Sir: I am dismayed by the extent to which Roger Blassberg (letter, 2 March) misunderstands the concept of brain stem death and procedures of organ donation. The United Kingdom has extremely exacting criteria for the diagnosis of brain stem death, before which organ donation and procurement may not occur.
Whilst Mr Blassberg is right to say that some organs are in a state of activity and the patient has a blood pressure, brain stem death implies the death of the brain as a whole, without which we are not sentient beings. The criteria by which we arrive at a diagnosis of brain stem death are applied strictly. There is no possibility of a "potentially sentient" person being considered for brain stem testing, let alone for organ donation.
I carry out such brain stem testing frequently. It is evident, when despite "life support" the patient has absent thermal control and will rapidly cool, absent breathing and no responses to carefully performed tests of brain reflexes, that independent living could not occur.
I am greatly in favour of increasing the numbers of available organs for transplantation but not at the expense of alienation of people who may become donors. I agree that the concepts of brain-stem death are sometimes difficult, frequently for doctors themselves. The time is right to redress the misunderstandings with further education. Confidence, so easily undermined by a failure to grasp the facts, can then be improved in our organ donation and transplantation programme.
M T E HEAFIELD
Queen Elizabeth Hospital
Edgbaston, BirminghamReuse content