Media

Lessons from Scandinavia?

What’s happening in Scandinavia?

First this from Denmark:

Screenshot 2014-04-06 17.41.39
(Click the picture to go to the full story)

Now this from Sweden:
Screenshot 2014-04-06 17.43.54
(Click the picture to go to the full story)

What are we to make of this?
Firstly don’t trust media reports - notoriously incorrect. See
HERE for a similar UK example with enough internal inconsistencies that even without any knowledge of the actual events one should doubt the validity of the report. At least the BBC put ‘brain death’ in inverted commas.

Returning to the two Scandinavian cases based on the media reports these appear to be the facts:
  • Both patients appeared to be being considered for Donation after Brain Death.
  • The doctors had not yet carried out formal brain death testing, which would have categorically demonstrated life.
  • The doctors discussed donation with the families before death had been confirmed.
  • There was no chance of organ donation actually proceeding, as this will only ever happen after death has been confirmed.

The Scandinavian cases should remind us that
Donation after Brain Death requires two simple but essential steps that MUST be carried out IN ORDER.
  1. Accurately establish the diagnosis of death. Confirm that the patient has already died while on mechanical ventilation by the use of neurological criteria for death - brain death.
  2. Until the family has accepted the death of their loved one, discussions with family regarding organ donation are inappropriate and unempathic unless initiated by the family. Naturally there is no place for these discussions at the bedside of a patient.
i.e. get the death bit right first before discussing donation

Carrying out brain death testing only if the family first agree to organ donation, is in my opinion, to get this order the wrong way around.

Donation after Circulatory Death has not, to my knowledge, yet commenced in Scandinavia. None-the-less, can we use these two media cases to remind us of any lessons for donation after circulatory death? Simple steps still seem to apply.
  1. Accurately establish that the continuation of life sustaining treatment is not to the patient’s overall benefit. This will require a multi-disciplinary consensus as to the prognosis and a discussion with the patient’s family as to their loved one’s values, wishes and beliefs.
  2. Until the family has accepted that the continuation of life sustaining treatment is not to their loved one’s overall benefit, discussions with family regarding organ donation are inappropriate and unempathic unless initiated by the family. Naturally there is no place for these discussions at the bedside of a patient.
i.e. get the withdrawal decision right first before discussing donation

Donation after circulatory death is always an ‘IF’. If, after the withdrawal of life sustaining treatment, the patient dies in a time frame which would logistically allow donation (usually around three hours), donation may be possible. Families must understand this IF.
TOP