In his new book, Catholic bioethicist Nicholas Tonti-Filippini attempts to portray the surgeons involved in organ donation as modern-day grave robbers.
As described in a recent article in The Age, Professor Tonti-Filippini poses that some patients who are diagnosed as “brain dead” are not really dead because there is some mid-brain function. Further, he argues that brain blood flow testing should be performed to ensure these patients are not prematurely declared dead and inappropriately have their organs donated.
So what is brain death and how is it diagnosed?
According to the Australian and New Zealand Intensive Care Society, whole brain death is required for the legal determination of death in Australia and New Zealand. A patient must be declared dead by a physician in order for deceased organ donation to be permitted.
Brain death occurs following a severe brain injury associated with significant elevation of pressure in the skull (called intracranial pressure). As the brain swells, exposure to oxygen reduces and intracranial pressure increases. Eventually brain blood flow ceases and the entire brain, including the brainstem, permanently dies. There is no recovery from brain death.
Neither myself nor Tonti-Filippini are neurologists and it’s important to note that those clinicians are the genuine experts in the field and undertake ongoing research. In fact, the Quality Standards Subcommittee of the American Academy of Neurology updated its practice parameters for determining brain death in 2010.
The Academy also created a brochure which clearly explains the key features of brain death diagnosis to families:
the person is in a permanent coma, and the cause of the coma is known;
all brainstem reflexes have permanently stopped working; and
breathing has permanently stopped.
If these three items are verified and there are no confounding factors (such as hypothermia) or situations that could mimic neurological death, doctors can diagnose irrecoverable brain death. If there is uncertainty, confounders, or mimicking conditions, then a diagnosis of brain death cannot be made and further testing, such as brain blood flow imaging, is performed.
It seems Tonti-Filippini doubts the certainty of the three diagnostic parameters and asks the public whether the current approach is acceptable. The problem with his method is that very few of us are neurologists and most lack the scientific preparation to analyse Tonti-Filippini’s doubts.
As a consequence, his fears have the potential to spread and affect the community’s views of organ donation, with families refusing to honour their loved one’s wish to be an organ donor, and people removing their name from the donor registry or simply refusing to register.
Research and academic debate are important features of medicine and are critical to ensure clinically and ethically appropriate practises. But Tonti-Filippini’s latest claims seem merely a lightening rod of emotive oration. Along the way, patients with end-stage organ failure potentially endure more suffering as their waiting time for an organ increases.
Now is the time for professional societies in the spheres of transplantation and neurology to weigh in. Now is also the time for adults to talk to their families about their wishes and values about organ donation.