MOH Clarifies on Brain Death

03 Aug 2007, Bertia Harian

Question

Name of the Person: Mohamad Rosle Ahmad

The HOTA issue is not as black as white as assumed

I would like to give my view on the comments of Mr Ramli Puteh entitled Put Muslims under Hota for long-term solution (BH, 18 July).

Like most of the pro-Hota (Human Organ Transplant Act) views in this newspaper so far, the writer’s comments also do not help much in improving public understanding of the process and procedure of organ transplant from the medical perspective.

Hence, I feel compelled to give a different perspective because I think it is right and fair that the community have a deeper and detailed understanding of the issues related to Hota.

The issue of automatic inclusion in Hota is based on the premise on ‘presumed consent’.

Personally, I do not agree with the implementation of this concept as is the practice of many banks, of giving cheque or credit facility without the need for application, and asking clients to write in if they do not want the facility; what more presuming my consent to donate my organs if I were confirmed to be brain dead.

This does not yet include the differences in opinion on the definition of brain dead among a handful of neurologists.

In February this year, the Los Angeles Times reported the story of a patient, Mr John Foster, who was confirmed to be brain dead by two doctors at a hospital in Fresno, California.

However, his daughter, a nurse, was not convinced with the conclusion and sought the assessment of another neurologist who found Mr Foster to be not yet brain dead.

So, the Hota issue is not as black and white an issue and as simple as Mr Ramli wrote, that ‘The fatwa (Islamic religious ruling) has already permitted it.  What else?’

It covers the issues of ethics, emotions and human rights.

However, those who want to pledge, go ahead; no one is stopping them.

Reply

Reply from MOH 

MOH Clarifies on Brain Death

Responding to recent articles on HOTA, Mr Mohd Rosle Ahmad shared his concerns on the possibility of a misdiagnosed case of brain death ("The HOTA issue is not as black and white as assumed", BH, Jul 21).

These are valid concerns indeed. We do not have the specifics of the US case quoted by Mr Mohd. But often the media confuse brain death with coma.  While some patients may recover from coma, brain death is completely irreversible. 

We would like to assure Mr Mohd that there are very stringent safeguards and procedures in the certification of brain death, based on a set of internationally-recognised clinical criteria.

Brain death occurs when there is total and irreversible cessation of all functions of the brain in a person. When a person is declared brain dead, he will not be able to breathe on his own unless it is artificially supported by a ventilator. Once the ventilator is switched off, the person's heart will cease to beat as his brain has already stopped functioning.

There are clear procedures for certifying brain death. Brain death can only be certified by two doctors who have examined the patient and determined that all seven clinical criteria required for a diagnosis of brain death are met.  They must also NOT:

• have been involved in the care or treatment of the patient being certified

• belong to the team of medical practitioners who will remove the organ from the body

• have been involved in the selection of the proposed recipient of the organ

• be involved in the care or treatment of the proposed recipient of the organ during his hospitalisation for the transplant.

There are seven clinical tests for determining irreversible cessation of all functions of the brain.  For instance, the pupils are fixed and non-reactive to strong light, there is no corneal reflex, there is no spontaneous motor response to painful stimulus, excluding spinal reflexes.  Where any of the seven clinical tests cannot be carried out, supplementary tests (e.g., brain scan) will be conducted instead.

MOH understands the need for more dialogue on HOTA and will work with MUIS to help the Muslim community have a deeper understanding of these issues.