00:15:21.220anyway it's the issue that is is that aside from that very logical thing of like we need to have a
00:15:27.040talk about this the organ transplantation issue was prominent and explicit in this report and and
00:15:32.620it's not the first thing to discuss i know i know i know anyway the downstream consequences of this
00:15:39.240meant that under prevailing medical and legal standards in the u.s a properly determined brain
00:15:44.600dead patient is dead like legally they're dead despite a ventilator maintained heartbeat warm
00:15:51.080skin and circulation. It's treated as death and not a prognosis or a consent to withdraw care.
00:15:59.100So it's kind of different from other seemingly similar situations. And anyway, let's talk about
00:16:07.560how brain dead patients are treated differently if they're organ donors, because this is what
00:16:12.640really, really got me. Because part of me is like, okay, I get it, right? And in a lot of cases,
00:16:17.620people who are declared i have to clarify for people when she made me put that organ donor
00:16:21.800thing on my card she was still a progressive okay this was before oh thanks for yeah you converted
00:16:28.260and woke up to the world is lying yeah guys this was before simone it was the before simone
00:16:34.920i feel so bad we just live in a society that lies about everything and like yes this is back when i
00:16:42.120i don't know have more trust in institutions i guess yeah i well that's a problem institutions
00:16:47.980are pretty evil things yeah yes i anyway uh right so if you are declared brain dead doesn't matter
00:16:59.460if they got it right i guess you know like sometimes they get it wrong as we know from
00:17:03.500recent cases but if they declare you brain dead are you going to get paralytics yes you're going
00:17:10.720to get paralytics. They're also referred to as neuromuscular blocking drugs. According to one
00:17:15.640bit of research, I looked at this, everything's linked in the show notes about 90% of the time
00:17:20.440they're using paralytics. Maybe they didn't use them with this one guy, you know, who is like
00:17:25.260crying and like, Oh yeah. Because they don't like to deal with that when they're killing somebody,
00:17:30.720you know, it's, it's unpleasant. So, okay. Paralytics are used. Are our patients medicated
00:17:38.820for pain? No. Are pain meds sometimes used? Yeah. So one review that looked at one center's cases
00:17:46.700found that about one third of brain dead donors received an opioid, most often fentanyl, and around
00:17:53.32063 received an inhaled anesthetic such as savoflurane or isoflurane, and about 90% received
00:18:01.800a neuromuscular blocker. But is this to medicate for pain? And would it actually reduce pain? No,
00:18:09.120the medication is actually just standard procedure for organ preservation and to suppress spinal
00:18:15.720reflexes and stabilize physiology. They're not necessarily enough to prevent pain. And there are
00:18:22.780no universally binding national or international interoperative anesthesia guidelines for brain
00:18:28.100dead donor recovery. So they're just going to use whatever they think is appropriate to make
00:18:35.180the body not move and to keep the organs functioning. But if, I don't know, if the
00:18:42.720paralyzed patient is not thrashing and the organs seem okay, they're probably going to save on their
00:18:48.860pain medication budget. So I'd not heard about the Lazarus reflex or Lazarus sign. Have you heard of
00:18:57.060that before i had not but it sounds like just an excuse for murdering people i know it's like it's
00:19:02.880the it's like something you know when they they throw the lobster in the in the pot of boiling
00:19:07.900water and they're like oh it's just a natural reaction that yeah it's a yeah it's not it
00:19:14.920doesn't hurt or any like oh my god anyway the lazarus sign is a pattern of movement sometimes
00:19:21.180observed in people declared brain dead who remain on a ventilator this person may flex both arms and
00:19:27.680elbows raise their arms upward bring their hands toward their neck chin or chest or endo endotracheal
00:19:35.140take sorry endotracheal tube or they'll cross their arms over their chest or occasionally
00:19:41.200lift or arch their upper body yeah one of the really common parts of the Lazarus effect is
00:19:46.980when they start screaming i'm still alive don't kill me please don't kill me i have a family
00:19:52.720that's one of the most common of the symptoms that they have yeah so it's a reaction that
00:20:00.360bodies have when they get scared well yeah the standard explanation is that the movement is
00:20:05.820generated by neural circuits in the spinal cord and below the brain stem without input from the
00:20:12.260cerebral cortex or brainstem that there's no sound basis to describe it as a conscious defensive act
00:20:19.140if the brain death diagnosis was correctly made but that is if the diagnosis was correctly made
00:20:25.740and also like if it's a real thing other than a diagnosis that they make to get organs and here's
00:20:31.840the thing about pain there doesn't really seem to be a scientific way to measure pain
00:20:37.680science like doctors don't have a way to know if a patient there's the what what scale the
00:20:43.060scopol scale where they measure pain from like insects bites and they there is a scientific way
00:20:50.040to measure pain but there might not be a scientific measure pain in a person using an mri or something
00:20:55.700subjectively like oh wait how does the bug thing work okay i'll look it up because i go into a
00:21:03.440doctor's office and they're like, what level of pain do you have? One through 10. But then if they
00:21:08.360think you're like trying to get opioids or something, they're like, I don't know about you.
00:21:14.120And I, yeah, I mean, like, I know, I know people who have dealt with chronic pain
00:21:19.120throughout their lives. And yes, it's called the Scoville system. Okay. Tell me how this works.
00:21:24.380It's a Schmidt sting pain index created by entomologist, Dr. Justin O. Schmidt.
00:21:30.480it ranks that is an autism if i've ever seen one stings from ants bees and wafts on a numeric scale
00:21:37.420much like the scobell scale ranks the heat of chili how it works one to four rating the scale
00:21:42.580runs from zero completely harmless or ineffective against human skin of the four excruciating
00:21:47.560incapacitating pain each whole number step up is roughly tenfold more painful than the next level
00:21:52.980firsthand testing schmidt cataloged the data by intentionally allowing himself to be stung by0.84
00:21:58.740more than 80 species of insects right but no that's just giving that's that's like a a spiciness
00:22:04.560meter it's the number of chilies on your menu that's not allowing a doctor to objectively be0.64
00:22:09.600able to tell if a body in front of him is is in pain or not i mean like maybe they're screaming
00:22:17.060and writhing but like you don't know if that's acting or if that is real as as as a third party
00:22:23.040there's no way looking at some of these insects they can really do a number on you okay anyway
00:22:28.480sorry i need to get demiked can can we pause for a second right if the diagnosis was correctly made
00:22:34.480oh anyway so the way that like doctors put the the lazarus sign they're like well i mean you know
00:22:44.120because the the arms appeared to reach toward the face or two people sometimes describe it as trying
00:22:50.980to pull out the tube or sitting up or fighting the surgeon which can be deeply unsettling to see
00:22:59.200and it deserves a clear explanation before family members witness withdrawal of ventilation or donor
00:23:04.700surgery but that sounds awful dystopian and kind of like we need an explanation for these that is
00:23:12.580the most dystopian and this is all coming in the context of i understand that organ donation saves
00:23:18.620lives. And I know that's where I feel. We need a better system for doing it than this.
00:23:23.780Or at least to be like, look, because I think, you know, there's a lot of people who are like,
00:23:28.660if I'm damaged goods, I don't, don't bring me back. Like I lived a full life. I'd love to do
00:23:33.000some good if, you know, I don't want to live the rest of my life severely disabled. Cause that's,1.00
00:23:37.560I mean, that is often what happens to, to people who are declared brain dead after. So, you know,
00:23:43.700And it is true that many, many patients who are declared brain dead don't make it, even if they last for a really long time.
00:23:50.940So the paper I actually referenced when looking up the Lazarus effect, there's this academic paper that specifically reported on two brain dead patients who survived for over 100 days after being declared brain dead.
00:24:03.740They note in the abstract of that paper that while typically someone who is declared brain dead dies of some form of like cardiac arrest or like they just their heart fails after a week.
00:24:15.180One was like they survived for like 117 days and the other one survived for longer.
00:24:20.840And both had showed these Lazarus signs during that process.
00:24:26.100And the paper does also note that organ donation was recommended to both families, but both families refused.
00:24:32.760so I mean good on them but also like that there is that conflict of these
00:24:38.340very often people who do get this bad don't survive but then we have that like like you said
00:24:47.760like you've heard of people in the medical profession who are like yeah sometimes we just
00:24:51.740won't really bother to do this all the right way we're not really properly diagnosing we're kind
00:24:55.920of triaging a situation and it's just easier for someone to be brain dead than for us to have to
00:25:00.640work on them a whole lot more when you know i could say i mean i think that my take would be
00:25:04.900we just need a lot more research into how to tell if somebody actually isn't going to come back
00:25:09.920and that is just not something that there's a lot of motivation for right now yeah yeah because the
00:25:15.960the money is in favor of funneling toward organ donation anyway also she'd mentioned the apnea
00:25:22.440test so we'll take a look at that in the apnea test what clinicians do basically is if someone
00:25:27.420if you're on oxygen support, they, they will get you to a hundred percent in, in like your blood
00:25:33.300oxygen. And then they'll just turn it off. And what they're trying to see is within this 10
00:25:39.620minute window, if when your oxygen concentration goes down, whether you will take a voluntary
00:25:47.620breath. And what my friend had said was like, well, that, you know, like they use this as part
00:25:55.200of maybe a classification for someone is brain dead, but if someone is extremely sedated or on
00:26:01.840a bunch of other meds, look, they're probably not going to breathe on their own. Like any sedated
00:26:07.800person is brain dead for them. Like they're just like, anyone you took to a hospital and put in
00:26:12.520that situation would be in that situation. So I look it up because when, when, when I first looked
00:26:18.880around, it was like, well, that would never happen because current us guidelines specifically
00:26:23.020require that sedative effects and pharmacologic paralysis should be excluded and not present
00:26:28.680before the test can support a brain death determination. But then I was like, well, okay,
00:26:36.000these guidelines are not enforced. We actually can't know with certainty that every U.S. hospital
00:26:41.600or even every clinician in every case follows these 2023 guidelines around this test exactly.
00:26:48.520The guideline is a national professional standard. It's supposed to improve consistency. It's not a law. It's not like a hospital policy. And so there's nothing technically in most cases that there may be states where there actually are hard laws about this. Not that I found while I was researching this though, that say like you have to like make sure everything's completely out of the system before you run this test.
00:27:13.720however there doesn't seem to be a whole lot stopping people let's go to the the mentions of
00:27:20.040of like i mean one of the things to remember here is hospitals are systems yes and there is a huge
00:27:27.100incentive for these people to die and in addition to that huge incentive there's a huge incentive
00:27:32.120for them to not realize or not take moral culpability if they've been making a mistake
00:27:36.640here and on top of all that there is a huge financial incentive because you're not going to
00:27:43.040get another job easily if you if you whistleblow on this and then on top of all that they believe
00:27:49.440that they're probably doing the right thing because they're saving more lives than they're
00:27:53.380taking yeah and i mean these are again like these are cases where it's like look their odds of
00:27:57.600surviving are so low and these are also often probably clinicians who are like i know this kid
00:28:03.380who needs a kidney so bad you know this this this and they've gotten to know them probably over time
00:28:09.100I bet you know if they're just in hospitals so like you know this kid they've been on the list
00:28:13.600like they could die they're so sweet you have a relationship with them and then here comes in0.98
00:28:18.060this stranger who had a drug overdose and you're like who's this you know like jerk you know like0.97
00:28:23.800what they're like you know someone comes in and like you know they're in their 30s and they're0.98
00:28:27.260a parent or whatever but they just had a car accident well they're probably dead and it's
00:28:30.800really busy and who knows if we could even save them now so it's just better to declare them0.97
00:28:34.320brain dead, blah, blah, blah. So I get it. Like it is, it is an ethically fraught situation,0.99
00:28:39.200but from a personal standpoint, like, Whoa, anyway, it's not just about what like this,
00:28:46.020this moment of triage. It's also about what happens to these live bodies. And that's kind
00:28:50.880of where I have the problem with it. I'm like, okay, it's one thing for like a doctor to be
00:28:54.780like, all right, Simone, she looks pretty wasted. Like she got really messed up in that car accident1.00
00:28:58.780or whatever, like, let's just declare this an organ donation situation. Look, if you're going
00:29:04.540to do that, if you're going to harvest my organs, I want to be like, I want the pain meds. I want
00:29:10.500the pain meds that are going to work. Okay. Like I, I, and, and also I didn't know that, that a lot
00:29:16.440of other things can happen. So yes, there, there have been studies in which genetically modified
00:29:22.300pig kidneys were connected to or transplanted into brain dead research patients there you can
00:29:29.940see i i'll link to it in the show notes this this study human brain dead recipient model in solid
00:29:35.260organ xenotransplantation a scoping review of technical and ethical issues the chances of a
00:29:41.060tomato very low i saw that there was going to be a little bit of rain around 3 p.m and then clear
00:29:45.480for the rest of the evening so you're all set buddy i've got to finish this up and then i'm
00:29:49.860gonna go cut your hair okay okay i love you buddy go go do some chess strategy learning or watch
00:29:56.340something else educational or do lessons even better okay okay i love you buddy i don't love
00:30:05.920you so freaking much you you be good he's he's doing his his normal his normal thing oh he's
00:30:14.360gone now okay close the door please door okay whatever i don't care um where were we right0.97
00:30:27.360so anyway you can see that study and it's all about pig kidneys on organ donors also trainees0.83
00:30:33.900can absolutely participate god imagine a muslim gets that i can see why the muslim man was so0.85
00:30:39.460freaked out yeah no kidding i think it had to do more with burial but you're right that the the0.96
00:30:45.160pig kidney for muslims they need their body intact remember our episode on the muslim afterlife0.88
00:30:49.380oh that's it yeah so it was about that but yeah anyway the the pig kidney thing would just add1.00
00:30:54.880insult one of our best videos by the way i strongly recommend it it's a good one it's1.00
00:30:58.220it's a very good one it's crazy what muslims believe about the afterlife1.00
00:31:02.680yeah and then even the additional things we learned in the comments like well and you can1.00
00:31:07.740see their shins through their legs and their eyes or anyway okay back to brain dead she's talking0.99
00:31:16.620about the sex slaves they all get in the afterlife the virginal companions if you haven't seen that0.99
00:31:23.820one for a bit of a teaser i would get at least one extra wife all muslims get at least one extra0.99
00:31:30.440wife yeah yes this is true i mean you would get more you've been so great so i'd have to i'd have0.87
00:31:37.040to compete, but I wouldn't feel bad about it because that would happen to me if I make it
00:31:41.720to heaven, though probably not because Mohammed saw more women in the fire. And I clearly have
00:31:46.580done wrong by you telling you to go on the organ donation registry. Oh my God. So I guess I'm
00:31:52.980going to burn in the fire. Thanks, Malcolm. Fantastic. Anyway. Yeah. So it's not just that
00:31:59.340you may get some kind of weird experimentation. It's also that the trainees might operate on you
00:32:03.960because they're like oh what are we you know who cares if you flub something a little bit you know
00:32:09.560just do the practice operation on the brain dead patient but then things like actual whole body
00:32:15.180donation for anatomy teaching or dissection and in some forms of practice surgery apparently you
00:32:21.180need to like sign up extra for that i'm not really sure how that works i don't know i mean you got
00:32:28.240brains from people for things yeah schizophrenic people presumably those schizophrenic people and
00:32:34.540none of them were brain dead they were dead i know but presumably they said you can have my brain
00:32:41.240correct presumably i don't know a lot of them were sort of like words of the state
00:32:48.060so you were just part of this system that was like i don't know where this i don't care about
00:32:54.420taking i'm just here to pick up the brain i think it's quite different to take body parts from a
00:33:00.180dead person yes this is taking body parts from no 100 yeah yeah yeah yeah no that's true that's
00:33:06.220true i mean i prefer to be turned into diamonds so i want all of that carbon so that all of my
00:33:12.360children can wear a bit of dead mommy but you do you we really need to buy a diamond compression
00:33:18.440machine because they're just individually so expensive this is what you're gonna have to
00:33:23.420use my life insurance to buy and you're going to be very angry the diamond machine and then
00:33:27.280i'll sell them we'll make it a techno puritan thing oh my god yes you could sell them so it'll
00:33:32.100have an roi buy a piece of buy a piece of history it'll be great no for other people you make it
00:33:39.100like right right right right yeah never mind yeah so yeah you could just keep mine for the family
00:33:43.760jewels that come on how cool would that be if the family you're like on alibaba buy a machine for
00:33:51.460turning dead bodies into diamonds i found some they look legit and i mean it's such a big industry
00:33:56.920now i don't think there's it's an industry i'd have fun working in if i'm going to be honest
00:34:02.400i don't want dead bodies showing up at the house they're not they're ashes they're not going to
00:34:07.720give you the thing the the meat part they give you the burnt part and we had my mom's ashes
00:34:16.760sitting in our house for the longest time before you found the perfect tree and it was very
00:34:20.340thoughtful of you thank you the tree's doing really well by the way i know you're the best
00:34:24.180you really are the best anyway think about it malcolm okay think about it i'll think about it
00:34:32.220right we're burning me i'll do a go fund me when you die oh you're not even gonna use the life
00:34:37.380well i guess you probably are not allowed to you no i the life insurance i'm gonna use that on the0.99
00:34:41.700kids you crazy no that's true then never mind you're right what was it yeah no honestly like0.93
00:34:46.420that the only reason I don't want to die is because I need to take care of you and I need0.96
00:34:50.920to take care of the kids. And that is why. Life insurance isn't a windfall. I've got a date.
00:34:56.780Oh, great. Right. Of course. Anyway, moving on, let's get to the business of organ harvesting.
00:35:04.320And I think this is where it sort of is like, like a lot of this could just be well-intentioned
00:35:09.060people trying to do their best. It gets a little messy sometimes. It becomes a problem when there's
00:35:14.920a systematic need for organs. So just to set the scene, broad hospital operating margins
00:35:24.960are really thin. This organization called KFF, which is linked in the show notes,
00:35:30.220reported a national average hospital operating margin of 5.2% in 2023. And then more recent
00:35:37.040nonprofit system reporting found a median 1.5% operating margin in 2024. And in that environment,
00:35:45.340managers are going to care about every reimbursable activity. And even if it's not a central profit
00:35:52.520driver, an organ donation isn't for hospitals. It's, you know, it's the flashy like outpatient
00:35:58.220stuff, hip replacements, et cetera, whatever, right? Like the kind of routine, easy stuff that
00:36:02.680they can just kind of make a lot of money on and they can just run people through.
00:36:06.960But organ donation is one of those things where you can kind of turn a situation that
00:36:11.740would possibly even be a negative into a positive.
00:36:16.000And so there isn't any single trustworthy national figure for hospital profit per donor
00:36:22.100because hospitals don't separate out organ donation as like a line item in their financials,
00:36:30.380But Medicare reported roughly $3.3 billion in claimed organ acquisition costs in 2016 and reimbursed around $1.6 billion, that is to say 48% as its share.
00:36:43.900And a more recent policy discussion reports that basically 2024 data in which non-renal organ revenue exceeded non-renal acquisition costs by $100 million, which shows some kind of system-level possibility of over-recovery in a specific reimbursement category.
00:37:02.500And I don't know why they're separating out renal and non-renal organs.
00:37:08.480There are financial incentives, especially when the margins are that thin, and that makes me worried.
00:37:15.020So it's clear that basically any large transplant center with substantial Medicare organ acquisition activity is going to receive a very meaningful reimbursement through its Medicare cost report.
00:37:27.200And if you have a high performing donor hospital, it could really improve not just its own economics, but then this economics of this whole affiliated organ transplant organization ecosystem, which could be putting pressure on doctors.
00:37:43.480I found one 2019 conference abstract using fiscal year 2016 Medicare cost report data that estimated that each organ procured for one of those organizing operations increased average Medicare organ acquisition reimbursement by roughly $10,918 per kidney, $11,291 per liver, $11,371 per heart,
00:38:10.7409,294 per lung. And if you add all those things up, like one human that has a decent kidney,
00:38:20.700liver, two lungs, and a heart, that's a decent amount of money. Anyway, for the standard
00:38:29.020transplant programs, the estimated average annual increase in Medicare reimbursement attributable
00:38:33.840to procurement was approximately 460, sorry, 456,000 for kidneys, 593,000 for liver programs,
00:38:44.120383 for heart, et cetera. Anyway, these are reimbursements. They're not the net profits,
00:38:49.160but also like, I don't know how much in terms of incremental costs you have for things like
00:38:56.880organ extraction at a hospital. I mean, presumably you have like your doctor's
00:39:03.840who are on call, like you're paying your, your salaried staff to do this stuff. And I would
00:39:09.940probably, if I were the hospital, have a brain dead patient scheduled for organ transplantation,
00:39:15.100like I would just fit them in to unscheduled spots. Right. And then like slow times,
00:39:22.240cause you can just kind of keep them alive as long as you want, like within at least a week
00:39:26.140before they're very likely to die. And then you just slot them in. So I don't think the marginal
00:39:31.400cost of processing people for organ transplantation costs hospitals incrementally that
00:39:37.480much more. So as far as I'm aware, as far as I can figure, it's just upside. Anyway.
00:39:45.680Isn't that great? Every day you get potential organs coming through your door.
00:39:51.580I mean, if I were a hospital administrator, I would have a difficult time seeing it as anything
00:39:55.480other than that. Wouldn't you? If you're that concerned, if you're running at a 1.5% margin,
00:40:00.640oh absolutely that's so thin I mean you are definitely chewing people out for not I want
00:40:06.400some of the spicy popcorn friend why do you smell like barbecue buddy eating chips why am I going
00:40:14.280to give you more junk food if you're just already eating junk food friend I'm going to be down in
00:40:19.100about 10 minutes can you give me time until then please I love you and off he goes anyway we need
00:40:27.400to get you off the organ donor registry we need to get me off the organ donor registry and i'm just1.00
00:40:32.040gonna i'm gonna go through first a scary case of the the muslim convert and then we're gonna talk0.99
00:40:37.820about how to do it so this was actually in 2026 this is a man in new jersey named keith lott he
00:40:45.240he previously registered as a donor through his new jersey driver's license just like we all do
00:40:50.540for those of who are outside the u.s when you get a driver's license in the united states
00:40:55.540They ask you on your little form, would you like to be an organ donor? And on your driver's
00:41:01.980license, if you are an organ donor, you have a little heart, a little cute red heart. And if
00:41:07.340you see someone's license that doesn't have a little red heart, you just know that they're a1.00
00:41:12.060jerk, a selfish jerk who doesn't want to save that poor Jimmy, who just like you said to me,1.00
00:41:18.460there's a lot, there is like, there's genuine social pressure around it. Like if someone's1.00
00:41:23.640looking at your driver's license and they you know believe in helping kidney heart transplant
00:41:30.180whatever like vulnerable people get the organs they desperately need they're gonna judge and
00:41:36.520also keep in mind the effective ultras community is pretty famous for donating kidneys like going
00:41:43.180out of their way to give organs of course they're all going to register as organ donors i mean i
00:41:47.840think what we should do is make it legal for living people to donate organs for money for no
00:41:52.680like actually i i think that that's super important i i wish that that were the case
00:41:56.840because it would make things i think in many ways more ethical you could make constraints for it
00:42:02.400look you can set you know if this person is impoverished then they can't or whatever i don't
00:42:07.680care but like make it sell your organs if you reach a certain state of health oh like if you're
00:42:14.740not healthy enough you can't sell them did you set off a mousetrap no not at all you had a call
00:42:21.360before oh i did yeah it looks like spam what's spam what spam spam means it's a random person
00:42:30.220that really didn't want to reach me they were just trying to sell me something it's like a scam
00:42:33.460okay hey thanks for helping yeah you're welcome i thought it was someone important
00:42:41.320oh we'll be done super soon octavian okay okay oh good lord anyway so after he converted to islam
00:42:53.620and did not reselect his donor option in 2025 he finds himself very tragically on life support
00:43:03.440and representatives connected to the donation process told his family that his earlier
00:43:09.220registration was a lifetime contract and reporting of this case and nobody told me that when i ticked
00:43:16.380a freaking box and did you know that the main thing that effective altruists have talked about
00:43:21.680when i've talked to them in their meetings is making it the default when you sign up yes yeah0.95
00:43:26.060yeah yeah yeah and if they're gonna treat it as a lifetime contract and it's the default option on
00:43:31.120a long standardized form that is wildly unethical that just makes me hate these organizations so
00:43:37.880Hold on, hold on. There actually is no legal basis in New Jersey law for the claim that
00:43:42.680a donor registration cannot be revoked during the donor's lifetime.
00:43:47.120Oh, in New Jersey law? What about Pennsylvania? What about any other state?
00:43:50.700I know, I know. We all have to look this up. But allegedly, the New Jersey Sharing Network
00:43:55.120reportedly said that it accesses Motor Vehicle Commission donor status information in real time
00:44:01.000to verify the most current status. But what appears to have happened is the organ procurement
00:44:07.720organization was using outdated records and then just lying about them. This whole lifetime,
00:44:13.580they just made that up. They're like, look, his name's on the list. We're taking his organs.
00:44:18.600And so his family had to seek court intervention in this very time sensitive conflict in order to
00:44:28.120stop the process. So another element of this that concerns me isn't just like, oh, is the person
00:44:35.580actually brain dead? Did you actually get the diagnosis right? It's also, did this person
00:44:41.120actually consent to this? Like, are you, are you even checking up to date records? What if they
00:44:45.200changed their mind because they saw this episode? I don't know, but what you need to do, if you want
00:44:51.280to change it is first, if you're in the United States, go to your DMV state website. Are you
00:44:59.420going to book time for this? Are you going to handle this? I am going to handle this for you,
00:45:03.940Malcolm. Yes. I obviously got you in this problem. I'm going to get us out of it, but you, you have
00:45:08.860to first make sure your license doesn't have that designation. And then you need to make sure that
00:45:13.280when you change the designation that you print and keep the receipt, then you need to make sure
00:45:18.660that your friends and family know that you're not an organ donor. So you have to very openly broadcast
00:45:24.580and they're going to criticize you and you're going to have to push through and just send them
00:45:29.340a link to the show notes that we have on patreon or subs well though our family know because our
00:45:33.920fans know okay okay fine but who's gonna be at the hospital we're gonna be telling my brother about
00:45:40.420this i'm sure yeah yeah i was gonna say i'm sure he's not but he probably would have said yeah i'll
00:45:47.580do it you know because he's such a nice person too and like oh god anyway make sure that the
00:45:54.040people who are gonna show up at the hospital if something bad happens to you know that you're
00:45:58.240super not cool with it. And then a very strong practical measure on top of that is to add a
00:46:04.120direct statement to your advanced directive or healthcare power of attorney. That's something
00:46:09.260like, and I have this written down in the show notes. I revoke any prior anatomical gift organ
00:46:14.980donor registration, tissue donor registration. I don't know donor registration, whole body donation
00:46:21.020and authorization for post-mortem research and education. I do not authorize the recovery
00:46:26.480donation, transplantation, therapy, research, education, training, or other use of my organs,
00:46:30.900tissues, eyes, or body after death. My healthcare agent and family are directed to communicate
00:46:35.780and enforce these wishes. So I don't know, consult a lawyer. This is not legal advice, but
00:46:41.120don't show up to stuff without documented, not for no taking, no touch. I would,
00:46:52.280i would appreciate if you all did that but then of course i feel conflicted because like
00:46:58.280if you're actually done those you know if you want to give your organs i i feel so but also i i i
00:47:05.800don't want to i don't want to be brain dead but also maybe not brain dead and maybe feeling all
00:47:10.520the pain as they harvest my organs so i don't know where are you with all this i mean i think
00:47:16.360this is horrifying i can't believe that you this whole lazarus effect thing the way that they
00:47:21.800worded I'm sure it's in part a real effect I'm sure something they say to sleep at night you
00:47:29.200know I'm sure yes both I mean well so here's like where I have a problem with it they're like I mean
00:47:34.840it's impulses in your spinal cord and I'm like yeah but it's also like maybe this is due to my
00:47:40.400very poor understanding of biology but it's you know like impulses in my spinal cord etc that
00:47:46.040like cause me to feel things yeah impulses that is true that is how your entire nervous system
00:47:52.060works is impulses in your spinal cord yeah you know that's being like oh it's just your pain
00:47:56.380receptors firing like don't worry about it and how complicated the motion is and i'm sure there
00:48:01.580are some simple you know like you cut a snake in half and the bottom half is still writhing right
00:48:07.640like simple actions that are just happening because the spinal cord but a lot of it doesn't
00:48:13.440sound like that a lot of it sounds like they understand that that like we're doing something
00:48:20.760we just don't care like that's what i'm getting from this i'm glad you brought this up i'm glad
00:48:24.660we did an episode on this i'm glad my friend told me about it early in the morning so guys
00:48:31.020please please please check out rfab.ai it is our ai website i really want to share this with you
00:48:38.620guys was the world and accused it is the best ai chatbot site in terms of allowing you to use
00:48:43.560frontier multi-window models which is just in terms of technology if you compare it to something
00:48:49.020like janitor ai or the chat gpt or you know i've actually like an important note i've heard a lot
00:48:57.080of companies advertising like oh well you just need one place where you can switch between you
00:49:04.020know one thing and the other instead of paying for all the subscriptions separately this is much
00:49:08.300more affordable the problem with them is that they are in this case for-profit companies that
00:49:15.860are not run by people who are just really nerdy about them and they need to make money and like
00:49:19.420i guess we really do need to make money we're just very bad at it and so you you charge much
00:49:24.080less of a margin right the industry standard is four was three to five x is the industry standard
00:49:30.280are you serious 50 yeah right so we are charging like in terms like oh sorry we don't even always
00:49:36.140charge at 50 percent if something is a stable price and large like video production because
00:49:40.960that's very costly we charge half that sometimes i feel like we'd be operating on hospital margins
00:49:46.120my friend i mean especially when you add in like the the vibe quitting expense we're operating on
00:49:50.780what much worse than hospital margins right now we're operating on negative margins but we'll be
00:49:54.280extremely negative margins but i would say from that perspective like if you remember the days
00:49:59.920of like startups offering extremely inexpensive but high quality services because they were
00:50:07.020basically subsidized by vc money we're the equivalent of that except we're subsidized by like
00:50:12.820malcolm's intensely laborious volunteer labor and our i don't know pathological inability to
00:50:22.700well a lot of people will be like why are you more expensive than my other site and it's like
01:00:35.140No, I'm like legit, really excited about what you built with this because someone actually
01:00:40.500just today emailed us about some Chrome plugin that he created after you were like, Simone,
01:00:45.240you can't keep saying this word or that word, you know, because I was reading the Andrew
01:00:49.780Tate article quotes that I was, you know, from the, from that episode on Andrew Tate.
01:00:54.200And he was like, well, I built a Chrome plugin, which is actually quite clever.
01:00:57.520That takes all the naughty to YouTube words and we'll just switch them to acceptable words
01:01:02.040just in your browser so that you don't accidentally read the wrong thing which is
01:01:06.680somewhat clever for like all the youtubers who are trying to self-censor but you
01:01:10.180like i created a beep with an indian head pattern that happens with our editing system yeah where
01:01:16.320you could just take every single word that is naughty and just replace it immediately with
01:01:20.960censorship which which i think is funnier i think it's funnier too i think that there was this period
01:01:25.980in the 90s when shows just had abundant beeps in them and they were like better than actual bad
01:01:32.360words and i think for a while then sitcoms and other comedies well you know what show is famous
01:01:36.960for adding random beeps yeah like when it's not the real word right yeah you know what show
01:01:43.060a bunch of them did it right which one is famous for it there's a show that's famous for doing it
01:01:49.160because the family didn't cuss and they wanted to make them look more like redneck okay who what
01:01:55.260duck dynasty duck are you serious yeah the real duck dynasty family never curses and so what they
01:02:01.040would do is they would add beefs to make it look like they were cursing up the storm all the time
01:02:05.200okay that's that's actually pretty amazing why would they do that because they're progressives
01:02:11.900who have an incredibly bigoted view of conservatives oh so they thought they0.55
01:02:15.660weren't rednecky enough if they didn't have potty mouths yeah and normal conservatives0.60
01:02:22.080are like christians and so they're like no why would i curse i'm not gonna be inappropriate right0.79
01:02:26.780wow okay but they needed to dehumanize them so you know you can't you can't have people think
01:02:31.340oh maybe conservatives aren't you know that's really crazy that is genuinely okay it's wild
01:02:36.380how long this has been going on but let's let's get into this simone yeah you found a fun topic
01:02:40.580for me yeah separate for like not just so there are two ways that i can introduce this i can just
01:02:46.380briefly introduce it or i could just read like slightly edited but the texts that i was sent
01:02:51.520that made me be like what because i was like what and i feel like maybe that would just be a good
01:02:56.360enough introduction i think that is a good introduction and i think you are a very special
01:03:01.920person and this is the first public podcast because somebody's like i'm so glad to see you
01:03:05.880guys bouncing back and i was like i haven't recorded any since then yeah well that was
01:03:09.660from the before times and that's why we were so cheerful and bouncy but anyway okay you can see
01:03:14.580those teary simone eyes right now oh god well you know what we cry for a lot of reasons and there
01:03:20.880were a lot of, anyway. What did you want to show me? A video. We have to make a video. You have to
01:03:29.420make a video. Three, two, one, go. Bogey on it, bogey on it, bogey on it, bogey on it, bogey on it, bogey on it, bogey on it, bogey on it, bogey on it, bogey on it.
01:03:40.480Don't mind me. Stay there. I'm going to come back, okay?