The British criteria for brain-stem death test for lack of function in the part of the brain which regulates body function. Where the brain stem is irreparably damaged, Dr Andrew Robinson (letter, 24 February) is quite correct in asserting that survival is impossible; but this highlights the very point at the centre of the argument. This is the distinction between the situation where death is certain (circulation has stopped and the body is cold) and where death is inevitable, when the brain stem is dead but cardiac and respiratory function is supported.
The brain-stem death criteria test nothing about function above the brain stem. People who decline to sign a donation card do so because they do not want to have their organs removed while any possibility, however remote, remains that they might have an awareness of this taking place.
The procedure frequently involves an incision from the pubis to the throat, so as to expose all the organs in the abdominal and chest cavities. The breastbone is broken and the ribs spread apart. It is carried out with the lungs ventilated and heartbeat sustained. Certain transplant surgeons have indicated reluctance to allow anaesthesia for the unfounded reason that it might damage the organs. Once the organs have been removed, the ventilator is disconnected. It is only at this point that death is certain in the form accepted by the laity: breathing ceases, the heartbeat stops and the body cools, although death has been declared on the basis of cessation of brain-stem activity some hours before.
These are some of the facts which need consideration before collective public consent to donation is enacted in the form of legislation.
Dr JOHN URQUHART
West Suffolk Hospital
Bury St Edmunds