These excerpts are highlights from an article printed in a magazine supposedly devoted to nursing employment issues. The rest of the article is equally ludicrous and ignorant, but this suffices to cover what Wensley is using in her attack on organ donation. Below these quotes from the article are two letters to the editor sent in response. The first is written by Dr. James Zisfein, Chief of Neurology at Lincoln Hospital, Bronx, NY, and corrects the ridiculous misunderstandings Wensley is promoting regarding the declaration of death. The second letter is my attempt to relate the promotion of myths and misunderstandings regarding donation to the people who are dependant on support for donation. We have so far (5/23/97) not received a response from the editors.

Anyone else wishing to lodge a protest should write to:

Quotes from "Considerations Before Signing An Organ Donor Card" by Germaine Wensley, RN, in Revolution - The Journal of Nurse Empowerment, Spring 1997, pg. 74-76

At first blush, signing an organ donation card appears to be the ultimate gift for our fellow humans: a selfless, noble act. ... Before taking that step, perhaps it would be well to consider that there might be future circumstances in which your own life could be compromised by doing so.

...An Ad Hoc Committee of the Harvard University Medical School suggested in 1968 that total and irreversible cessation of all brain functions could be this new way to define death. The Committee went on to list critcria to determine when that cessation had occurred. In fact there are now thirty so called 'medical criteria" for brain death, some in clear contradiction to others.

One member of the International Academy of Philosophy, Joseph Seifert, argues that no argument has yet shown that the state of irreversible dysfunction of destruction of the brain is actual death, ...

To confuse the issue even more, some brain-death criteria, but not all, use electroencephalogram (EEG) results as a requirement for diagnosis. An EEG however, records electrical activity only from the surface of the brain, meaning that it conveys little or no information about areas deeper in the brain. It should be noted that the EEG is not an infallible act. ...

With the two subjects so intimately entwined some physicians worry that colleagues interested in organ transplations might be more easily swayed to make the diagnosis of brain death because of their own or another colleagues' practical purposes. ...

The idea of being prematurely declared dead and buried has a modern twist today - that is to be declared dead, and have your organs removed while you're still alive. ...

It was reported that S. William Winogrond winked just as a surgeon was preparing to remove his kidneys and eyes (Kansas City Times, 2-23-75) and that Philip Cockerham twithched his foot just as his liver was to be removed (Memphis Commercial Appeal 2-8-84). One nurse relates the story of a patient diagnosed as "brain dead" who was about to have his heart removed for transplant. She went to the side of the operating table and was working away when the patient reached out and put his arm around her!

... A consultant anesthesiologist at Addenbrooks Hospital in Cambridge, England, Dr. David Hill, says some doctors give anesthetics to organ donors who have been pronounced dead because they fear the donors will feel pain when their organs are removed. Heart and liver transplants need to be carried out while the heart of the "brain dead" donor is still beating. Dr. Hill says, "There is bound to be speculation - one cannot be sure donors are not aware of what is happening to them."

An additional area of concern is the period of observation time required to pronounce a patient "brain dead". ... 20-year old man in New Jersey was declared 'brain dead" in less than 25 minutes after arriving at the hospital and a 16-year old girl in Charleston, South Carolina was declared "brain dead" in less than two hours -- without doing brain wave testing or evaluating circulation to her brain.

... Could this desperate search for usable organs provide occasion for a temptation to be less than careful in the diagnosis of death?

Along with the issue of determining whether a person is really dead, another important consideration was raised by Paul M. Quay S.J. "What is likely to be the quality of medical treatment for those still-living patients whose bodies already have been given away by their next ot kin?" ...

... It seems appropriate that we ponder these issues and choices carefully before we decide whether or not to attach that organ donor sticker to our driver's licenses.

Response from Dr. James Zisfein, M.D. Chief, Section of Neurology, Chair, Bioethics Committee, Lincoln Hospital, Bronx, NY <jzisfein@POL.NET>

To the editors:

I reply to "Considerations before signing an organ donor card" by Germaine Wensley (Revolution, Spring 1997) with suspicion that the article might have been an April Fool's joke. There are so many misstatements and misconceptions that I find it difficult to believe that journal editors would publish this article seriously. Nonetheless, if your readers take it seriously, they could become seriously misinformed. As a neurologist at a trauma hospital where nurses have been of immeasurable help in saving lives through organ transplantation, I know how important it is that nurses understand the truth about brain death and organ recovery. If the article indeed was a hoax, let the joke be on me.

Ms. Wensley states: "There might be future circumstances in which your life could be compromised [by signing an organ donation card]". The statement is false. Nobody's life is "compromised". Organ donation occurs only after death. Medical treatments during life are not compromised by the possibility of organ donation after death.

Ms. Wensley states: "There are now thirty so-called 'medical criteria' for brain death, some in clear contradiction to others". She does not tell us which criteria contradict others. In fact, the medical criteria for brain death are quite clear, not contradictory, and readily available for your perusal at any medical library.{1},{2}

Ms. Wensley states: "A person can be determined to be 'dead' based on the sense of some or even all brain functions." The statement is false. All brain functions must be irreversibly lost before a person is determined to be dead.

Ms. Wensley states: "As long as the human organism as a whole lives, there is at present no reliable way to determine if the entire brain has been destroyed." The statement is misleading and irrelevant. Brain death is not the destruction of every last cell in the brain; it is the irreversible loss of all brain functions. The diagnosis of brain death is made with a certainty as great or greater than any other diagnosis in medicine.

Ms. Wensley states: "Some brain death criteria, but not all, use electroencephalogram (EEG) results as a requirement for diagnosis.... It should be noted that the EEG is not an infallible act." The statements are true but irrelevant. The EEG for brain death is sometimes misleading. Because of this, no criteria for brain death have ever used EEG as the only test. Of note, current standards for brain death in adults do not require EEG {1}.

Ms. Wensley states: "With the two subjects [brain death and organ transplantation] so intimately entwined, some physicians worry that colleagues interested in organ transplantation might be more easily swayed to make the diagnosis of brain death because of their own or another colleagues' practical purposes." I can't speak for anonymous "some physicians", but what worries me and my colleagues is public mistrust of medicine, caused by inaccurate and misleading statements made by people with axes to grind and agendas to pursue. To clarify what Ms. Wensley has obscured: death is diagnosed only by the patient's attending physician and by consultants called by that physician - not by transplant teams or transplant surgeons. There is no conflict of interest. As a consulting neurologist, I can state categorically that my only agenda is the patient before me, and my loyalty is to that patient and that patient's family. I angrily reject innuendo to the contrary.

Ms. Wensley states: "Decisions regarding the pronouncement of death are sometimes made quite quickly." The statement is true, but the innuendo that decisions are made inaccurately or with undue haste and dark, ulterior motives is false. When my patient has died, my responsibility to the patient's family is to rapidly and accurately diagnose death so that the grieving process can begin, and so that family members can ultimately return to the business of living. It would be irresponsible for me to delay the diagnosis of death for any reason other than uncertainty about the diagnosis.

Ms. Wensley cites several reports in the lay press of patients who were diagnosed brain dead but were found to be alive on the operating table when their organs were about to be removed. These reports were never substantiated by official investigations or by reports in the medical literature. Your readers, I hope, understand that a lie repeated over and over is still a lie. If Ms. Wensley has information that any of these events actually happened, she should give that information at once to the State Office of Professional Medical Conduct for further investigation. If she doesn't have any new information, then the editors of this journal were remiss in allowing their readers to be misled.

Ms. Wensley states: "A coroner or hospital administrator can make the designation to donate all or part of the body." She doesn't mention that this only occurs in the case of unclaimed bodies, when no family members can be found despite prolonged and repeated attempts.

Ms. Wensley cites cases in which brain death was diagnosed within two hours, "without doing brain wave testing or evaluating circulation to the brain", and states: "Mistakes can easily be made when such a short period of time for observation is allowed." She is correct that protocols do not need arbitrary minimum time periods for patient observation, or require specific laboratory tests {1}. She is incorrect about the mistakes. There are no reported cases of mistaken diagnoses of brain death when standardized criteria are adhered to.

Ms. Wensley repeats a rhetorical question, originally raised by Paul Quay: "What is likely to be the quality of medical treatment for those still-living patients whose bodies already have been given away by their next of kin?" The question reflects a misunderstanding. Next of kin cannot "give away" bodies of still-living patients. Also, readers of this journal should be aware that reducing medical treatment in a brain-dead patient would accelerate cardiac arrest and could cause organs to become unusable for transplantation. The best way to recover organs is to give optimum medical treatment, so that cardiac and circulatory functions are preserved despite brain death.

In her last paragraph, Ms. Wensley states: "We can't overlook the need to move with caution, particularly in regards to the true determination of death." On that, we agree. Doctors recognize the need to move with caution, and are more cautious with the diagnosis of death than with any other medical diagnosis. It would be nice if journal editors would exercise similar caution before publishing an article so filled with misinformation.

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{1}. Practice parameters for determining brain death in adults. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1995; 45:1012-1014.

{2}. Guidelines for the determination of brain death in children: Report of special task force. Pediatrics 1987; 80:298-300.

Response from Michael Holloway <holloway@concentric.net>

Dear Editor,

The article by Germaine Wensley in your spring issue, "Considerations Before Signing An Organ Donor Card", is not simply one woman’s view of organ donation, but a totally false view with obvious errors in medical fact. This, as well as the outrageous accusation that surgeons would murder for organ procurement, make it equally outrageous that this ignorant, and harmful, article would be considered for publication in a medical professional journal. Whether or not Wensley herself actually believes this collection of myths and fairy tales, the editors of your publication have an obligation to insure that false information is not legitimized by appearing in print in your professional journal. By publishing Wensley’s article, Revolution has unnecessarily gained a very bad reputation among the medical professionals that have been shown the Wensley article.

Others with medical expertise are responding to the errors regarding brain death in the article. There are no contradictions in criteria for brain death, and only confusion among those who have not bothered to study what is meant by "brain death", and how it is diagnosed. What I want to address are the results of Wensley’s attempt to confuse professionals, and through them the public, about the facts of organ donation, that is the death of innocent children, women, and men on the transplant waiting lists. Spreading myths and misconceptions about donation, whether it’s done innocently or not, has the real consequence of decreasing organ donation, the last hope of thousands of children, women, and men with terminal illnesses. When published in a professional journal, and read by medical professionals who have the expectation that the information they find there has some authenticity, it has the potential to be even more devastating. UNOS reports that last year close to 3500 people died on the waiting list [1]. This does not include patients who were removed from the waiting list due to their condition deteriorating past the point that they could survive the surgery. A liver transplant surgeon tells me the true number of people who die after waiting could easily be twice the reported UNOS number. It is also known that only about a third of possible donations are realized.[2] When compared to the figure obtained in a 1993 Gallup poll on attitudes toward donation of 85% of the population supporting donation [3] it seems that over half of the people who think donation is a good idea change their minds when asked for permission for donation from a next of kin. The wide spread acceptance of many myths and misconceptions about donation, such as the one Wensley is spreading, that donation could harm the donor, are likely to be the major reason for second thoughts. People who are ignorant of the facts, but persist and spreading misinformation anyway, are directly responsible for counteracting the normal first impulse: to save the lives of children, women and men on the waiting lists. Information on other myths (that religions doesn’t allow it, that the majority of transplants are received by the rich and elderly, that an organ black market exists, etc.) is also available over the Internet [4].

The failure of support for organ donation could be one of the greatest tragedies of our time. It is a procedure that saves lives, hurts no one, costs the donor nothing, and which is allowed, or promoted, by every major religion in US, but disinformation stops the majority from participating, and as a consequence innocent and desperate people die. There is no other such crisis situation in our society where disinformation would be as tolerated as the ignorant stories spread about organ donation.

It would be interesting to hear from Wensley on what influences could have motivated her to do this. There are a small number of self-proclaimed bioethicists, such as Renee Fox, who have written several documents that portray transplantation as dark and unnatural.[5] The reasons for doing so are never explained. Donation is threatening apparently because Fox says it is. Her writings all have the look of a manufactured controversy, a problem created solely to benefit the ones who "discovered" it. Conspiracy stories are entertaining, to the point that some people have a hard time differentiating between reality and something shown in a science fiction movie, for instance. There really are people who believe in flying saucers, that the UN is taking over America, etc. For the most part, these conspiracy theories are harmless. Myths and misunderstandings about donation, however, are different. These stories cause deaths. If Wensley has been influenced by fictitious stories, as seems to be the case, her duty as a health care professional is to make up for this by promoting support for donation, and learning all she can about the procedures of her hospital’s Organ Procurement Organization so that she can promote cooperation with these procedures among her colleagues. Revolution has the obligation to print what they can to correct the damage done by Wensley’s article.

Michael Holloway, Ph.D.

1. UNOS statistics can be obtained on their Internet web site at (http://www.unos.org/sta_dol.htm)

2. Evans, R.W., Orians, C.E., Ascher, N.L., The potential supply of organ donors. An assessment of the efficacy of organ procurement efforts in the United States. JAMA 1992 Jan 8;267(2):239-46 http://www.med.umich.edu:80/trans/transweb/partnership/press.html#under "Hospitals Can Do More To Increase Organ Donation"

3. "The American Public's Attitudes Toward Organ Donation and Transplantation" http://www.transweb.org/gallup_survey/gallup_index.html

4. See the bit.listserv.transplant FAQ for references on various transplant myths (http://www.lib.ox.ac.uk/internet/news/faq/bit.listserv.transplant.html), the chapter on Religion and Donation in "UNOS Donation and Transplantation Medical School Curriculum" (gopher://info.med.yale.edu:70/00/Disciplines/Disease/Transplant/religion.txt), and two documents on TransWeb regarding Judaism and donation (http://www.transweb.org/donation_folder/religion/jewish_voice_1296.html http://www.transweb.org/donation_folder/rabbi_tendler.html)

5. For instance, see: Fox, R.C., "An Ignoble Form of Cannibalism", in Procuring Organs for Transplant: The Debate Over Non-Heart-Beating Cadaver Protocols, Arnold, R.M. ed.