Are Some Patients Being Done In?

British show on brain death angers doctors, upsets public

In Coma, the bestselling novel that became a hit movie, greedy physicians have a nifty racket going: in order to acquire valuable organs for transplant surgery, they slip patients into unconsciousness, then declare them irreversibly braindamaged. If a recent television program in Britain were to be believed, Coma is not so far off the mark. The show, part of the BBC'S Panorama program, asked the question Transplants: Are the Donors Really Dead? The shocking answer: maybe not.

Panorama arrived at its conclusion after examining methods used by doctors to determine "brain death." The concept holds that a person is dead when the brain has permanently stopped functioning; the heart and lungs can be kept going by machines. In Britain, doctors must figure out what caused the patient's condition--say, a blow to the head--and then do an extensive series of tests. Among them: shining light into the eyes to see if the pupils contract, spurting ice-cold water into the ears to check whether the eyes react by quivering. In the U.S., physicians also often do an electroencephalogram (EEG) to confirm that there is no brain activity.

The program suggests that the brain-death criteria, particularly in Britain, are not strict enough and intimates that a factor may be the need for healthy organs for transplants. To buttress the show's argument, the producers described the experiences of five American patients who were thought dead but who survived. Only one was ever considered as a possible organ donor. Two were women who had taken drug overdoses, one was a premature infant, another was a man paralyzed by a muscle-relaxing agent. The most sensational case was that of a man who lost consciousness after suffering a heart attack. He was saved only when the transplant surgeon, who was about to remove the kidneys, noticed a bobbing Adam's apple.

Doctors in Britain, including Neurologist Bryan Jennett and Surgeon Robert Sells, who were interviewed on the program, are crying foul. In a barrage of letters to newspapers and medical journals, they claim, with some justice, that the show distorted facts. They point out that brain-death codes were set up not to ease transplants but to spare families draining bedside vigils. Says Jennett: "Only one in eight or nine patients taken off respirators ever becomes a donor."

As for the American patients, none could have been declared brain dead by the criteria set up in British or American codes. Doctors must first exclude certain conditions such as drug overdoses, which may mimic death but are reversible. Indeed, there is some confusion over the American cases cited. Neurologist Fred Plum of New York Hospital, who was interviewed for the program, stresses that the patient he discussed was never officially declared brain dead.

The use of the EEG, which Panorama pushed, is also controversial. Doctors note that people who are alive can have a flat EEG, suggesting no brain activity. Moreover, even inanimate matter can appear to have life. A doctor once wired a plate of Jell-O in an intensive care unit and proved it was "alive"; the electrodes picked up impulses from equipment in the room. Says Plum: "EEGS are done more as a reassuring step to doctor and family than because they are any more foolproof than good clinical observation."

Meanwhile, the British public is frightened. London Photographer Sally Greenhill expressed a common reaction to the broadcast: "I immediately tore up my organ donor card." In the four weeks after the telecast, the number of kidney transplants fell by a quarter, but is now beginning to increase again. British doctors hope the public will finally be reassured in February, when they state their case in a special 90-minute program.

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