The term “organ harvesting,” once a misnomer for organ procurement after organ donation, echoes in the phrase “procedure harvesting,” which could be an inadvertent misnomer for procedure procurement following procedure donation. Who knows if some may even suggest preemptive extracorporeal membrane oxygenation when cardiac arrest seems imminent during an elective non-cardiac procedure? Regardless, while pre-procedure optimization is always a goal for elective procedure procurement—and may even be achievable in emergent cases—the optimized living of the procedure donor may not always be feasible. Therefore, the donor must fully understand the implications before providing informed consent, and the payer must calculate costs carefully to cover even unexpected peri-procedure events. Consequently, optimization solely for the sake of procedure donation and procurement could be considered appropriate.
Proper peri-procedure optimization, coupled with a successfully completed procedure, may ultimately improve the overall health of the procedure donor. While the responsibility for pre-procedure optimization often lies with the patient’s referring physician and consulting proceduralist, the onus of peri-procedure optimization rests with the patient’s anesthesia provider. Thus, the question arises: should the decision to reschedule a procedure due to inadequate pre-procedure optimization or to abort a procedure due to apparent peri-procedure complications be an independent call or a collaborative decision by the patient, proceduralist, and provider?
Interestingly, everyone seems to desire procedures. Patients may prefer procedures over lifestyle modifications; providers might find administering anesthesia easier than canceling it; proceduralists could favor interventional procedures over medical optimization. Revenue generation may be prioritized over litigation mitigation, leading institutions to favor procedures. Insurers might find raising premiums easier than denying authorization, and regulators may prefer appeasing stakeholders over regulating them. Society, too, might favor economic growth over addressing socioeconomic issues, thus fueling the demand for procedures.
In this dynamic, the working class, through taxes and premiums, may bear the burden of everyone’s desire for procedures until they themselves become sick, hindering their ability to contribute to the economy. Essentially, it is crucial to ensure optimization before procedure donation to guarantee peri-procedure optimization during procurement. The hope is that procedure donors can sustain optimized living after donating a procedure to a society in which everyone seems to desire procedures, in a health care system perilously dependent on such procedures to sustain the economy.
Deepak Gupta is an anesthesiologist.
