Man was not brain dead: Organ transplant not considered - The Straits Times

15 Jun 2008, The Straits Times

Question

Name of the Person: Susan Sachs

How dead is dead?

June 15, 2008

Revival of 'dead' man being prepared for organ donation sparks French ethics debate

Paris - The donor appeared to be dead. But he was not. The 45-year-old heart-attack victim returned to life on the operating table just as surgeons were preparing to remove his organs for transplant. The case has sparked a new debate in France over bioethics and science. The drama was recounted last week by an investigating committee at a public hospital in Paris. 'This situation was a striking illustration of the questions that remain in the field of resuscitation... and what criteria can be used to determine that resuscitation has failed,' according to a report on the case, posted online by a medical ethics team.

Until last year, a patient was not considered an organ donor in France unless neurological and other tests confirmed brain death. But, faced with a chronic shortage of donor organs, bioethics regulators decided to experiment with new guidelines for deciding when death in a potential donor should be considered irreversible. Under a pilot programme, doctors at nine hospitals were permitted to remove organs from patients whose hearts had stopped beating and could not be restarted after a series of emergency procedures. Many other countries, including the United States, have long permitted transplants in such cases. Because of the case of the patient who came back to life, those guidelines are now being reconsidered in France.

Earlier this year, a middle-aged man collapsed on the street in Paris, apparently from a massive heart attack. When paramedics reached him, they determined that his heart was not beating. They started emergency treatment as they rushed him to La Pitie-Salpetriere hospital. The efforts of doctors at the hospital also failed to restart the man's heart. 'Everything was done by medical teams to save the patient,' the public hospital board in a study of the case. Since he was determined to be dead, transplant specialists were called in to remove his organs for use. It was a race against time. Generally, doctors have six hours after a person's heart stops beating to harvest the organ for transplant into another patient. For 90 minutes, as they waited for the specialists to arrive, the hospital doctors continued to massage the man's heart. But the surgeons had a shock just as they were about to cut him open. The man began to breathe on his own again. His pupils were active and there were signs that he could feel pain. His heart began beating. The patient was reported to later be able to walk and talk, although doctors remained guarded about whether he had recovered full brain function.

Experts said the man's revival, after his heart had stopped beating for at least two hours, was highly unusual. All specialised medical literature indicates that a person is brain dead after suffering a cardiac arrest and undergoing more than 30 minutes of properly administered cardiac massage, said Dr Alain Tenaillon, an organ transplant specialist at the French Biomedical Agency. 'But we have to admit there are exceptions,' he told Le Monde newspaper. 'No one knows why cardiac massage is effective with some people and not others. In other words, there are no absolute rules about the best course.'

Last year, 4,664 organ transplants were performed in France. Some 14,000 people with serious illnesses are on the waiting list for a donor organ transplant. France has strict laws on bioethics dealing with organ procurement, embryo and stem-cell research, fertility treatments and genetics. At the same time, its doctors have a reputation for carrying out daring medical procedures, including the first face transplant several years ago.

Reply

Reply from MOH 

In “How dead is dead?” (The Straits Times, 15 June 2008), it was reported that France has a case of a  45-year old man whose heart stopped beating for 90 minutes after a massive heart attack, only to "return to life on the operating table just as surgeons were preparing to remove his organs for transplant".

We have studied this case and would like to point out that what the article had claimed, ‘just as surgeons were preparing to remove his organs for transplant’, was completely inaccurate. In a press statement released by the Agence de la biomédecine, the French authority for organ transplantation, it was stated in French that "the patient was not dead and no death certificate was therefore drawn up for this person, who was in cardiac arrest.  The removal (of organs) with a view to a transplant was therefore not envisageable at that stage of care of the patient".

In Singapore, under the Human Organ Transplant Act, the removal of organs for the purpose of transplantation takes place only after brain death has been certified by two senior specialist doctors. They are independent and must not have been involved in the care or treatment of the patient being certified nor are they in the transplant team of doctors. The certification of brain death is based on accepted international standards that follows a well-defined set of stringent clinical criteria and diagnostic tests. No preparation for organ retrieval or transplantation takes place until death has been certified in this manner. Brain death is widely accepted as a definition of death by international medical communities.

The Ministry of Health recognises the sensitivity surrounding the certification of death before the retrieval of organs under HOTA. We would like to assure all of the reliable nature of both the processes used to certify brain death and brain death itself as a process for certifying death.