologist tool essentially, they'll have to do an
array of tests to determine that. Another one is just
blockages in your cornery arteries. That's the most classic thing
(11:11):
that we see out there, blockages in the blood vessels
leading to your heart. So, as you know, I myself,
I'm a vascular interventionalist. I do a lot of peripheral
art chial disease, but a lot of patients also have
what we call cornery art disease, which is plaque build
up in your vessels, so that can lead to heart
attacks and damage the underlying heart muscle. Another thing is
(11:33):
a lot of children, especially have heart defects, underlying heart
defects that they just grew up with. Maybe there may
be a whole present, they may just have issues with
their heart that can lead to heart failure. Another thing
that we see with older patients is valvular disease. So
there are these little vows that separate the little chambers
(11:53):
of your heart. So your heart has four chambers, okay,
so it needs to the blood has to go from
each these chambers, from each of these little rooms to
the other room or chamber, and a valve that door
separates them. Now, over time, that door can get really
you know, to use an analogy, can get really creaky.
Maybe you can build up you know, it could stop
(12:14):
opening as well, and it could develop valvular disease. So
that could be little calcifications that develop, little hardening of
that valve, and so that can impede that transportation of
the blood, impede blood flow and lead to eventually to
heart failure. Another thing, and my partner that I work
with as a that electrophysiology dog, deals with a lot
(12:36):
of arrhythmias, meaning your heart's just not does not have
the proper beating that we normally observe. A lot of
variety can a lot of variety of things that can
lead to premature heart failure. But I don't really want
to get into that. I want to get into the
decisions that influence a transplant decision. So most of the
(12:57):
times they try to deal with this with medications. Sometimes
what they may also try to do is they may
try to do surgeries. You might also try to have
a device like a pacemaker placed. These are all less
invasive mechanisms to support your heart beating because, as I said,
there aren't too many hearts that are just lying around exactly,
(13:19):
not on the shelves there. So one thing that folks
often do is called a left ventricular assist device. Okay,
that's something that's frequently placed, and it's often done for
two reasons. One is, let's say you need a heart
transplant and you've qualified for heart transplant. You're just waiting
for the heart transplant, but you need something to get
(13:42):
you through that interval. Maybe you have to wait several
months for that now. The other thing is maybe you
just decided you don't want to go. You are too
sick to undergo a big operation like a heart transplant,
and you just want to be able to get through
the rest of your days with your hearts till pumping.
So ventricular syst device is something that is you could
(14:03):
use as a mechanical pump that's actually implanted in your
chest and they attach it to the left ventricle, so
the left ventricle is as I said, there's two atria
and two ventricles, the four chambers of your heart, and
the left ventricle is really key in contracting and pushing
that blood through to the rest of your body. So
(14:24):
they put a little additional little pump, a mechanical pump
attached to that left ventricle, and what that does is
it's able to help it. It carries the blood to
the aorta and really helps push all that blood to
your organs, helps them be well perfused and functioning. Yeah,
(14:44):
so it can increasingly be used for long term treatments,
although it was really indicated initially for patients who want
to get a heart transplant. So this is where we
come to the key part of this discussion, which is
what I wanted to get into, which is about harvesting
hearts individuals.
Speaker 2 (15:01):
So there has to be a better word for harvesting exactly.
Speaker 1 (15:06):
That's true. That's true, right, Yeah, sure, for sure. So
when you want to get a heart from a patient
who has been declared dead, you know what they typically
do is they use the aorta. Okay, the order is
the main blood vessel that's sort of extending from your
heart and they inject fluid, okay, and that fluid it
(15:27):
runs through a machine and it oxygenates that blood. So
if your heart's not working, they oxygenate that blood and
then what they do is they put that blood back
in and so that way, your heart is still pumping
like oxygenated blood because it can't really just pump regular
fluid because remember, your heart also needs oxygenated blood right
(15:48):
your cornery arteries, the blood vessels that feed your heart
need oxygen. You can't just be putting saline. You can't
just be putting blood that has no oxygen in it,
because the heart needs oxygen. So this thing that they
do is it's something called I don't want to get
into it too much JAP, is called normalthermic regional profusion.
So let's say a patient has been declared dead. They
(16:10):
now put them on a little bypass to send oxygenated
blood to the heart so it still keeps beating because
they don't want it to die off. That's a classic
way of obtaining or for lack of a better word,
harvesting that organ.
Speaker 2 (16:31):
To sustain it and to expose into a new body exactly.
Speaker 1 (16:34):
Now, So the problem is that there are certain countries.
There are certain hospitals that prefer not to do that
because there are some ethical concerns with doing that. And
the reason for that is there's this thing that we
have called the dead donor rule. Okay, so what that
dead donor rule basically states, it's just sort of an
ethical principle guiding transplant, is that organ retrieval must not
(16:57):
begin until your donor is legally dead. Right, So, unfortunately,
I don't know if there's anybody who's woken up in
an ice bag.
Speaker 2 (17:05):
I mean, we're right next to Mexico.
Speaker 1 (17:06):
I wouldn't be surprised, that's true. Right, So you know,
ideally you should be legally dead before you can harvest
an organ, although there are people who are willfully given
up a kidney. Yeah, right, So you don't have to
be dead to give up a kidney. Everyone's got two
of them. And if you want to get contributed to somebody,
you could certainly be willing to do that without being
without having expired. But we need to procure these organs
(17:31):
without where we know that the patient has already died.
So the reason why people have problems with that is
that they feel that this concept of artificially keeping the
heart pumping and alive violates that principle, and so that's
why they don't want to. They have now decided there's
(17:53):
a very interesting new thing that's come out where they
can actually let a patient expire, be declared dead, and
wait a short period of time between two to five minutes,
and don't even touch that heart, okay, And then after
two to five minutes they decide, you know what, that
heart's not pumping on someone for two to five minutes.
And then what they do is they then put some
(18:15):
oxygenated fluid through the heart and see if the heart
still pumps. And so what they have done is they
actually have done and this is what the study showed,
this new and journal medicine study which prompted this entire
discussion for the show. They found that this other mechanism
of getting a organ actually worked just fine. The heart
(18:35):
just worked perfectly if you just let it sit there
for two to five minutes. And they checked how this
heart worked in a patient one month, three months, six
months afterward, and the heart actually worked just as well
as if you did it the old method of artificially
keeping it pumping. So I think that's really interesting and
that's really good news because I think this will open
the door for more people to contribute organs even if
(18:58):
you have ethical concerns about about your the viability of
your heart, and also says a little bit more about
you know, the reversibility of death of cellular death. So
even though you have circulatory death, meaning your heart is
not pumping blood in your body, essentially we can essentially
(19:18):
revive the heart to a certain degree. And that's what
this study is shown. So now it wasn't a very
big study. They just did about three adult hearts. They
did one pediatric heart, so not a big number about
four patients. But what they found is by using this
new method of just letting heart sit there then letting
it function, it works just fine. So I think that's
great news and hopefully there'll be a lot more hearts
(19:41):
out there. Yeah, so I'm gonna take a quick break
here on the Hackers and go in a little bit
different direction.
Speaker 3 (19:47):
You're listening to the Medical Hackers with doctor Sandy Brow,
Board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news Radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Raw call nine one five five hundred four to
three seven zero, or by emailing rawat medical hackers dot com.
Speaker 1 (20:14):
Back here on the Hackers doctor Row here, and I
just finished a little discussion on transplantation. But I know, Amber,
I think you had some questions.
Speaker 2 (20:23):
Yeah, I have the question I had. You talked about
waiting two to five minutes, and that would be better
quote unquote better ethically. Why do we wait the two
to five minutes's what's the point of that?
Speaker 1 (20:34):
So really the reason why they're waiting two to five
minutes is that it's easy for people to wrap their
heads around the fact that a patient or a heart
that's not that we have just sat on the side
for two to five minutes. And I don't know why
they came up with two to five or versus I
guess you could also wait ten to fifteen minutes, right,
(20:55):
but then there're probably a little lower likelihood of that
cellular recovery. Maybe someone has to investigate that. But it's
just the idea of we're kind of letting this this
sat the state, this patient who's in this state, we've
left them alone. Right, they are not going to just
within two to five minutes unless they magically just jump
up and.
Speaker 2 (21:15):
They're not kind of dead, they're dead.
Speaker 1 (21:16):
Dead, yeah, exactly, difference exactly. So we've given them two
to five minutes to not wake up on their own, exactly.
And that's the reason why. So two to five is
pretty a random number, but I think it's if you
waited half an hour, then you might actually lose that
heart as well. Who knows. I don't know if you
(21:36):
would be able to recover a heart after say, thirty minutes.
Speaker 2 (21:40):
And so that's where the more ethical ways of getting
harvesting this heart come in, is just making double making
sure that they're un alive.
Speaker 1 (21:48):
Okay, exactly, that makes sense. Now, I know you had
some question about who gets these organs? Is there a priority?
Speaker 2 (21:57):
So yes, I'm an organ donor, right and I know,
you know, if my heart was to be donated, and
this might sound a little harsh, but if it's gonna
go to someone who's say ninety versus a ten year old,
you know, I know that I can't say who it
goes to, but that just brought up into my head
the question, Yeah, who gets priority when it comes to
(22:18):
getting these hearts? Since they aren't flying off the shelves.
Speaker 1 (22:21):
Sure. So as so far as your question goes specifically
relate to heart transplants, I have to tell you I
don't deal much with heart transplants specifically, so I don't
know if there's a priority list, although I'm sure there
might be based on my experience with liver organ donation.
So my experience has been a lot more with liver
(22:41):
organ donation since I deal with a lot more liver
cancer patients and a lot of the concept of brain
death actually deals with people are trying to obtain livers,
and so I can tell you when it comes to
liver donation or people who are eligible for livers, there's
definitely a hierarchy. The hierarchy is based on a lot
(23:03):
of different things. It's based not just on the severity
of your disease, but on whether you have underlying do
you have an alcohol use disorder, things like that, so
exactly a lot. So so what they'll do is they
will they will do it based on that. But I
have to tell you I don't really I'm not on
(23:24):
the side of obtaining these organs, harvesting these organs, so
to speak. But I think that's a great question and
It's definitely something that is worth looking into because you know,
definitely people would like to think that, you know, the
organ that I have given up is going to my
(23:44):
preferred patient, my preferred person that I want too I
think will benefit I don't want a serial killer, right, Yeah,
you want You wanted to benefit somebody, and I totally
understand that, because you probably wanted to benefit somebody who's
probably going to be like if it's a ten year old,
someone who's going to be on this earth much longer
than somebody who's probably just has maybe five more years
(24:05):
to live, right, And.
Speaker 2 (24:06):
Because you brought this topic up, do you see like
is do you see it being a really big issue
getting heart donations? I mean, I just know what I've
seen in the movies and from what we've talked about today,
And is that why you wanted to talk about it?
Speaker 1 (24:18):
So in general, I think it's just very good to
know we need to be aware of organ donation because
there's a lot of people who have stigmas about organ donation. Yeah,
some people think that it's a part of your body
that's you know, they think, oh I lost my heart,
now maybe my soul somehow will not exactly right. So
there are certain people who feel that they don't want
(24:41):
to give an organ because they feel that a part
of their body, a part of their their essential being,
is being taken away from them. And I honestly want
to just get rid of that entire stigma, and I
want people know there are people who need organs, and
there are a lot of folks who are obviously dying for
a variety of different things. It's always worthwhile paying it
for and being able to provide somebody with something at
(25:04):
that time. So I'll kind of want to I actually
wanted to talk about something else on this.
Speaker 2 (25:09):
Sorry, those are pressing questions.
Speaker 1 (25:11):
In my head, oh for sure, because we don't talk
about transplant enough. One of the things I wanted to
get into is the concept of opioid use disorder. I
don't think of too much time, but I want to
get into it very very briefly because people often ask
me why am I involved as a vascular interventionalists, someone
who does procedures, Why do I treat patients who have
opioid disorders? And the reason why this came up is
(25:33):
there was a study in the General of American Medical
Association which found that they're basically about six million people
in the US with opioid use disorders, but there are
less than two thousand doctors in the US who are
trained in addiction medication. So that's a very small amount
of doctors for a large number of patients. And we
(25:56):
also know that about eight hundred thousand people in the
US have died from opioid overdoses over a three year
period of time. Okay, And so the reason why I
say that is it's very important because now a lot
of different docs have to be involved with drug management.
So I don't know if you know this, but as
part of our continuing medical education, a lot of these
(26:18):
states have also said, you know what, as doctors, we
need to now start reading up. Even if you're not
an addiction medication doc, even if you're not a doc
who deals with opioids, you need to know about opioids
because one patients might ask for them after a procedure.
But also it's good to identify and know if you
have a patient with this problem when you might need
to send a referral or honestly, you could probably even
(26:42):
try to manage it yourself. And that's what they're trying
to do. They're trying to actually get more primary care
doctors to manage opioid use disorders. Now, sometimes it's difficult
to do that because one is from an educational standpoint.
But you might wonder, how do I, as a vascular
inventionalist deal with opioid dis Now we're running very short
on times. I'm gonna give you the quick thirty second answer,
(27:05):
which is, I deal with a lot of pain procedures, right,
and a lot of patients who are on opioids. Unless
you've done it because of some addiction, A lot of
patients might have gotten addicted because of chronic pain. And so,
as somebody who deals with chronic pain, I do a
lot of procedures for chronic back pain or failed back surgeries,
patients who have severe pain in their legs, and so
(27:26):
I do a lot of procedures where I can interrupt
the nerve signals to prevent the patient from recognizing that
pain signal in their brain. So I can actually and
I'll discuss it much more depth on a different top
on a different show. But I put tiny little wires,
tiny little leads near the back, near the nerves that
(27:46):
travel up the spinal canal into your brain and it's
really designed to help patients, and I've seen significant umber
of patients who've been able to get off their opioids
or at least decrease them significantly. And so that's the
little part that I'm trying to play when it comes
to opoid use disorders. But obviously when it comes to
(28:08):
this overall thing we're trying to do in society, there's
you know, there's three main drugs bupron, orphan now trek Zonne,
and methodone that are three drugs that are identified for
opioid use disorder management that I think a lot of
docs primary care docks especially unfortunately, you have to now
be more and more familiar with because there aren't enough
(28:28):
addiction management special so out there. Unfortunately, our time this
Saturday's up. If you're interested in any more information on
any of the mentioned treatments, you can always call to
get more information at nine one five five hundred forty
three seventy that's five zero zero four three seven zero.
You can also reach me by email at row at
(28:50):
medical hackers dot com. That's r Ao at medical hackers
dot com. I hope these healthcare hacks have helped you
navigate our complex medical system. If you've been tuned into
this whole time, bless your heart and your health. I'm
doctor sandeep Row, and you've been listening to the metaquackers
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New Heights with Jason & Travis Kelce
Football’s funniest family duo — Jason Kelce of the Philadelphia Eagles and Travis Kelce of the Kansas City Chiefs — team up to provide next-level access to life in the league as it unfolds. The two brothers and Super Bowl champions drop weekly insights about the weekly slate of games and share their INSIDE perspectives on trending NFL news and sports headlines. They also endlessly rag on each other as brothers do, chat the latest in pop culture and welcome some very popular and well-known friends to chat with them. Check out new episodes every Wednesday. Follow New Heights on the Wondery App, YouTube or wherever you get your podcasts. You can listen to new episodes early and ad-free, and get exclusive content on Wondery+. Join Wondery+ in the Wondery App, Apple Podcasts or Spotify. And join our new membership for a unique fan experience by going to the New Heights YouTube channel now!