New act regulating human organ transplantation could facilitate organ donation

Editor—As the rapid responses to Hoffenberg's reminiscences show, the United Kingdom has not been spared misunderstandings and controversy over death and brain function.¹ Skegg has chronicled the confusion that followed the report by the conference of Medical Royal Colleges in 1976, when the conference was not asked (nor apparently was it able) to agree whether patients with brain stem death were dead and so avoided saying they were until 1979; yet even the editor of the BMJ failed to notice the point in 1976 and declared that the report “sets out clear guidelines for the diagnosis of death.”²

The only reason we need to label as dead those patients without brain stem function is to make beating-heart organ harvesting from them legal and because attempts to extend the label to patients with what we now call persistent vegetative state were not generally accepted.² The main premise on which the colleges have argued the propriety of accepting brain stem death as death of the person has always been the claimed inevitability that when brain stem function ceases “the heart will stop beating shortly thereafter.”³ There is no physiological reason why this should happen, and review of the published evidence shows that it is not true.⁴

An important danger of persisting with this false premise is that more perceptive observers and critics of medical practice have already noticed the discrepancy and have concluded (inappropriately) that misdiagnoses are being made.⁵ I suggest that it is time to revise the law, perhaps by a new Human Organ Transplant Act, to allow families to give informed consent to beating-heart organ donation under anaesthesia for patients certified to have irreversible loss of brain stem function. The unanswerable semantic question of whether the donor is dead would then disappear.