Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I read with interest the letter submitted by Dr Bihari. His
suggestion that organ donation should be reported as number of organ
donors per 1000 brain dead patients would suit the intensive care
community but is of course fundamentally flawed.
There is no doubt that the number of organ donors is influenced by a
number laws, including those related to drink driving, seat belt use, etc.
The willingness of our intensive care colleagues to perform brain stem
death tests is however another major influencing factor. The data from the
three year Potential Donor Audit of all intensive care deaths in the UK
clearly demonstrated that over that period there were in excess of 700
patients per year in whom brain stem death was a likely diagnosis but in
whom brain stem death test were never considered or performed and donation
was not considered. Without a suitable denominator Dr Bihari's suggestion
would produce flawed data.
Dr Bihari then goes on to blame the consent rates on multicultural
richness. We have no doubt that this does have a role to play however in
the Spanish and recent US model the family discussions and consent process
has been removed from the remit of intensive care doctors and now lies
with the appropriately trained transplant coordinator teams. This allows
new approaches to consent and in addition allows the trained professionals
to spend more time with the families. There is compelling evidence from
Spain that the time spent with families is directly related to their rates
of consent.
We also have sympathy with our intensive care colleagues but
ultimately one has to have more sympathy with the vast number of patients
dying in every country of end stage organ disease while thousands of
suitable organs are being wasted.
1. Barber K, Falvey S, Hamilton C, Collett D, Rudge C. Potential for
organ donation in the United Kingdom: audit of intensive care records. BMJ
2006 May 13;332(7550):1124-7.
Competing interests:
None declared
Competing interests:
No competing interests
26 April 2010
Simon R Bramhall
Consultant Liver Transplant Surgeon
John A Buckels
Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH
We Need Different Comparisons
I read with interest the letter submitted by Dr Bihari. His
suggestion that organ donation should be reported as number of organ
donors per 1000 brain dead patients would suit the intensive care
community but is of course fundamentally flawed.
There is no doubt that the number of organ donors is influenced by a
number laws, including those related to drink driving, seat belt use, etc.
The willingness of our intensive care colleagues to perform brain stem
death tests is however another major influencing factor. The data from the
three year Potential Donor Audit of all intensive care deaths in the UK
clearly demonstrated that over that period there were in excess of 700
patients per year in whom brain stem death was a likely diagnosis but in
whom brain stem death test were never considered or performed and donation
was not considered. Without a suitable denominator Dr Bihari's suggestion
would produce flawed data.
Dr Bihari then goes on to blame the consent rates on multicultural
richness. We have no doubt that this does have a role to play however in
the Spanish and recent US model the family discussions and consent process
has been removed from the remit of intensive care doctors and now lies
with the appropriately trained transplant coordinator teams. This allows
new approaches to consent and in addition allows the trained professionals
to spend more time with the families. There is compelling evidence from
Spain that the time spent with families is directly related to their rates
of consent.
We also have sympathy with our intensive care colleagues but
ultimately one has to have more sympathy with the vast number of patients
dying in every country of end stage organ disease while thousands of
suitable organs are being wasted.
1. Barber K, Falvey S, Hamilton C, Collett D, Rudge C. Potential for
organ donation in the United Kingdom: audit of intensive care records. BMJ
2006 May 13;332(7550):1124-7.
Competing interests:
None declared
Competing interests: No competing interests