| Home Go To Quote of the Archive 3 (from 1 July to present) Go to oldest Quote of the Week Archive No 1 (30 April 2002 to 21 April 2003) Quote of the Week Archive 2 28 April 2003 to 1 July 2006 For the week starting 1 July 2006 "Since that time there have been many more challenges to the several concepts of “brain death” and the means of their diagnosis worldwide (vide infra). Indeed, it seems that there is now an emerging consensus that “brain death” diagnosed by any of the protocols in current use worldwide is not death." Dr David Hill and Dr David W Evans in their contribution to the revision of the 1998 Code of Practice for the Diagnosis and Certification of Death in the United Kingdom. Read the Draft for Consultation to which Evans and Hill contributed: html file Read their contribution below: Dr Peter Simpson MD PRCA Convener, Academy of Royal Colleges Working Group revising the Code of Practice for the diagnosis of brain stem death The Royal College of Anaesthetists 48-49 Russell Square London, WC1B 4JY Dear Dr Simpson, A Code of Practice for the Diagnosis of Brain Stem Death - 1998 We understand that your Working Group is charged with revision of the above booklet which was published by the Department of Health in March 1998. The Introduction1 to that booklet was titled “Cadaveric Organs for Transplantation - a Code of Practice Including the Diagnosis of Brain Death”, although the use of the term “brain death” had been discouraged by the 1995 Working Party2 and the Secretary of State for Health wrote3, in 1997, “The terms ‘brain death’ and ‘brain stem death’ can be confusing, and the former should not be used in the context of organ donation”. Since that time there have been many more challenges to the several concepts of “brain death” and the means of their diagnosis worldwide (vide infra). Indeed, it seems that there is now an emerging consensus that “brain death” diagnosed by any of the protocols in current use worldwide is not death. We ask, therefore, that your Working Group gives the most serious consideration to the fundamentals of diagnosing death for transplant purposes with a view, on this occasion, to providing clear advice to the Department of Health on the diagnosis of death and on the content of its transplant-related literature. To that end, we bring the following points to your special notice. 1. In the UK, published challenges to the diagnosis and certification of death on so-called “brain death” grounds date back to 19804,5. Accounts of our efforts6,7 to counter the bad science underpinning that practice can be found in an anthology titled “Beyond Brain Death : the Case Against Brain Based Criteria for Human Death” published in 2000 (Kluwer Academic Publishers, ISBN 1-4020-0366-8). Since then we have maintained our challenge in correspondence with the Department of Health, and with our Members of Parliament, and by means of contributions to journals and to bmj.com8-15. From other parts of the world, there has been increasing criticism of “brain death” and its diagnosis since the Youngner, Arnold and Schapiro anthology16 of 1999. Noteworthy examples include Lock’s (2001) “Twice Dead - Organ Transplants and the Redefinition of Death”17, the 2001 special issue of the Journal of Medicine and Philosophy18, the 2002 critique by Karakatsanis and Tsanakas19, Kerridge et al’s20 (2002) plea for the reinstatement of irreversible loss of circulation as “the major defining characteristic of death”, Truog and Robinson’s (2003) article in Critical Care Medicine21, Machado and Shewmon’s (2004) “Brain Death and Disorders of Consciousness”22, the September 2004 issue of the Kennedy Institute of Ethics Journal23 and a recent contribution24 from nurses involved in critical care. Some of these publications, such as that of Veatch25 - and that by Singer26 earlier - provide revealing insights into the manner in which “brain death” was introduced as a basis for the certification of death. It was clearly not founded on any new and agreed philosophical concept of human death. Nor was it underpinned by sound science6. As Truog and Robinson21 say, “the concept fails to correspond to any coherent biological or philosophical understanding of death”. The present situation was summed up thus in a statement27 to the Pontifical Academy of Sciences “Signs of Death” conference held earlier this month in Rome :- “there is widespread doubt and growing conviction that brain death is not death among some of the finest scientists, philosophers, and theologians and among persons of such different world-views as Peter Singer and Robert Spaemann”. That assessment applies at least equally, of course, to the state of lesser brain incapacitation known as “brain stem death”. In light of the above, there are now calls20, 21, 28 for an end to the “dead donor rule” and all obfuscation in regard to the status of patients diagnosed “brain dead” or “brain stem dead” by means of one or other of the many protocols in use for the purpose worldwide29 . The very number of these speaks to the lack of consensus about diagnostic practice and to the fact that the clinical syndromes so diagnosed cannot be considered one and the same true entity. 2. The claim that the UK Code of Practice suffices for the diagnosis of death of the whole brain - or of death of the brain “as a whole” - has long been abandoned. Protocols which involve similar brain stem testing plus additional “higher brain” testing by electroencephalography, and which purported to establish “whole brain death” (the U.S.A. legal requirement for certification of death), are no longer universally accepted as adequate for that purpose (vide supra). The state referred to in the 1998 Code of Practice as “brain stem death” is clearly a lesser state of brain tissue loss than “brain death”, in both conceptual and clinical terms. It is, therefore, no longer possible to equate the state diagnosed by the Code of Practice procedure with the death of that patient on the 1979 Memorandum30 premise (that all brain function had irreversibly ceased) or, indeed, on any of the philosophical concepts of human death allegedly served by “whole brain death” protocols. If, despite the growing tendency worldwide to abandon all forms of death certification on purely neurological grounds, your Group continues to advise that its “brain stem death” syndrome can be regarded (and certified) as death, then it has a clear duty to specify the precise grounds rather than simply relying upon established practice. The 1995 Working Party 2 “suggested that ‘irreversible loss of the capacity for consciousness, combined with irreversible loss of the capacity to breathe’ should be regarded as the definition of death”. This definition was “recommended” by the 1998 Working Party (Code of Practice, page 4). If this is now to be the premise upon which your Working Group continues to advise that its “brain stem death” syndrome is death, then this must be clearly and unequivocally stated - recognizing that this is an highly idiosyncratic concept of human death, for which there is certainly no general philosophical support. It is also open to the following scientific objections. a) Consciousness is not understood, nor even defined. We have no means of testing for its absence - still less for permanent loss of the capacity for its return in some form under certain conditions. Setting aside the problem of long-term memory stored in normally inaccessible parts of the hippocampus (or elsewhere), it must be said that we do not know what might be termed the minimum neuroanatomical substrate necessary for the arousal of consciousness and cannot, therefore, say with certainty that there is no possibility of its recovery in some form while life remains in any part of the brain. The old idea that the arousal system is confined to the brain stem (however defined) is no longer universally accepted31. Machado32, in pointing out that “brainstem death alone is not brain death”, has postulated that “stimulation of the non-specific thalamic nuclei might produce some degree of arousal”. It is interesting that Pallis33 admitted, as long ago as 1985, that these structures may be alive in patients diagnosed “brain stem dead”. The arousal mechanism (ascending reticular activating system) has been thought of, by some, as more of a metaphor than a discrete anatomical entity. But even when it was believed to be confined to the brain stem there was the difficulty that it cannot be specifically tested. Its permanent loss of function can only be inferred, i.e. when the whole of the brain stem has been shown to be permanently functionless (destroyed). The Code of Practice tests do not have the power to establish that state34. There is no requirement to establish that the medullary cardiovascular centres are permanently out of action. There is no evidence for the assumption that the well-recognised haemodynamic responses to organ harvesting surgery35 are not mediated via the medulla.These and the motor responses to surgery (paradoxically for a cadaver) require some form of anaesthesia36. Lower oesophageal reflexes and evoked responses are not sought6,34,37,38. The spontaneous co-ordinated movements of the Lazarus phenomenon are not adequately explained. It is clearly not safe - even on the simplistic understanding of consciousness which ascribes to the brain stem a quintessential rôle - to assume that patients whose brain stems have not been rigorously tested for signs of remaining life have permanently lost the capacity for consciousness. b) Permanent loss of the capacity to breathe is not established by the Code of Practice apnoea test in current use. While much has been written about the dangers of apnoea testing39,40, which are offically recognized in Japan41, it must be said that it relates, in any case, only to the hypercarbic drive stimulus. The medullary respiratory centre is not subjected to the ultimate anoxic drive stimulus, the power of which may sometimes be seen (agonal gasping) when ventilators are finally disconnected after negative response to the prescribed Code of Practice test if organs are not sought for transplantation. It seems to us, therefore, that it is not reasonable to continue to equate the pre-mortal clinical state “brain stem death”, as diagnosed by the Code of Practice, with death itself - even if death be defined as recommended in the 1998 Code. 3. There are obvious implications for the wording of the Department’s NHS Organ Donor Register forms and for its Donor Cards and other transplant-oriented literature. The concept of “death” to be used for transplant purposes is not explained and may be unknown to, and at variance with, that of the potential donor. The phrase “a patient declared dead following brain stem testing” currently recommended by UK Transplant42 is not equivalent in meaning to “after my death” and will not do as a description of the state donors will be in when operated upon for the removal of their organs. We trust that your Working Group will address this vitally important aspect in the interest of avoiding misinformation of the public, particularly as it becomes more aware of the worldwide concern about the misdiagnosis of death in the perceived interest of the organ transplantation programme. Great sensitivity will be required but, in the long run, that interest is likely to be better served by open-ness and honesty. Yours sincerely, David J. Hill David W. Evans References 1. A Code of Practice for the Diagnosis of Brain Stem Death. Department of Health, March 1998, p.1 2. Criteria for the diagnosis of brain stem death. Working Group convened by the Royal College of Physicians and endorsed by the Conference of Medical Royal Colleges. J Roy Coll Physns of London 1995;29:381-2 3. Milburn A. Personal correspondence with DWE, 7th September 1997 4. Evans DW, Lum LC. Cardiac transplantation. Lancet 1980;1:933-4 5. Evans DW, Lum LC. Brain death. Lancet 1980;2:1022 6. Evans DW. The demise of “brain death” in Britain. In Beyond brain death : the case against brain based criteria for human death 2000. Eds. Potts M, Byrne PA, Nilges RG. Kluwer Academic Publishers, Dordrecht etc. 7. Hill DJ. Brain stem death : a United Kingdom anaesthetist’s view. In Beyond brain death - Ibid 8. Evans DW. Barnard’s first transplants and concepts of death. bmj.com 2001 (Response to Hoffenberg) http://bmj.bmjjournals.com/cgi/eletters/323/7327/1478#18279 - and see also Responses from Coimbra, Hill, Jarvis, Potts and Woodcock to Hoffenberg’s article on this site 9. Evans DW. Open letter to Professor Eelco Wijdicks, author of book on brain death. bmj.com 2002 http://bmj.bmjjournals.com/cgi/eletters/325/7364/598/a#27760 10. Evans DW. Rethinking our criteria for death. Lancet 2002;360:179 11. Evans DW. The demise of brain death : time to tell the truth. Invited editorial for BMJ, as commentary on Truog & Robinson (2003), rejected March 2004 12. Evans DW. Brain death is not death. Commentary on Truog &Robinson (2003) for the Lancet, rejected May 2004 13. Evans DW. What is “brain death”? A British physician’s view. Contribution to Pontifical Academy of Sciences conference “Signs of Death”, Vatican City 3-4 February 2005 14. Hill DJ. Brain death : a United Kingdom anaesthetist’s view. February 2005, Ibid 15. Potts M, Evans DW. Does it matter that organ donors are not dead? Ethical and policy implications. J Med Ethics 2005 (in press) 16. Youngner SJ, Arnold RM, Schapiro R (Eds.). The definition of death - contemporary controversies 1999. Johns Hopkins Press, Baltimore & London 17. Lock M. Twice dead - organ transplants and the reinvention of death 2001. University of California Press, London 18. Lustig BA (Ed.). Revisiting brain death. J Medicine and Philosophy 2001;26 (5) 19. Karakatsanis KG, Tsanakas JN. A critique on the concept of “brain death”. Issues in Law & Medicine 2002;18:127-141 20. Kerridge IH, Saul P, Lowe M, McPhee J, Williams D. Death, dying and donation : organ transplantation and the diagnosis of death. J Med Ethics 2002;28:89-94 21. Truog RD, Robinson WM. Role of brain death and the dead-donor rule in the ethics of organ transplantation. Crit Care Med 2003;31:2391-6 22. Machado C, Shewmon DA (Eds.). Brain death and disorders of consciousness 2004. Kluwer Academic/Plenum Publishers, New York etc. 23. Youngner SJ, Schapiro R, Siminoff LA (Eds.) Death and organ procurement : public beliefs and attitudes. The Kennedy Institute of Ethics Journal (Special issue) September 2004;14 (3) 24. Sundin-Huard D, Fahy K. The problems with the validity of the diagnosis of brain death. Br J Crit Care Nursing 2004;9:64-71 25. Veatch RM. Abandon the dead donor rule or change the definition of death? In Kennedy Inst Ethics J 2004 - Ibid 26. Singer P. Is the sanctity of life ethics terminally ill? In Brain death 1995. Ed. Machado C. Elsevier Science B.V. 27. Seifert J. On ‘brain death’, page 17. Contribution to the Pontifical Academy of Sciences conference on the Signs of Death, Vatican City, 3-4 February 2005 28. Woodcock TE. New act regulating human organ transplantation could facilitate organ donation. BMJ 2002;324:1099 29. Wijdicks EFM. Brain death worldwide : accepted fact but no global consensus on diagnostic criteria. Neurology 2002;58:20-25 30. Conference of Medical Royal Colleges and their Faculties in the UK. Memorandum on the diagnosis of death 1979. BMJ;1:332 31. Jones JG, Vucevic M. Not awake, not asleep, not dead? Int Care Med 1992;18:67-8 32. Machado C. A definition of human death should not be related to organ transplants. J Med Ethics 2003;29:201-2 33. Pallis C. Defining death BMJ 1985;291:666 34. Evans DW, Hill DJ. The brain stems of organ donors are not dead. Catholic Medical Quarterly 1989;40:113-121 35. Wetzel RC et al. Haemodynamic responses in brain dead organ donor patients. Anesthesia and Analgesia 1985;64:125-8 36. Hill DJ, Munglani R, Sapsford D. Haemodynamic responses to surgery in brain dead organ donors. Anaesthesia 1994;49:835-6 37. Facco E, Munari M, Gallo F, Volpin SM, Behr AU, Baratto F, Giron GP. Role of short latency evoked potentials in the diagnosis of brain death. Clinical Neurophysiology 2002;113:1855-66 38. Naquet R. The history of brain death in France. Contribution to Pontifical Academy of Sciences conference, Vatican City 3-4 February 2005 39. Coimbra CG. Implications of ischemic penumbra for the diagnosis of brain death. Braz J Med Biol Res 1999;32:1479-87 40. Coimbra CG. The apnoea test - a bedside lethal “disaster” to avoid a legal “disaster” in the operating room. Contribution to the Pontifical Academy of Sciences conference 2005, Ibid 41. Watanabe Y. Controversies on brain death in Japan … Contribution to the Pontifical Academy of Sciences conference 2005, Ibid 42. UK Transplant Organ Donor Registry Team Leader. Personal correspondence with DJH, 28th January 2005 Edwards SD, Forbes K. Nursing practice & the definition of human death. Nurs Inq 2003;10(4):229-35 - added later by supplementary letter. Read the Draft for Consultation For the week starting 19 June 2006 "One reason for the dearth of information about the donor family experience is that transplantation is often perceived as merely a medical procedure. The outcome of such a perception is that the social, spiritual, ethical and personal dimension of the donor’s family experience with trauma-driven grief are often ignored or are undervalued. The stories of these families do not fit the celebratory tone of transplantation and therefore largely go unheard in a society inebriated by hype and posturing." Catherine Coste in Paris commenting about the book "Wrapped in Mourning: The Gift of Life and Organ Donor Family Trauma" by Sue Holtkamp who reviews the impact of transplanting on families of the deceased donor. http://ethictransplantation.blogspot.com/ For the week starting 12 June 2006 "Treatment" is not oriented toward the patient but toward the goal of preserving organs. Proper comfort care for the dying patient may be omitted because the donor is considered as a repository for organs rather than as a person." from Michael Potts' letter in the British Medical Journal, 13 May 2006. Associate Professor Potts was responding to the Colin C Geddes and R Stuart C Rodger article: Kidneys for transplant: more of them, better allocated BMJ, Apr 2006; doi:10.1136/bmj.38833.785984.47 Read the full letter in the British Medical Journal http://bmj.bmjjournals.com/cgi/eletters/bmj.38833.785984.47v1#132950 For the week starting 5 June 2006 'It is sad to see the term "brain dead" still being used (1) to describe the state of comatose, ventilator-dependent patients certified dead for transplant purposes. Use of that term was formally discouraged by the RCP Working Party and Conference of Medical Royal Colleges (2) in 1995, the term "brain stem death" being preferred although not factually correct (3), and the Minister of State for Health declared (4), in 1997, that "the term 'brain death' ..... should not be used in the context of organ donation".' Dr David W Evans in Rapid Responses The British Medical Journal, 1 May 2006. http://bmj.bmjjournals.com/cgi/eletters/bmj.38833.785984.47v1#132950 Read the Full Letter in British Medical Journal Quote of the Week starting 24 April 2006 'The paralysed donors have no subsequent opportunity to tell us what they may have experienced. But the responses are so similar to those accepted as indicators of possible subjective distress during everyday therapeutic surgery that attending anaesthetists may be prompted to administer effective analgesia and anaesthesia "just in case".' David W Evans, Retired physician 27 Gough Way, Cambridge, CB3 9LN United Kingdom Link to Dr Evans Rapid Response Letter in the British Medical Journal If Link doesn't work place the following in the URL bar. http://bmj.bmjjournals.com/cgi/eletters?lookup=by_date&days=14#132141 Quote of the Week starting 23 March 2006 "If I can pay them back by April, my kidney will not be removed." Jung Sung-san, director of Yodok Story, a musical about life in a North Korean prison camp. He used his kidney as collateral to take out a loan to produce the musical. in South Korea. Link to National Public Radio story : A prisoner sings a song about how he ended up at Yodok. http://www.npr.org/templates/story/story.php?storyId=5281517 Quote of the Week 9 March 2006 Back from the “brain dead” "Two, in whom the end of life decisions were revised, survived." The University of Bonn Medical Center study: On the difficulty of neurosurgical end of life decisions, shows that two out of 113 patients who were initially thought to be mortally brain-damaged defied the fatal prognosis and survived to make good recoveries. The study involved neurosurgical patients mostly suffering brain trauma injury (bangs to the head), and intracranial haemorrhage (strokes). The decisions to terminate further treatment, once it became clear that it would be futile and improper, were made after stringent and extensive brain activity testing. Yet despite this, two such “end of life” diagnoses were subsequently reversed and the patients made unexpected recoveries. If such "brain death" mistakes are made despite such comprehensive testing, one might also doubt the accuracy of "brain death" and "brain stem death" diagnoses, with their supposedly invariably fatal prognoses, in patients identified as organ donors - where those diagnoses are made, as Dr David W. Evans observes, solely on the basis of “…simple bedside tests (performed) after only a few hours' of ventilator-dependent coma…” One might logically conclude that some patients previously harvested for their hearts, livers and lungs could have survived if harvesting hadn't been rushed. "On the difficulty of neurosurgical end of life decisions" by C Schaller and M Kessler Department of Neurosurgery, University of Bonn Medical Centre, Bonn, Germany Correspondence to: Carlo Schaller MD Department of Neurosurgery, University of Bonn Medical Centre, Sigmund-Freud-Str 25, 53127 Bonn, Germany; carlo.schaller@ukb.uni-bonn.de Schaller and Kessler (J Med Ethics 2006;32:65-69) Link to the Abstract Dr David W. Evans response in the Journal of Medical Ethics For the week starting 28 November 2005 The Orange County Register newspaper Body Broker series is again accessible without charge. Sections inlcude an American state-by-state listing of organ agencies' ties to for-profit suppliers. Introduction Page and Links to Articles For the week starting 4 July 2005 Does it matter that organ donors are not dead? "Does it matter that organ donors are not dead? Ethical and policy implications." The latest article by Michael Potts and David W Evans in the Journal of Medical Ethics. They argue that causing the death of the donor by harvested the organs is killing them rather than letting nature take its course as argued by Robert Truog and Walter Robinson. View the Abstract For the week starting 2 May 2005 Pretty good for a dead person “Persons who meet whole-brain criteria of death, if mechanically ventilated, typically remain normothermic, continue to grow hair and fingernails, often retain spinal reflexes, maintain cardiac and circulatory function, digest and absorb food, filter blood through both liver and kidneys, urinate and defecate, heal wounds and may even gestate foetuses” Taylor R. (1997) ‘Reexamining the definition and criteria of death’ Seminars in neurology 17(3) 265-270. This quote was printed in "Nursing practice and the definition of human death" Steven D.Edwards, RMN, BA (hons), M.Phil, PhD. Centre for Philosophy and health care, School of Health Science, University of Wales Swansea Swansea SA2 8PP Kevin Forbes, RGN, BA (hons) School of Nursing & Midwifery, Faculty of Health & Social Care, The Robert Gordon University, Garthdee Campus, Garthdee Road, Aberdeen, Scotland AB10 7QG Published in Nursing Inquiry magazine http://www.blackwellpublishing.com/journal.asp?ref=1320-7881&site=1 Read the Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14622369&dopt=Abstract For the week starting 25 April 2005 Do the beating-heart "Dead" Donors feel pain as the organs are excised? "Indeed, anaesthetists have called for sedation and analgesia to be given routinely to brain dead organ donors during the process of organ removal." From “Nursing practice and the definition of human death” Steven D.Edwards, RMN, BA (hons), M.Phil, PhD. Centre for Philosophy and health care, School of Health Science, University of Wales Swansea Swansea SA2 8PP Kevin Forbes, RGN, BA (hons) School of Nursing & Midwifery, Faculty of Health & Social Care, The Robert Gordon University, Garthdee Campus, Garthdee Road, Aberdeen, Scotland AB10 7QG Published in Nursing Inquiry magazine. http://www.blackwellpublishing.com/journal.asp?ref=1320-7881&site=1 Read the Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14622369&dopt=Abstract Quote based on an article by Young P.J., Matta B.F. (2000) ‘Anaesthesia for organ donation in the brainstem dead – why bother?’ Anaesthesia 55(2), p.105. For the week starting 18 April 2005 Nurses and Professional Integrity "…why should nurses try to placate relatives of patients diagnosed as brainstem dead when they refuse to accept that their pink, warm, relation is dead. And second, why should nurses themselves suppress their own intuitions when brainstem dead patients move around on the operating table and when their heart rate and blood pressure “shoot up”? If what has been argued in this paper is correct, it is not clear why nurses should try to persuade relatives of patients diagnosed as brain dead that they are actually dead, even though they look alive." From “Nursing practice and the definition of human death” Steven D.Edwards, RMN, BA (hons), M.Phil, PhD. Centre for Philosophy and health care, School of Health Science, University of Wales Swansea Swansea SA2 8PP Kevin Forbes, RGN, BA (hons) School of Nursing & Midwifery, Faculty of Health & Social Care, The Robert Gordon University, Garthdee Campus, Garthdee Road, Aberdeen, Scotland AB10 7QG Published in Nursing Inquiry magazine. http://www.blackwellpublishing.com/journal.asp?ref=1320-7881&site=1 Read the Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14622369&dopt=Abstract For the week starting 11 April 2005 Is the loss of bellows breathing capability a reliable indicator of 'brain death'? "…the sense in which one’s chest expands and contracts; and respiration in the sense in which a gaseous exchange occurs (i.e. of oxygen and CO2). The latter is what really matters to life since it is that process which maintains homeostasis. It is easy to see that breathing in the ‘bellows’ sense is not necessary for respiration to occur: a human being may be capable of respiring in the ‘gaseous exchange’ sense, but not the ‘bellows’ sense. Thus for example in ECMO (extra-corporeal membrane oxygenation), and in the oxygenation of blood during cardiac bypass operations. Here there is respiration in the sense which matters for life, but no breathing in the ‘bellows’ sense. Also of course in the womb foetuses don’t respire in the ‘bellows’ sense but still have the capacity for respiration in the ‘gaseous exchange’ sense." From “Nursing practice and the definition of human death” Steven D.Edwards, RMN, BA (hons), M.Phil, PhD. Centre for Philosophy and health care, School of Health Science, University of Wales Swansea Swansea SA2 8PP Kevin Forbes, RGN, BA (hons) School of Nursing & Midwifery, Faculty of Health & Social Care, The Robert Gordon University, Garthdee Campus, Garthdee Road, Aberdeen, Scotland AB10 7QG Published in Nursing Inquiry magazine. http://www.blackwellpublishing.com/journal.asp?ref=1320-7881&site=1 Read the Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14622369&dopt=Abstract For the week starting 4 April 2005 How are potential living kidney donors approached? "Remember that is your decision…It's OK to say NO!" from page 4 of "Kidney donation by live donors" published by the Department of Health of the state of New South Wales in Australia. One might easily understand the above quote to mean the potential harvestee has been asked rather than voluntarily come forward. This raises the question how potential harvestees are approached. Does the person on dialysis make up a list of relatives for transplant coordinators to chase up? Or does the donor come forward, without prompting, upon hearing a friend or relative has gone on renal dialysis? Marion Downey of the New South Wales Department of Health has been contacted for clarification but has not responded. For the week starting 28 March 2005 Is Organ Selling Legal in Australia? The following is from "Kidney donation by live donors" published by the Department of Health of the state of New South Wales in Australia. "The person offering to be a live organ donor must be: - psychologically stable - freely willing to donate - free from any coercion - medically and psycho-socially suitable - full informed of the risks and benefits - fully informed of the effectiveness of current dialysis treatment available to the recipient" While the legislation prohibits the sale of organs few people read this document, while in the promotional material there is no mention of prohibition from receiving payment for a kidney. For the week starting 21 March 2005 All Above Board? The Royal Prince Alfred Hospital in Sydney, Australia has failed to publish the guidelines used by its ethics committee to approve or reject living kidney donations. This follows Nick Ross' donation of one of his kidneys to his employer, billionaire Kerry Packer. Some countries prevent organ selling by usually disallowing a kidney transplant when the organ is directed by a low-income organ donor, who is still walking around, to a very rich person. That the Prince Alfred Hospital won't provide the guidelines used when determining this case, and the fact that Kerry Packer donated $10 million, part of which was used to refurbish the newly named Nick Ross Clinic, casts doubt on the fairness of organ allocation in Australia. For the week starting 14 March 2005 Is Bone Marrow transplanting worth the money; and the impetus for body parts trading "The actual one-year survival of the 141 patients was 40.0%" NATIONAL MARROW DONOR PROGRAM (U.S.A.) http://www.marrow.org/PATIENT/understanding_survival_statistics.html Accessed 7 March, 2005 "And in the United States, a bone marrow transplant costs $483,000; India it’s just over $36,000." Stan Correy, Background Briefing, Australian Broadcasting Corporation http://www.abc.net.au/rn/talks/bbing/stories/s1308505.htm Accessed 7 March 2005 For the week starting 7 March 2005 Correction of Error in last week's "Quote of the Week" as posted until 3rd March 2005 The Mistake: 4) How is brain death determined and are high-technology machines used to determine it, or do doctors just perform the response to pain (reflex) testing and the apnoea oxygen deprivation "brain death" test? The Correction: (thanks to Dr D.W. Evans, Cambridge, United Kingdom) The apnoea test (para 4) does NOT, in fact, involve oxygen deprivation. The prescribed procedure tests the respiratory centre for response to hypercarbia (raised carbon dioxide tensions) only. Great care is taken - by pre-oxygenation and the diffusion of oxygen into the lungs throughout the test - to try to ensure that the body (with its wanted organs) is not rendered severely anoxic. The fact that the respiratory centre is, therefore, not exposed to the much more powerful (than hypercarbic) anoxic drive stimulus - which is the ultimate stimulus, one mght say - means that it has not been tested rigorously for remaining life (ability to function). That has long been a plank in the argument against acceptance of "brain stem death", as diagnosed by the UK Code of Practice, as truly the death of the brain stem - the whole of which must be certainly dead if it is to be safely assumed that there is no possibility of the return of consciousness, even on the old Magoun theory of consciousness - as adopted by Pallis and the UK Conference of Medical Royal Colleges (1998). "The fact that the respiratory centre CAN sometimes respond to the ultimate anoxic drive stimulus, although it did not respond to the hypercarbic stimulus prescribed by the "brain stem death" diagnostic protocol, is demonstrated by the agonal gasps sometimes seen after ventilators are finally disconnected in ICUs in the patient's interests only. That - and the Lazarus phenomenon - are not seen where "beating heart" transplants are concerned, of course. In those cases, the ventilator is not disconnected until the end of the procedure, which may take several hours, and the donor has been paralysed throughout with muscle relaxants which prevent signs of movement and breathing." For the week starting 28 February 2005 School Students: Questions to ask your friendly organ donation promoter 1) Is the donor's heart still beating when harvesters saw through the breast-bone with an electric circular saw? 2) Are heart and liver donors given anaesthetic to prevent pain? 3) Who invented the term "brain death"? 4) How is brain death determined and are high-technology machines used to determine it, or do doctors just perform the response to pain (reflex) testing and the apnoea "brain death" test? 6) Can you prove the Apnoea "Brain Death" Test doesn't cause further brain injury? 7) Can you produce statistics showing heart transplant recipients live longer than those also on the waiting list who miss out on the transplant? For the week starting 21 February 2005 Feel the ice in your veins as you consider the logic of Robert Veatch, a leading American intellectual "...Our society now has demonstrated a moral weakness of the will to address those needs by some other means. If it is immoral to make an offer to buy organs from someone who is desperate because those making the offer refuse to make available the alternative solutions, it must be even more immoral to continue under these circumstances to withhold the right of the desperate to market the one valuable commodity they possess. If we are a society that deliberately and systematically turns its back on the poor, we must confess our indifference to the poor and lift the prohibition on the one means they have to address their problems themselves. It is thus with shame and some bitterness that I propose that the time has come to lift the ban on marketing organs. .." Kennedy Institute of Ethics Journal Vol. 13, No. 1, 19–36 © 2003 by The Johns Hopkins University Press Robert M. Veatch Why Liberals Should Accept Financial Incentives for Organ Procurement For the week starting 14 February 2005 Sweet-talking on the organ donation dateline Robert Metzger, President of the United Network for Organ Sharing has announced on January 12, 2005 the forming of an ad-hoc committee to investigate the trend of people forming organ donor/recipient relationships through Internet chat rooms and discussion forums. Dr Metzger questions the use of public solicitations for live organ donors and the use of commercial websites for this purpose. UNOS currently has the monopoly for allocating vital organs in the United States. Perhaps he is concerned that these organ-dating agencies could act like romance agencies where inappropriate people are introduced and encouraged to form a relationship merely to justify the fees charged rather than for the benefit of those concerned. Read Dr Robert Metzger's memo http://www.transplantliving.org/community/news.aspx?id=389 You might need to do a search of their site. For the week starting 7 February 2005 Pig Hearts Into Baboons - Background to the Smiling Transplant Recipient Stories A baboon has survived 179 days after being transplanted with a pig's heart. It died from thrombosis in the small blood vessels a condition also experienced by transplanted human hearts while the human is on immune-suppressant drugs. Dr. David K. C. Cooper, of Pittsburgh University Medical Center's Thomas E. Starzl Transplantation Institute made the announcement in the December 26th online issue of Nature Medicine. The breakthrough in this experiment was the prevention of hyperacute organ rejection usually associated with heart transplants between different species. Dr Cooper also announced in the same issue of Nature Medicine pig-to-baboon kidney transplant survivals of up to 83 days. Read the Whole Story http://www.transplantliving.org/community/news.aspx?id= For the week starting 31 January 2005 "Brain Death" believers seek revenge Soon after William Rardin shot himself on 26 September 2003, his beating-heart body was harvested of six vital organs. Montrose County (Colorado) Coroner Mark Young declared the death a homicide - the organ harvesting killed him, not the bullet. A Committee of medical professionals, citizens and harvest promoters formed and investigated Young's decision and concluded Rardin's death was suicide, not homicide, because, they say, he was declared "brain dead" before his organs were harvested.. In response to their report Coroner Young, a former paramedic, is changing his homicide ruling, as cause of death, to suicide. Nevertheless, the Committee is now gathering petition signatures for a recall of Mark Young, forcing him to contest an early election for the post of Montrose County Coroner. News Reports on this subject: http://www.denverpost.com/Stories/0,1413,36%257E53%257E2484230,00.html http://news4colorado.com/topnews/local_story_299155237.html http://www.denverpost.com/Stories/0,1413,36%257E53%257E2486344,00.html Members of the Committee: http://www.jerrypournelle.com/mail/mail332.html For the week starting 24 January 2005 Knowing by Heart: Cellular Memory in Heart Transplants "...On May 29, 1988, a woman named Claire Sylvia received the heart of an 18-year-old male who had been killed in a motorcycle accident. Soon after the operation, Sylvia noticed some distinct changes in her attitudes, habits, and tastes. She found herself acting more masculine, strutting down the street (which, being a dancer, was not her usual manner of walking). She began craving foods, such as green peppers and beer, which she had always disliked before...." Kate Ruth Linton Under the supervision of Tom Anderson Montgomery College Student Journal For the Week Starting 17 January 2005 Australian Hospital Keeping Secret Its Living Organ Donor Policy The Queen Elizabeth Hospital in Adelaide, South Australia has refused to provide its living donor policy guidelines for public viewing. These ethics rules list the requirements for kidney donation from a living donor to another person. They are to ensure living kidney donors aren’t being blackmailed, intimidated, paid, or suffer a mental illness. For example, the ethics committee theoretically would be reluctant to approve the harvest and transplant if the donor was verypoor and the recipient extremely rich. Queen Elizabeth Hospital Chief Executive Officer, Dr Alphonse Roex of the Queen Elizabeth Hospital has failed to respond to two requests for these guidelines. For the Week Starting 10 January 2005 A critique on the concept of "brain death". "Since the concept of "brain death" was introduced in medical terminology, enough evidence has come to light to show that the concept is based on an unclear and incoherent theory. The "brain death" concept suffers by internal inconsistencies in both the tests-criterion and the criterion-definition relationships. It is also evident that there are residual vegetative functions in "brain dead" patients. Since the content of consciousness is inaccessible in these patients who are in a profound coma, the diagnosis of "brain death" is based on an unproved hypothesis. A critical evaluation of the role and the limitations of the confirmatory tests in the diagnosis of "brain death" is attempted. Finally it is pointed out that a holistic approach to the problem of "brain death" in humans should necessarily include the inspection of the content of consciousness." by Karakatsanis KG, Tsanakas JN. from the Medical School, Aristotle University of Thessaloniki, Greece. Their article appeared in Law & Medicine, Vol 18 (No2),2002, pp 127-141. This abstract also available in from National Library of Medicine (USA) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12479157&dopt=Abstract For the Week Starting 3 January 2005 Bending the diagnosis for transplant purposes “In the U.S, the evolution of the notion of brain death was explicitly motivated in part by transplantation considerations…” David Price Legal and Ethical Aspects of Organ Transplantation Cambridge University Press, 2000 For the Week Starting 27 December 2004 Do More Educated People Avoid Becoming Donors? “Anecdotally, the wealthier, more educated communities in Spain have a relatively low compliance rate with organ donation” Tonti-Filippini, Nicholas. Revising Brain Death: Cultural Imperialism, Linacre Quarterly. Boston. May 1998 The author served as health care ethicist for eight years at St Vincent’s Hospital, Melbourne, Australia For the Week Starting 20 December 2004 Do medical staff lie to donor families? “Until relatively recently (1992), as an ethicist, I was myself misled in this respect, having had brain death explained to me and seen it explained to donor families many times as the brain event equivalent of having been guillotined. Having now studied the medical literature I know that to be false, and more than that, it was known to be false as early as 1977 following the multi-center study funded by the National Institutes of Neurological Disease and Stroke.” Tonti-Filippini, Nicholas. Revising Brain Death: Cultural Imperialism, Linacre Quarterly. Boston. May 1998 The author served as health care ethicist for eight years at St Vincent’s Hospital, Melbourne, Australia For the Week Starting 13 December 2004 The Secret Side of the Kidney Transplant Waiting List “…as a hemodialysis patient I have often sat with other patients to whom the alternative of a cadaveric kidney transplant was being put most forcefully, on both economic and personal health grounds, and seen the patients’ disquiet at the prospect, and their unanswered questions about anything to do with the source of the organs.” Tonti-Filippini, Nicholas. Revising Brain Death: Cultural Imperialism, Linacre Quarterly. Boston. May 1998 The author served as health care ethicist for eight years at St Vincent’s Hospital, Melbourne, Australia For the Week Starting 6 December 2004 The Joy of Donating A Relative’s Beating Heart Body? “In many accounts of their experiences given to me by donor families, even by those who do not regret donation, the matter of being confronted by the concept and reality of death by brain death, and being asked for consent to donation, was later seen as part of the original trauma.” “In a sense, they may feel assailed or assaulted, not just by devastating events that led to the relative suffering the brain injury, but also by the additional events which occurred for the sake of organ transplantation.” Tonti-Filippini, Nicholas. Revising Brain Death: Cultural Imperialism, Linacre Quarterly. Boston. May 1998 p 58 The author served as health care ethicist for eight years at St Vincent’s Hospital, Melbourne, Australia For the Week Starting 29 November 2004 Surprise, Surprise “When members of the family later investigate and find out, for instance, sometimes for the first time, that organs are taken while the heart still beats, or that the practice is to administer a general anesthetic to donors for the harvesting operation (which the relatives often interpret as implying the need to suppress capacity to feel pain indicating continued brain function), they may be extremely distressed and feel exploited.” Tonti-Filippini, Nicholas. Revising Brain Death: Cultural Imperialism, Linacre Quarterly. Boston. May 1998 The author served as health care ethicist for eight years at St Vincent’s Hospital, Melbourne, Australia For the Week Starting 22 November 2004 Used Car Dealer Syndrome “As an ethicist I have frequently encountered circumstances in which families of donors, who in the aftermath (sometimes very much later) of having agreed to donation, doubt whether their relative was in fact dead at the time. Grief can be vastly complicated in such circumstances by the notion that one has betrayed one’s relative.” Tonti-Filippini, Nicholas. Revising Brain Death: Cultural Imperialism, Linacre Quarterly. Boston. May 1998 p 57 The author served as health care ethicist for eight years at St Vincent’s Hospital, Melbourne, Australia For the Week Starting 15 November 2004 Is “Brain Death” testing deliberately cursory so as to maintain the flow of organs? “…the Harvard and Royal Colleges criteria are clinical criteria only and do not require ancillary testing such as cerebral angiogram, Doppler ultrasound, and X-ray using contrast media to assess brain flow in the various parts of the brain and electroencephalograms. Laboratory assays establishing the presence of hormones originating from that part of the brain known as the hypothalamic-pituitary axis would also be significant.” Tonti-Filippini, Nicholas. Revising Brain Death: Cultural Imperialism, Linacre Quarterly. Boston. May 1998 p 54 The author served as health care ethicist for eight years at St Vincent’s Hospital, Melbourne, Australia For the Week Starting 8 November 2004 Scientific Experts versus "Ordinary" people “In 1988, the Danish Council on Ethics, in a Report on Death, drew attention to a perceived divide on ‘scientific’ (unseen) and ‘ordinary’ (seen) views of death. It stated that ‘The concept of death must relate to the everyday experience’, according to which ‘the identity of the person relates no less to the body than to the mind’, and recommended that the standard of death should be cessation of respiration and cardiac activity. David Price quoting the Danish Council of Ethics Report – The Criteria of Death in the Legal and Ethical Aspects of Organ Transplantation Cambridge University Press, 2000 For the Week Starting 1 November 2004 A Concept's Short LifeSpan “It is ironic that so soon after the medical and legal legitimisation of the concept of brain death, whole-brain criteria for death seem to be disintegrating – neurologically, clinically and socially.” S. Miles from "Death in a Technological and Pluralistic Culture" For the Week Starting 25 October 2004 Consent for donation of organs FROM DR DAVID J. HILL To The Times newspaper Sir, Transplant surgeons (letter, October 4) blame apathy for the lack of organ donors. Mistrust may be a greater disincentive. Consent to join the Organ Donor Register (or to carry the card) has never required full explanation or countersignature. Death was redefined for transplant purposes because most organs need to be taken from a living body that requires both paralysis and anaesthesia for the operation. Both the science and the philosophy of the concept of brainstem death have been, and are increasingly being, questioned. Simply urging people to sign on, as your correspondents emotively request, evades the issue of obtaining fully informed consent. Yours faithfully, DAVID J. HILL (right) (Honorary Consultant Anaesthetist), The Old Post House, Eltisley, Huntingdon, Cambridgeshire PE19 6TG The Times Newspaper England October 08, 2004 http://www.timesonline.co.uk For the Week Starting 18 October 2004 Doctors accused of homicide in organ harvest "I think it (the organ donation) was done in good faith. ... But the standard has me thinking about taking the organ donation card off my license. I don't mind donating organs if I'm dead, but I want to be dead first.'' Colorado Coroner Mark Young The Montrose County [Western Colorado] Coroner Mark Young said Montrose Memorial Hospital in Montrose and St. Mary's Hospital in Grand Junction failed to complete adequate tests before harvesting organs and that 31-year-old William Rardin’s death was caused by the "removal of his internal organs by an organ recovery team,'' rather than from a self-inflicted gunshot wound that brought him to the hospitals. He said that he believed the case wasn’t a criminal matter but that it "should lead to a clarification of what the accepted standard is". from the Albany Democrat Herald Albany, Oregon, USA Sunday, October 10, 2004 Last modified Tuesday, October 5, 2004 1:38 PM PDT Go To The Newspaper Article For the Week Starting 11 October 2004 Five Year Ban On Xeno Transplanting in Australia The National Health and Medical Research Council has imposed a five year ban on animal to human transplanting in Australia because the health risks are too great. Adelaide Advertiser Newspaper, South Australia, 22 September 2004 For the Week Starting 4 October 2004 One Truth for the Experts and another for the Donors "Nonetheless, there are still worldwide controversies over the very concept of human death and the putative neurological grounds for diagnosing it (whole brain, brain stem, and higher brain formulations of death). There are also disagreements over the diagnostic criteria of BD, whether clinical alone, or clinical plus ancillary tests. Moreover, a group of scholars who were strong defenders of a brain-based standard of death are now favoring a circulatory-respiratory view. Hence, the debates on human death are far from concluded." Calixto Machado and Alan Shewmon from the book 'Brain Death and Disorders of Consciousness', edited by Calixto Machado and D. Alan Shewmon (Vol 550 in the 'Advances in Experimental Medicine and Biology' series, Kluwer Academic/Plenum Publishers, New York, Boston, Dordrecht London, Moscow, 2004. ISBN 0-306-48482-X). D. Alan SHEWMON, MD Professor of Neurology and Pediatrics Vice-Chair of Neurology at UCLA Chief, Department of Neurology Olive View-UCLA Medical Center California, USA Dr. Calixto Machado, MD, Ph.D. Institute of Neurology & Neurosurgery Havana, Cuba For the Week Starting 20 September 2004 The “Brain Death” Jury is Still Out “While some people have concluded that organs should not be removed from patients who meet the brain death criteria because they believe that they are still alive, others draw a very different conclusion." "They suggest that the concept of brain death was not introduced because its proponents really believed that such patients were actually dead, but rather as a “convenient fiction” which enables ventilator support to be withdrawn from patients, and allows organs to be transplanted in good condition.” From Certifying Death: The Brain Function Criterion Ethical Issues in Organ Donation Discussion Paper No 4 Commonwealth of Australia http://www.google.com.au/search?q=cache:G_1J91bfR8UJ:www.health.gov.au/nhmrc/publications/pdf/e32.pdf+%22some+people+have+concluded+that+organs&hl=en Publisher Details This discussion paper is one of four in a series on the ethics of transplantation. The complete series is as follows: Donating organs after death: ethical issues Ethical issues in donation of organs or tissues by living donors Ethical issues raised by allocation of transplant resources Certifying death: the brain function criterion The papers can be purchased by contacting: The Australian Government Publishing Service GPO Box 84 CANBERRA ACT 2601 Phone: 132 447 (free call) Fax: (06) 295 4888 For the Week Starting 13 September 2004 Not Dead? “…brain dead patients sometimes move their hands toward the chest automatically and show a praying posture (known as the Lazarus sign)…” Reconsidering Brain Death A Lesson from Japan’s Fifteen Years of Experience Masahiro Morioka Hastings Center Report 31, no.4 (2001): 41-46 http://www.lifestudies.org/reconsidering.html Or Dead? “At the other end of the spectrum of pitfalls are signs that are compatible with brain death but may suggest persistent brain stem or brain function. The most dramatic examples are brief lifting of both upper extremities or assuming a sitting position by the patient…” BRAIN DEATH Eelco F. M. Wijdicks, M.D. Professor of Neurology Medical Director of Neurosurgical Intensive Care Unit Saint Marys Hospital Mayo Clinic Rochester, Minnesota http://www.snowtigermed.com/cgi-local/viewarticle.pl?doc=20001222150458 For the Week Starting 6 September 2004 Responses of a "Brain Dead" organ donor - ready for harvesting “…the head and torso may flex and for a few seconds rise from the bed with arms outstretched, then falls back and the dead body remains permanently flaccid in the supine position.” http://wings.buffalo.edu/faculty/research/bioethics/man-baa.html Why the "Brain Dead" Donor is paralysed prior to harvesting “You stick the knife in and the pulse and blood pressure shoot up. If you don't give anything at all, the patient will start moving and wriggling around and it's impossible to do the operation. The surgeon always asked us to paralyse the patient." Dr Phillip Keep,consultant anaesthetist at the Norfolk and Norwich Hospital in the United Kingdom Guardian Newspaper, United Kingdom. Sarah Boseley, Health Correspondent. 19 August 2000 www.guardianunlimited.co.uk 23 August to 6 September 2004 Two types of death for organ donors in Japan "In 1985, criteria for brain death were announced. The committee distinguished “medical criteria for brain death” from “the concept of human death” and declared that the latter depended on the consensus of the Japanese people." Masahiro Morioka Reconsidering Brain Death A Lesson from Japan’s Fifteen Years of Experience Hastings Center Report 31, no.4 (2001): 41-46 Japanese Organ Donor cards offer two choices for prospective organ donors - "brain death" and "cardiac death" - The latter being when the heart stops and which reflects general opinion on what constitutes death. Despite being a technological society Japanese dislike both the concept of "brain death" and the idea of being harvested. It is so unpopular that "There have been fourteen transplantation cases from brain dead donors up to the present." Japan Organ Transplant Network View Japanese Organ Donor Cards at OrganRetainers 9 August to 23 August 2004 Another Hidden Cost of Organ Transplanting The ethical anguish of using pigs and non-human primates for research and the risk of animal virus' jumping the species barrier and infecting humanity are just two issues researched by the Campaign for Responsible Research. http://www.crt-online.org/ Go To Campaign for Responsible Research Site 27 July to 9 August 2004 Organ Selling Racket Exposed in South Africa involving Brazilian kidney sellers and Israeli recipients Dr Jeff Kallmeyer, a senior nephrologist, is on trial in Durban facing charges under the Human Tissues Act. It is alleged intermediaries arranged for Brazilian kidney sellers to travel to South Africa where their organs were transplanted into Israelis. Several other surgeons have been arrested. It is also alleged Brazilian donor/sellers had their passports confiscated upon arrival and were kept in low-grade accommodation. Some have been sent back to Brazil, missing one kidney and without having being paid. Read the Whole Story by Pat Sidley in the British Medical Journal For the Fortnight starting 5 July 2004 Doctors Avoiding Organ Transplant Surgery A United Kingdom Dept of Health meeting of officials, surgeons and patients’ representatives has met to discuss the shortage of transplant surgeons. They fear viable organs, particularly kidneys, may be lost due to lack of surgeons. One Plymouth hospital needed to advertise three times before finding a suitable candidate. Professor Peter Friend, a consultant renal surgeon at the Oxford Transplant Centre, said the demands of the job were very intense. "…there is an image problem, and it is largely due to the fact that kidney transplant surgeons are seen to be over-worked, and perhaps in some senses, under-valued." The meeting concluded that more money, merged transplant centres, and increased donation would create thriving transplant centres more attractive to surgeons. However, a source outside of the United Kingdom suggests that better technology throwing doubts on the accuracy of “brain death” diagnosis, and the risk of harming a still-living patient further with the apnea “brain death” test, has discouraged young doctors from entering this specialty. http://news.bbc.co.uk/1/hi/uk/3793045.stm Click Here To Read Full BBC Report For the Fortnight starting 21 June 2004 SeaChange Shift in Heart Transplanting Attitudes The British Department of Health is spending £3million on mechanical heart research after realising they can’t surmount the increasing reluctance of citizens to become “beating-heart donors”. They could have saved themselves much bother by listening to David W Evans, who wrote in the Cambridge Review, back in 1982: "The development of the mechanical heart offers a much better prospect for the future".1 David W Evans, Retired physician and sometime consultant cardiologist at Papworth Hospital in the United Kingdom 1 "Heart transplants: some observations and objections"; David W. Evans; - Cambridge Review (Vol 103, pp338-9): November, 1982 Click here to read Dr Evan’s full Brain Death is Not Death Commentary on the Truog & Robinson article from Crit Care Med 2003; 31: 2391-96 For the Fortnight starting 7 June 2004 Harvest Expediency versus Science in the United Kingdom “The term “brain death” was formally abandoned, in this country, in 1995. But comatose, ventilator-dependent patients are still being certified “dead” for transplant purposes using similar tests. These are now held to diagnose the irreversible loss of the capacity for consciousness, although no sound scientific evidence has been advanced to support that claim.” David W Evans, Retired physician and sometime consultant cardiologist at Papworth Hospital in the United Kingdom. Click here to read Dr Evan’s full Brain Death is Not Death Commentary on the Truog & Robinson article from Crit Care Med 2003; 31: 2391-96 For the week starting 31 May 2004 Four Moscow Doctors Charged With Attempted Organ Theft (British Medical Journal) Police burst into a surgical theatre and found a car smash victim lying on the table with his hands tied behind his neck. There wasn’t a death certificate and the man, Mr A Orekhov, had a beating heart and normal blood pressure. Organ Donors must be declared “biologically dead” in Russia. The hospital, Moscow City Hospital No 20, had been under police surveillance after a woman said”she arrived at a city hospital to find that her friend had been "cut open" for his organs after an accident.” Mr Orekhov died later. http://bmj.bmjjournals.com/cgi/content/full/328/7448/1092-a Read the whole document For the week starting 24 May 2004 European Union Moves Against Organ Trafficking The European Parliament has approved draft legislation making it illegal for citizens to go abroad and pay for a transplant, or to bring people into the European Union countries to be harvested of organs against their consent or under coercion. But to meet increased demand some European MPs are advocating a stricter application of the opt-out law. Many countries have legally adopted opt-out, where the government assumes ownership of vital organs unless citizens register as Organ Keepers. However, to avoid a backlash governments often still seek permission of next of kin. http://bmj.bmjjournals.com/cgi/content/full/327/7422/1009-b Back in the real world, The Kidney Group, based in Vancouver, Canada, offer kidneys in as little as 15 days. http://www.thekidneygroup.com For the week starting 17 May 2004 Terminology Becoming More Honest In United Kingdom "There are currently 7,172 patients who need a transplant to save or greatly improve their lives - an increase of 31.8%." from UKTransplant http://www.uktransplant.org.uk/newsroom/news_releases/news_item/need_for_transplants_increasing.htm Remember all those "gift of life" sales pitches to attract organ donors. UKTransplant, a British government organisation, is now using more honest terminology. Instead of lying and claiming everyone on the vital organ waiting list is awaiting a "life-saving" transplant they've add the proviso "...or greatly improve their lives". A fact of organ transplanting is that most patients on the vital organ waiting list are awaiting kidneys. These patients can live long-term on dialysis (though it isn't pleasant), and are not about to drop dead on the waiting list. All we need now is for other transplant promoters to adopt the same terminology. They might even divide the waiting list into those awaiting life-saving transplants and those awaiting kidneys. Link To The UKTransplant Page For the two weeks starting 3 May 2004 Organ Donation Made "Easier" The Australian Federal Government is apparently withdrawing the right of next-of-kin to veto organ harvesting from relatives who have signed donor cards - though there is confusion about what is actually planned. Government statements suggest harvesters will no longer have to seek "explicit approval" from relatives, but the latter will still be able to veto harvesting. This paradox is called, “flying a kite” where the final rules will be determined on public response. “Organ donation made easier” is one description given to this change. Another description is that family ownership of the heart-beating “brain dead” relative has been replaced by government ownership. The body is handed over to the relatives after harvesting – what’s left, anyway. This change will theoretically increase organ harvesting 50% in Australia – from 200 to 300 annually – unless there is a backlash. This move may be open to legal challenge by relatives who could claim their dying relative was harvested while still alive (there are experts who support this concept), or that harvested relatives signed donor cards while not fully informed – they didn't know that harvesting begins while their hearts are still beating. The legality of the Australian Organ Donor Register may also be questioned as most registered donors signed cards with state and private registers. The change is spearheaded by the Minister of Health, Tony Abbott, who, along with his partner, gave up their child for adoption when it appeared it would interfere with Tony’s career. For the two weeks starting 19 April 2004 Opt-Out crowd gain ground An Australian March, 2004 opinion poll done by NewsLtd indicates 47% of those asked agree with Opt-Out legislation. Opt-Out is where the government assumes ownership of every person's body unless they have registered as organ keepers. This level of agreement is usually enough impetus to propel legislation through the Parliaments. But the pro-harvest experts are less enthusiastic. The harvesters' reluctance for Opt-Out may be that: 1) it may stimulate a surge of organ retainer sentiment that might not otherwise have existed. 2) a critical mass of anti-transplant sentiment may be enough to encourage the formation of organised resistance. 3) |