I was saddened when I read Dick Teresi’s article “What You Lose When You Sign That Donor Card” last week. The article was printed in a highly-respected newspaper, The Wall Street Journal, and is the type of argument that can create public mistrust in the organ donation and medical communities.
Mr. Teresi alleges that doctors aren’t doing their due diligence to determine brain death. I find that absurd and I would like to clarify a few of Mr. Teresi’s claims.
Brain Death Declaration
Let me first say that brain death declaration is independent of organ donation. Organ procurement organizations are not involved in declaring death, nor are hospital personnel who may assist in an organ recovery. There is no reason for a neurologist to falsify a death declaration.
Physicians are trained to make diagnoses, including brain death. While Mr. Teresi might feel that the clinical exam is rudimentary, it is practice approved by the American Academy of Neurology (AAN) that occurs when a doctor believes a catastrophic brain injury may have been fatal for a patient. These clinical neurologic death examinations test for a neurological response from the patient that indicate the brain is still functioning. Clinical evaluation for brain death, like most procedures doctors do every day, must be performed under carefully-controlled circumstances following hospital-approved protocols.
I am confident in the medical professionals who determine death and those who work in the organ recovery industry. I wouldn’t do this job if I didn’t wholeheartedly believe in the cause and trust in those who make donation possible. - Dorrie Dils, Lifeline of Ohio
Mr. Teresi states in his article that the brain death criteria were set in 1968, implying that they’re antiquated. In fact, the AAN reviewed the guidelines for determining brain death and published new standards in June 2010. A thorough review was completed and updates were made to ensure proper waiting times and patient condition; such as no medications in the system and that the temperature is normal when evaluating. The AAN guidelines are what we routinely see hospitals and physicians referring to as they establish their hospital policies on how brain death is declared, not the Harvard criteria of 1968.
Mr. Teresi expressed his concern that Electroencephalography (EEG) tests are not routinely performed when determining brain death, implying that they are the gold standard, when in fact that is not true. A clinical exam is recognized by the AAN as sufficient for determining brain death. Some hospital protocols may require confirmatory tests after a clinical exam, such as a blood flow study. The blood flow study examines the brain and brain stem to look for blood being carried to the brain. If it is not, the patient is brain dead, without hope for recovery. Of course clinical exams for brain death are only done when there is an indication to do so, for example a believed catastrophic injury and that the patient is not at all responsive to external stimuli.
Though tests for determining brain death might seem “simple” to Mr. Teresi, they are effective for determining brain death. Once certain brain functions are lost, they cannot be reversed. There has never been a documented case of patient recovery from death determination by neurologic criteria under circumstances where all clinical testing and confirmatory tests were properly performed.
Regardless of a hospital’s procedures on how brain death testing is to be completed at their facility, the diagnosis is independent of organ donation and Mr. Teresi’s implication that patients are only declared brain dead so they can be donors is ridiculous.
In his article, Mr. Teresi says that when you register to be an organ donor, “You’re also giving up your right to informed consent. Doctors don’t have to tell you or your relatives what they will do to your body during an organ harvest operation because you’ll be dead, with no legal rights.”
I think Mr. Teresi may be confused about the law. Informed consent is something that applies when a physician or surgeon is explaining the possible outcomes of a procedure or surgery to a patient. Organ donation falls under Gift Law and the laws are applied differently, consent is not even a legal term used in organ donation, it is labeled as “authorization,” which does have different requirements.
Signing up in an organ donor registry is an advanced directive. In this law, the person registering is responsible for obtaining whatever information they need to make an informed decision. A comparable parallel would be when we complete Living Wills on ourselves and indicate the type of care we want to receive at the end of our lives. The onus is on us to obtain all the necessary information to make the choices we may indicate in our living will. Organ procurement organizations (OPOs), like Lifeline of Ohio, work tirelessly to educate the public about organ and tissue donation. Organ and tissue recovery professionals have the utmost respect for donors and their families, and ensure that families receive communication throughout the donation process.
In general, when someone registers to be a donor, it’s because he wants to help someone else. He may not know every single detail about the organ recovery procedure (much like someone who signs a do not resuscitate (DNR) order may not know everything that entails) but he trusts the doctors to do everything to save his life. In the event his life cannot be saved, he trusts organ procurement professionals to honor his wish to save lives. It is that simple.
Cost of Transplantation
Mr. Teresi refers to the high cost of organ transplants in his article, seemingly insinuating that money is a driving factor for brain death declaration.
Doctors who declare death at hospitals are in no way financially benefiting from organ donation and transplantation. There’s no doubt that health care is expensive. An organ transplant is an expensive procedure, and a life-saving treatment. However, in comparison a life-long dialysis patient will likely spend more than one who undergoes transplant and is able to return to being a fully functioning member of society.
The recovery of organs is handled by nonprofit OPOs and selling or buying organs is a serious crime punishable by law. These measures are intended to regulate organ transplantation and ensure processes are ethically carried out. Mr. Teresi’s implication that organ donation is somehow a “profitable” venture for doctors declaring brain death is reprehensible.
Potential Impact of Article
Mr. Teresi closes his argument by suggesting readers do not register as donors in order to have more “bargaining power” in the hospital. This is a dangerous and irresponsible claim that perpetuates the misconception that doctors will “let you go” to recover your organs.
Whether you’re a registered donor or not, your life will always come first. Only after every effort to save a life has failed is organ donation considered.
I sincerely hope that Mr. Teresi’s article (and recently-published book) does not result in people removing themselves from organ donor registries. Making a donation decision at the time of death can be difficult for loved ones. There are many choices that have to be made at this incredibly tragic time and by registering to be a donor your family has one less decision to make. And they can take comfort in honoring your wish to save lives.
I am confident in the medical professionals who determine death and those who work in the organ recovery industry. I wouldn’t do this job if I didn’t wholeheartedly believe in the cause and trust in those who make donation possible. I believe in the general good of people and that when they sign up to be donors; they simply hope that when they are gone from this earth, they left a legacy of saving someone else.
Despite Mr. Teresi’s efforts to raise doubt about the organ donation system, I hope people will seek the facts to make an informed decision. I am a registered donor and I know that my life will always come first and my decision has the potential to give hope to those in need of transplants.
–Dorrie Dils, RN, BSN, MHA, CPTC, Chief Clinical Executive, Lifeline of Ohio