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EDITOR- With respect to Drs Khanna and Chaudhry, in the absence of
confounding factors, it may be better to allow nature to take its course
in brain stem dead patients without switching off the ventilator.1 These
are always difficult and sensitive decisions and I encourage the authors
to be on our decision-making team.
Intensive care is an expensive resource we can ill-afford to waste. Who
covers the cost when brain dead patients are ventilated as Drs Khanna and
Chaudhry suggest? In recognition of the expense involved, UK Transplant
(Southmead) reimburses ICUs from whom they receive viable donor organs.
This offsets some of the cost of keeping a patient ventilated with
appropriate support, nursing and medical time, while awaiting donation.
Furthermore the literature recognises caring for dead patients awaiting
organ donation is a stressor, especially for junior medical and nursing
staff, despite wide acknowledgement of the positive aspects of donation.2
Futile treatment while all support other than ventilation is withdrawn,
waiting for the heart to catch up with the rest of the body may have a
more detrimental effect on staff.
In the pressured environment of ICU beds where patients are frequently
refused admission,3 to who is our duty greater? The brain-stem dead
patient with grieving relatives, or the potentially survivable patient and
his/her relatives urgently waiting for intensive care management until a
bed becomes available? In this less than perfect world, one where Drs
Khanna and Chaudhry are sensitive to tabloid headlines, how would they
feel about headlines: "Dead patient kept in ICU bed while three die
waiting."
Discontinuation of ventilation after brain stem death.
EDITOR- With respect to Drs Khanna and Chaudhry, in the absence of
confounding factors, it may be better to allow nature to take its course
in brain stem dead patients without switching off the ventilator.1 These
are always difficult and sensitive decisions and I encourage the authors
to be on our decision-making team.
Intensive care is an expensive resource we can ill-afford to waste. Who
covers the cost when brain dead patients are ventilated as Drs Khanna and
Chaudhry suggest? In recognition of the expense involved, UK Transplant
(Southmead) reimburses ICUs from whom they receive viable donor organs.
This offsets some of the cost of keeping a patient ventilated with
appropriate support, nursing and medical time, while awaiting donation.
Furthermore the literature recognises caring for dead patients awaiting
organ donation is a stressor, especially for junior medical and nursing
staff, despite wide acknowledgement of the positive aspects of donation.2
Futile treatment while all support other than ventilation is withdrawn,
waiting for the heart to catch up with the rest of the body may have a
more detrimental effect on staff.
In the pressured environment of ICU beds where patients are frequently
refused admission,3 to who is our duty greater? The brain-stem dead
patient with grieving relatives, or the potentially survivable patient and
his/her relatives urgently waiting for intensive care management until a
bed becomes available? In this less than perfect world, one where Drs
Khanna and Chaudhry are sensitive to tabloid headlines, how would they
feel about headlines: "Dead patient kept in ICU bed while three die
waiting."
Tooley DA
lecturer in anaesthesia
Leeds General Infirmary, Leeds LS1 3EX.
1. Khanna R, Chaudhry MA. Discontinuation of ventilation after brain
stem death. Asystole rapidly follows brain stem death. Letter, BMJ
1999;319:1366-1367.
2. Hibbert M. Stressors experienced by nurses while caring for organ
donors and their families. Heart Lung 1995; 24(5):399-407.
3. Audit commission Report: Critical to Success. Oct 1999.
Competing interests: none
Competing interests: No competing interests