@FenTiger No, I think your intuitive reaction is correct, it's pretty complex. While many supporters view this as an important method for enhancing organ donation, there are many people who are uneasy about it. See this analysis, which raises questions about whether the practice is congruent with state laws on the determination of death and considers whether surgeons could be at risk for prosecution: https://www.tandfonline.com/doi/full/10.1080/15265161.2024.2336800

Announcing an upcoming panel on probably the most active controversy in #bioethics that people outside medicine (and many within) haven't heard of, #ta-NRP for #organdonation. (We're facing decisions about this at #UCSF and many other hospitals are also considering their policies.) This is a method for increasing the quantity and quality of organs available for transplantation, but which many critics believe violates the dead donor rule. In ta-NRP circulatory death of the donor is declared, after which perfusion is restored to thoracic and abdominal organs while brain perfusion is (we think) surgically prevented. Ta-NRP is performed in Spain, Italy, the Netherlands, France, and in some centers in the US; is contrary to guidelines in Canada, Australia, and NZ; and has been paused in Belgium and the UK pending further study.

At #Neuroethics2025 in Munich next month we'll host a panel, International Controversies over ta-NRP for Organ Procurement: Brain Perfusion and the Dead Donor Rule, including panelists to share key perspectives from three countries where ta-NRP has been performed, critiquing different conceptions of the role of the brain in circulatory death and how national professional and public norms affect views of this procedure:

• Karola Kreitmair (Univ. of Wisconsin, US) is a philosopher whose work addresses philosophical arguments regarding ta-NRP and the dead donor rule.
• Amelia Hessheimer (Hosp. Univ. La Paz, Spain) is a transplant surgeon and co-author of the European Society for Organ Transplantation's consensus statement on NRP.
• Alex Manara (N. Bristol NHS Trust, UK) is an intensivist and author of an influential early analysis on ta-NRP and the dead donor rule.

https://neuroethicssociety.org/posts/international-controversies-over-ta-nrp-for-organ-procurement-brain-perfusion-and-the-dead-donor-rule/ #neuroethics

We are #hiring - with 2 positions to announce.

In UCSF #Bioethics we're looking for a program manager for our education, research, and clinical activities - please see posting at https://sjobs.brassring.com/TGnewUI/Search/home/HomeWithPreLoad?partnerid=6495&siteid=5861&PageType=JobDetails&jobid=3617403#jobDetails=3617403_5861

In my lab we're looking for a #postdoc for an exciting empirical #interdisciplinary project on ethics and #caregiver experience in #dementia, with colleagues from sociology, philosophy, and psychology. https://decisionlab.ucsf.edu/hiring/

#UCSF #ScienceJobs #SocialScience #neuroethics #jobs

Decision Lab BBQ 2024! It was wonderful to welcome some new members in the lab, and an extra treat that several alums came back to join us!

Upcoming panel:

Clinician-Neuroethicist Career/Funding Roundtable
Tues Nov. 19, 8:10p Eastern

Please join us for a virtual panel with Dr. Brent Kious ( #psychiatry Univ. of Utah), Dr. Eran Klein ( #neurology OHSU & UW), and Dr. Cynthia Kubu ( #neuropsychology Cleveland Clinic & Case Western), who will reflect on their experiences in combining clinical work with ethics research and inquiry.

https://www.neuroethicssociety.org/clinician-neuroethicist-roundtable

#neuroethics #bioethics

A few belated points about the surprising and slightly troubling #NEJM study (https://www.nejm.org/doi/full/10.1056/NEJMoa2400645) on cognitive motor dissociation in #DisordersOfConsciousness, which I think have been underemphasized in the conversation so far:

The topline finding was that 25% of patients without observable responses to commands had fMRI or EEG evidence of awareness (physiologically meaningful activity modulation to specific commands). This is quite a bit higher than in earlier, smaller studies, many only using either fMRI or EEG.

A very surprising finding to me was in Figure S5. This shows even with the lowest possible bedside CRS-R score of 0, clinically doing nothing at the bedside, someone could have fMRI or EEG evidence of awareness. Some prior literature considers threshold scores in the range of 8 to 10, but the figure suggests that no bedside examination procedure can exclude preserved conscious awareness. This is super-humbling.

Also, 25% is really conservative, and almost certainly an underestimate. The fMRI and EEG tasks and statistical thresholds are demanding; maybe because they're from #cogsci research, they're designed to limit the likelihood of false positives. This comes at the cost of many false negatives, as seen in light blue (merely the known false negatives, there are still more undetected false negatives)--these patients follow commands at the bedside but their fMRI and EEG tests are negative. Also, given behavioral variability over time, serial assessments would have revealed more positives. While in science it's a priority to avoid false positives, arguably in the clinical setting false negative findings about consciousness are a bigger problem.

And: while this study used formal CRS-R scoring procedures from research, we know that informal clinical diagnoses of coma or the vegetative state are even less sensitive to signs of consciousness than the CRS-R. So overall in clinical settings we can presume there are many more patients falsely assessed as unconscious.

I don't do clinical work anymore with patients with disorders of consciousness, but I would take this study as a humbling reminder of how much we still don't know about consciousness and the brain. It reinforces the clinical teaching I received to treat every clinically comatose and vegetative person as if they might be covertly aware. Our bedside examination procedures and these new high-tech tests are highly specific for consciousness but also very insensitive and nonconcordant.

Philosophically and conceptually, there's important work to be done to design more sensitive and less stringent indicators of awareness, and to think more about the balance to strike between false positive and false negative findings in tests for these patients.

#bioethics #neuroethics

Two recent #podcast episodes to share on clinical topics in #neuroethics from our group:

First, Colin Hoy being interviewed for the #Neurology podcast about ethical considerations around the diagnosis of prodromal #Parkinsons disease: https://directory.libsyn.com/episode/index/id/32449797

(This is a companion to an article Colin and I wrote for Neurology: https://doi.org/10.1212/WNL.0000000000209522)

Second, a fun conversation for the GeriPal (geriatrics and palliative care) podcast with Sean Aas on philosophical and conceptual problems with #BrainDeath : https://geripal.org/what-is-death-winston-chiong-and-sean-aas/

Congrats to Emily Liu presenting a Scholar Spotlight at the opening of the 2024 NIH #BRAINconference! Patient experiences of resection versus responsive neurostimulation for medically refractory epilepsy. More details at her poster session tomorrow morning in session 3, hope to see people there!

Also, I've been so energized by the conversations I've been having with #neuroethics scholars at this meeting, particularly with a junior cohort of emerging scholars (like Emily and our own Narayan Sankaran and Colin Hoy). So exciting to see the new directions that neuroethics scholarship is taking, with a particular focus on topics of community engagement and broadening our conceptions of science/neuroscience.

Decision Lab reunion! #sfgiants

Mood #chihuahua #corgi

“If it came from a plant, eat it; if it was made in a plant, don't.”
https://med-mastodon.com/@bicmay/112492637135273237

In lab meeting today we discussed the challenges of assessing and measuring elder financial abuse, and I got a chance to mention this beautifully reported and sad story from last year about deep conflicts between caregivers about the validity of preferences in dementia. (Also worth noting that, while allegations of financial abuse were raised in both directions, in the end the woman's savings were depleted and the only people enriched were the lawyers...) https://www.nytimes.com/2023/05/09/magazine/dementia-mother.html

Wow! Coming home very energized after a great International #Neuroethics Society meeting; I’ve attended many and this was the most engaging. Truly international, cutting-edge and transdisciplinary perspectives on urgent topics such as neuroenhancement regulation, community engagement, “#neurorights,” and the brain disease model of chronic pain. https://www.neuroethicssociety.org/2024-annual-meeting-schedule