Letter: Confusion over PVS and brain death

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Sir: I have been following the debate on persistent vegetative state (leading article, 18 March).

As a nurse with 15 years experience of working in intensive care I feel it is extremely important to differentiate between brain death and PVS. In brain death there are no reflexes present and the patient does not breathe when off a ventilator despite raising the blood CO2 in an attempt to stimulate respiration. Brain death tests follow strict criteria and are taken twice, 24 hours apart, by separate consultants.

PVS patients can breathe unaided and display at least basic reflexes, eg pupil reaction to a bright light; brain dead patients do not.

To confuse the two states is to cause extreme distress to relatives who may feel they should not have allowed treatment to be withdrawn following brain death, and also results in brain-dead patients remaining on ventilators until all body systems fail and also a fall-off in the availability of organs for donation, which is so valuable and often a comfort to bereaved relatives.

Neda M. Desmond

Eastbourne, Sussex