Letter: Transplant fears

Sir: I am interested to find from your correspondence that not everybody knows that, for the more elaborate transplant operations, it is necessary that the heart of the donor be beating and that ventilation and the peripheral circulation be maintained. Certainly the transplant card widely available gives little indication of this fact and would not qualify, as Roger Blassberg (2 March) points out, as providing informed consent in the sense applied to other surgical operations.

"Beating-heart" donors and the idea of brain death were widely discussed in the Seventies and early Eighties and arose not, as is often said, because of the need of neurosurgeons, of whom I was one, to know when to stop ventilation if no further benefit to the patient could result, but rather from the desires and needs of transplant surgeons.

A prognosis (death imminent) was transformed into a state (being dead) and a redefinition of death for pragmatic reasons established: a momentous step. While I do not dispute the accuracy with which the present criteria predict that donors selected in this way will die when ventilation is discontinued, I have been unwilling to accept the abandonment of such an ancient concept as to what constitutes death because I thought that, since it was always certain that supplies of suitable donors would be inadequate, attempts would be made to widen further the criteria of "death". This has, in fact, happened in the case of anencephalic infants and in the suggestion that vegetative patients with head injuries be used.

It is probable that there is more widespread dislike amongst nurses and doctors for using beating-heart donors than is recognised and that this contributes to the loss of suitable organs complained of by transplant surgeons. No doubt these considerations are behind a remarkable suggestion by a medical ethicist recently that the organs of patients in this state should become the property of the government, to distribute in a regulated market, and the British Medical Association's call for a debate on the use of organs without consent.

T T KING FRCS

Brentwood, Essex