By Evangelia Lazaris
Jacquelyn Shaw is writing in response to Dr. Stephen Beed’s concerns about previous comments made on presumed consent and organ donation. She argues that the quality of brain death determination goes hand-in-hand with the quality of the tests used to confirm brain death. Though Beed supports the brain death tests that, since 2003, have been adopted across Canada, Shaw states that these tests are, in fact, unsafe and should not be the sole way to determine brain death.
Shaw states that all facts in her previous article, which Beed termed “incorrect,” were in fact drawn from the Canadian Council for Donation and Transplantation—the organization that publicly Beed supports. Shaw informs us that this organization holds a mandate in to increase Canadian organ availability, highlighting the reason for Beed’s continuing support of the CCDT brain death tests. Beed claims that with the CCDT tests, physicians examine both cortical function (consciousness, movement, and sensation) and brainstem function, a safer, more certain standard of brain death; however, the CCDT test simply tests brainstem function, making it significantly more inaccurate than what is claimed.
Shaw states that there are additional facts about the 2003 CCDT guidelines which Beed omits to mention. Prior to 2003, when the guidelines changed, two experienced specialist physicians had to perform brain death tests hours apart. Currently, these tests can be administered simulataneously. This is a fact that, although the CDDT acknowledges, Beed fails to reveal.
This previous “wait period” between tests was intended to assess whether or not the patients’ status was unchanging. In 2009 in Edmonton, Alberta, a barbiturate-treated baby was declared brain dead under the CCDT guidelines for simultaneous testing. The baby began breathing hours later, however, indicating a functional brainstem. This case emphasizes the necessity of reasonable wait periods between tests, as well as a ban on declaring death after recent barbiturate (a CNS depressant) dosage. Despite this case, the CCDT has removed these requirements from the brain death testing protocol.
Additionally, Shaw states that there is a clear conflict of interest with the establishment of the CCDT brain death tests of 2003. These tests were created by a forum charged with increasing organ donation. How can a group that advocates for an increase of organ donation across Canada be trusted to create brain death tests that favor the chance of recovery for the potential donor over immediate declaration of death and organ harvesting? Shaw proposes that the CCDT retires its current tests and that previous tests, such as those of the 1999 Canadian Neurocritical Care Group are reinstated.
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