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March 25, 2014
An open letter to the Producer, 5th Estate CBC - firstname.lastname@example.org
Re: March 21 2014 Episode "Dead Enough"
We thank you for airing a session that increases attention and awareness of the importance of organ donation in the Canadian health system. However, we believe that the show confused some fundamental issues. We empathize with the very real issues and decisions that the families portrayed on the show experienced, but we are concerned that families who have generously given consent for organ donation at the time of a significant loss may be harmed by doubts that your show could have created.
Death has always been recognized by the absence of vital signs, specifically breathing and a pulse, which quickly leads to cessation of organ function, including the brain. Brain death, now known as neurological determination of death, contrary to the assertion on your show, was in fact a more recent definition that recognizes irreversible loss of brain function after a major insult. If mechanical ventilation is provided (since the part of the brain that controls breathing is no longer functioning), the heart may continue to beat. Strict criteria to determine brain death are internationally recognized and were established to permit organ donation. In these cases, there is no question that the person has died prior to removal of the organs.
Many people die in intensive care units without a determination of brain death. These individuals have life support removed after the family and the health care team have decided that further life support would not achieve an outcome that meets the goals, wishes and values of the patient. Once this decision is made, families would often ask about the possibility of organ donation (as did the family in the case from Ottawa that you present on your website). Donation after cardiac death provides this opportunity for carefully selected donors. The intent to withdraw life support and allow the natural dying process to continue has been established before organ donation is performed. The time required for death to be confirmed, whether 5 minutes or 10 minutes (the only two variations used in Canada), is an important but secondary issue. It is important to keep this time to a minimum in order to increase the success of the organ transplantation. Families provide informed consent for the potential organ donation before allowing natural death and are supported by critical care staff through the entire process. We are not aware of any case in Canada where organ removal has commenced prior to death, despite the inference on your show.
The Canadian Critical Care Society has been a participant in various national and international forums over the years that have created guidelines and recommendations for all aspects of organ donation. There are many ethical and medical issues that merit ongoing open discussion and evaluation. However, we are confident that the process of donation after brain death, and more recently after cardiac death, has been respectful of the donors and their families. This generous act has saved and improved thousands of lives. We hope that the inaccuracies in your story do not detract from this act of altruism.
Claudio M. Martin, MSc, MD, FRCPC, CCPE
President, Canadian Critical Care Society
This letter is available to download