Those who celebrate two birthdays | Massimo Cita | TEDxMantova

Facing death might become a chance to give life back to someone else. In this moving talk, Massimo Cita explains how life's hardest passage can start a new life through organs' donation. “Thanks to donations", he shares on TEDxMantova stage, "someone else's death might mean life, or new vitality for someone else.”

This talk was given at a TEDx event using the TED conference format but independently organized by a local community.

Learn more at http://ted.com/tedx

I decided to start my speech

talking about death.

Since ancient times, life was located
in human heart and the breath.

If the heart beated and you breathed
you were alive, otherwise you weren't.

I think that's the case today
for most of you.

But look,

the modern resuscitation techniques
and the progress of medicine,

which can in part replace
that activity of the heart and breath,

this progress, has shown and taught us

that the death of an individual

is always attributable
to the death of his brain.

This can then happen
due to direct or indirect causes.

For direct causes,
imagine a serious head injury.

For the indirect causes

I need a slightly more complex example,

try to follow me.

Imagine a heart attack

that causes cardiac arrest.

It means that the heart stops pumping,
the blood stops,

no oxygen reaches the tissues.

The health workers arrive, they jump on,
as they say, to the patient,

they practice
the resuscitation techniques,

20, 30, 40, 50 minutes.

Sometimes it is possible
to restart that heart.

But that heart has been
at a standstill for so long

that it has generated such a severe
lack of oxygen in the brain

that it died.

So you see that different causes,

primitive, secondary, direct and indirect,

cause the same effect.

But then, what's
the diagnosis of brain death?

We read it here on the slide:

it is the irreversible cessation
of all the functions of the encephalon,

including the trunk of the brain,

which inevitably generates cardiac arrest.

Regardless of any therapy
or treatment administered.

Firstly, why do I talked about
the trunk of the encephalon?

It is a little-known part of the brain,
which is back here,

and there are the centers
of breath control

and regulation of
the cardio-circulatory system.

What is the meaning of this sentence?

It means that when the brain,

that is the entire content of the skull,

the entire content,
not just a portion of it,

more or less important,

when the entire contents
of the skull dies,

a process which has only one end starts,

that is the cardiac arrest.

In medicine they have an expression,
as precise as rough,

to describe that situation.

A brain-dead patient
is a corpse with a beating heart.

So what's the situation of that patient?

He is in a coma,

unable to breathe,

so he is connected
to an automatic ventilator,

he has a highly inefficient
cardiovascular system.

It means, in a nutshell,

that there is little oxygen
in all the tissues.

The brain is no longer able
to control its own temperature,

the body temperature of that patient

will drop to levels incompatible
with cardiac activity,

around 29, 30 degrees,
this is the temperature level,

and has very serious changes
in the fluid and electrolyte system.

In a nutshell, water exchanges

in the coagulation system
and the hormonal system.

In other words, the brain death,

the control room of our organism,

starts a series of degenerative processes

that will inevitably end

with the organs' disintegration,

including the heart,
which will obviously stop.

And our therapy can only
slow down this process,

it can't stop it, just slow it down.

However, as resuscitators,

when we have a patient in those conditions

we face the most important condition

to be able to proceed
with a possible organ donation.

That is, that patient is
a potential organ donor.

The other indispensable condition
is to obtain the consent for the donation,

that is, the permission
to take those organs,

and we certainly cannot ask him
because he is unable to answer.

Now, I need you to make an effort.

Come with me

to the resuscitation interview room,

where we summon the patient's relatives.

What do we tell them?

We tell those relatives
that their loved one is in brain death.

Therefore, he's dead.

That, shortly, following the law,

I should convene
a board of three specialists

who has the task of assessing
and verifying your diagnosis.

And that once ended that period
of assessment, which lasts six hours,

machines will be turned off,
therapies will be stopped

and then that patient's heart
in a few minutes,

a few minutes, will stop.

For him there is absolutely
nothing left to do.

But he could do something for others.

That is, he could donate the organs.

Have you ever talked about it,
what was his opinion,

did he leave a note?

Do you have any idea about this?

Generally, the first question they ask us,

you might guess,

is: Are you sure? Are you really sure?

The answer is: yes.

And our certainties derive

from the knowledge of
the mechanism of brain death,

from the diagnostic capabilities
to establish and certify that brain death,

and because that diagnosis will be
established and certified and verified

by that board I told you about.

I believe it is important I tell you
the mechanism of brain death,

it is a mechanism related to pressure.

It's pretty simple.

When the brain dies,

inside of the skull, its container,
which is inextensible.

So when the brain dies,
the pressure in there increases.

And the pressure increases

reaching and exceeding
the arterial pressure,

the one generated by the heart pump.

As a result, no more blood reaches there.

And if there is no more blood,
there is no more oxygen either.

That scenario is incompatible with life.

A few words on the assessment,
the board, etc.

Look, the whole process,

diagnosis, assessment
and possible donation of organs,

is strictly regulated by a rigorous law,

which guide us step by step,

it's extremely precise

and extremely extremely
extremely guaranteed,

and in line with international laws.

It's time I told you

that the process of diagnosis, assessment

and possible donation,

that's the process of
diagnosis and assessment

must be done regardless of whether
the person will donate or not.

The aim is, first of all,
to avoid any aggressive treatment.

If the patient won't donate,
they'll turn off the machines.

If instead, he will donate,

they will take the patient to
the operating room to harvest the organs.

A few words about the board.

Who are the members of that board?

Just to give you an example
of how strict that is.

It consists of three specialists
who have different areas of expertise,

they can't be the same doctors
who made the diagnosis,

and not even the ones who will
eventually harvest the organs.

So for the last time
I ask you to come with me,

and this time we go near
the patient's bed,

to see what happens, who's there.

Well, firstly there is
the guard personnel,

doctors, nurses, attendants,

who have the task of keeping
the therapies at an optimal level

throughout the observation period,

the six hour time I told you before.

First of all, to conclude
the observation period.

Second, if the organs will be donated,

to slow down the degenerative processes

of which I told you earlier

and then allow the harvest
of healthy organs

that will be good for a recipient.

Then that group of doctors,
the guard personnel,

is committed to verify

if that patient can donate
his organs or not.

And check which organs he can donate.

And finally, the guard personnel

is constantly in connection
with the coordination centers

that help us, guide us, observe us,

but above all verify

who needs organs and
which organs are needed,

where those patients are located.

They call them, they organize the harvest
and transplant teams.

But then, again, there's the board,
those three doctors

who have the very important task

of verifying and certifying

that everything takes place
according to the law

and of the scientific processes as well.

A multi-organ harvesting

involves around 100, or rather,
150 people including everyone,

radiologists, laboratory technicians,
doctors on call, teams,

couriers, all of them.

You might be wondering

which the organs
and tissues that can be donated are,

we wrote them on this slide.

Well, they are divided
by organs and tissues.

Meanwhile you read it through,

I tell you that some can be harvested
and donated during life.

Such as blood, marrow, bone marrow.

Others only after death:

heart, heart valves, and possibly
corneas, for example.

And now I'll show you this slide here.

This is Sabbioneta,
about 4.000 inhabitants.

It is the number of patients
who got a transplant in 2017,

3.950 to be precise.

I don't know if you consider a town
of 4.000 inhabitants big or small.

What I know is that in 10 years
it became almost as big as Mantua.

And this is Volterra,
a town of 9.000 inhabitants.

9.000 is the number of patients
who were on the waiting list in 2017,

needed a transplant but did not get it.

More than double of the previous one.

But 364 of them, 9.026,

died waiting for a transplant.

One a day.

I mean, a transplant
not only changes your life.

Think of those who need a kidney,

receive it and stop doing dialysis
three times a week.

But on many occasions it saves your life.

And it is no coincidence, in my opinion,
that many transplant recipients

celebrate the transplant day
as a second birthday.

I have no doubt that
this is a sign of awakening life.

I have no doubts.

So I invite you to think about your will

regarding organ and tissues donation.

Whether you are for or against,

I repeat, whether you are
for or against it.

It has to come from inside you.

And at least I invite you
to talk about it with your family.

Because if our family were

in that unfortunate condition
that I briefly explained earlier,

they would not be alone to decide

in that moment of pain, anger, fear.

It is an objectively
difficult situation to understand.

Even better, I invite you

to register your will,
I repeat, whatever it may be,

at the National Registry.

Among other things,

this second opition grants that
your wills will be respected.

And for those interested, it is a gift,

it's very easy to register.

You can find the online website,

everything is explained there:
how, where, when, with whom, why.

So simple.

I try to conclude.

Obviously, I had to summarize,
I think that was clear,

and I hope it's understood that
this matter goes far beyond

mere technical health issues.

It may be obvious, but I have
asked myself the question too.

What would I want

in case of my brain death?

Perhaps my job helped me

to answer this question,

I drew on my knowledge.

But I tell you something,

it was the answer
to a very simple question

that made me decide.

I realized that I came here
to ask you the same question.

The question is:

what can I bring with me
to the other side?

Whatever thing there is.

Stuff, organs that I don't need anymore.

Why not donate them
to someone who really needs them?

It costs me absolutely nothing.

I believe it is right to let each of you
to find your own answer.

Thank you.

(Applause)