Man was not brain dead: Organ transplant not considered - The Newpaper

12 Jun 2008, The Newpaper

Question

Wait, that man's not DEAD - Man comes back to life after 90 minutes as doctors prepare to harvest orgens

June 12, 2008

His heart had stopped beating for 90 minutes and doctors were getting ready to remove his organs for transplants.Then, the 45-year-old Frenchman came back to life. The case, which took place on 19Feb, is now fuelling heated ethical debates in France about when exactly is a person dead.

The man had suffered a massive heart attack and rescuers used cardiac massage to try and revive him without success. He was then transferred to a nearby hospital.Due to a series of complex circumstances, revival efforts on the man continued for longer than usual until doctors started preparations to remove organs.

MIRACLE REVIVAL

It was at this point that the astonished surgeons noticed the man was beginning to breathe unaided.His pupils were active, he was giving signs that he could feel pain and his heart started beating again. Just weeks later, the man who had nearly been taken as dead, was walking and talking again.

"This situation was a striking illustration of the questions that remain in the field of re-animation... and what criteria can be used to determine that a re-animation has failed," said a report on the case, published online by an ethics committee. The case has stirred debate among medical professionals on when a person should be considered dead. French daily Le Monde dedicated a full page to the subject on Tuesday.

In Singapore, under the Human Organ Transplant Act, a person is considered dead if he fulfils either one of two criteria:

a) There is irreversible cessation of circulation of blood and respiration in the body of the person; or

b) There is total and irreversible cessation of all functions of the brain of the person.

But the hospital where the Frenchman was treated is one of only nine in France that are allowed to perform organ transplants on patients whose hearts had stopped and can't be revived under a pilot programme launched last year. The programme, which was approved by the French agency in charge of bio-ethics, aims to help reduce the number of people waiting for a transplant.

LACK OF DONORS

Le Monde reported that more than 13,000 people were waiting for transplants in France and that 231 had died last year as a direct result of the lack of a donor.The newspaper said the pilot programme had already yielded an extra 60 organs. A committee has since been formed in France to discuss ethical issues arising from the practice of transplants on people in cardiac arrest. Made up of medical professionals involved in the revival of heart attack patients as well as organ transplants, it held lengthy discussions on the case. Meeting minutes on such re-animation cases noted that "participants conceded that these were completely exceptional cases, but ones that were nevertheless seen in the course of a career". – Reuters.

Reply

Reply from MOH 

In “Wait, that man’s not DEAD” (The New Paper, 12 June 2008), it was reported that France has a case of a  45-year old man whose heart stopped beating for 90 minutes after a massive heart attack, only to "return to life on the operating table just as surgeons were preparing to remove his organs for transplant".

We have studied this case and would like to point out that what the article had claimed, ‘just as surgeons were preparing to remove his organs for transplant’, was completely inaccurate. In a press statement released by the Agence de la biomédecine, the French authority for organ transplantation, it was stated in French that "the patient was not dead and no death certificate was therefore drawn up for this person, who was in cardiac arrest.  The removal (of organs) with a view to a transplant was therefore not envisageable at that stage of care of the patient".

In Singapore, under the Human Organ Transplant Act, the removal of organs for the purpose of transplantation takes place only after brain death has been certified by two senior specialist doctors. They are independent and must not have been involved in the care or treatment of the patient being certified nor are they in the transplant team of doctors. The certification of brain death is based on accepted international standards that follows a well-defined set of stringent clinical criteria and diagnostic tests. No preparation for organ retrieval or transplantation takes place until death has been certified in this manner. Brain death is widely accepted as a definition of death by international medical communities.

The Ministry of Health recognises the sensitivity surrounding the certification of death before the retrieval of organs under HOTA. We would like to assure all of the reliable nature of both the processes used to certify brain death and brain death itself as a process for certifying death.